Who runs the pump where you work?

[ecCA1]

---

Members do not see this ad.

Most places I have worked at the cardiac surgeon runs the pump and is responsible for the actions of the perfusionist. My current gig is a bit different: while the surgeon is in control of most of the perfusionist's actions (i.e. during cannulation/decannulation, flow rates, etc.), we dictate the separation from CPB and then sign for the overall chart after the case is over.

How does your situation compare to mine?

 

[proman]

We do. I like it. Makes for a much smoother separation. We also decide inotropes and pressors (obviously with participation of the surgeon).

 

[jetproppilot]

.

 

[sevoflurane]

Most places I have worked at the cardiac surgeon runs the pump and is responsible for the actions of the perfusionist. My current gig is a bit different: while the surgeon is in control of most of the perfusionist's actions (i.e. during cannulation/decannulation, flow rates, etc.), we dictate the separation from CPB and then sign for the overall chart after the case is over.

How does your situation compare to mine?

Seperation is a coordinated effort between surgeon, perfusion and anesthesia. Inotropes is our domain.

 

[Coastie]

We do. I like it. Makes for a much smoother separation. We also decide inotropes and pressors (obviously with participation of the surgeon).

Team approach. Regarding drugs, would any place have it any other way? I can't imagine having the surgeon dictate pressors/inotropes to the anesthesiologist...That would make for a pretty pathetic experience.

 

[Idiopathic]

surgeons make suggestions, anesthesiologists make decisions

 

[C.P.]

I don't know if it's different state to state, but my understanding is that the perfusionists run UNDER the anesthesiologist's licence.

Which means they're successes and f-ups are on your malpractice.

There's a general attitude of letting the perfusionists do their job, but you need to know how their equipment works and get involved.

It is absolutely a team effort; coordinating pump changes with the surgeons and the perfusionists, to help the patient come "off pump," but it's a very underappreciated importance that you understand the mechanics and physiology of what they're doing and know when to interviene and make changes.

I've always had fantastic perfusionists, and I've rarely stepped in to ask them to do anything differently, but a couple smaller hospitals I've been at, where they don't do much out of the way of straight forward CABGs, I've asked them to run higher flows at certain times when the patient hasn't been ideally cooled to optimize supply/demand, etc.

Point is, the idea of once they're "on pump," that you kick back and disconnect until they're ready to come off is a dangerous oversimplification of the process unless you know they're going to do exactly what you'd want anyway.

 

[sevoflurane]

I don't know if it's different state to state, but my understanding is that the perfusionists run UNDER the anesthesiologist's licence.

I'm not entirely sure about this as the CT surgeons direct them once on pump.

 

[C.P.]

I'm not entirely sure about this as the CT surgeons direct them once on pump.

apologies, my last post reads a bit too much like a rant.

Who directs the pump and who's responsible may not be the same.

Check into it to see if they're operating under your license.

regardless, if your team is solid, and you know they're following a plan you're comfortable with, then pump time is a nice opportunity to catch up, relax for a moment, and gear up for coming off pump (or take a pee break and grab some java).

Do make the effort to understand how the set up works though, and how it affects your patient's physiology.
To a degree, it's like a ventilator. There's many ways of running it, and there are times when it's helpful to stray from the standard protocols.

 

[urge]

I don't know if it's different state to state, but my understanding is that the perfusionists run UNDER the anesthesiologist's licence.

I have never heard of such thing. Could you verify on that? Which state are you in?

 

[C.P.]

So, I made a call to look into it. It's institutional.
I was referring to my experience in New York and California.
Here's the California regulations:

California Health and Safety Code Section 1255.6, mandates that during cardiovascular surgery a perfusionist, “shall operate the extracorporeal equipment under the immediate supervision of the cardiovascular surgeon or anesthesiologist.”

We signed off on them at the hospitals I worked at.

Regardless, it's still important to know how the system works, since how the pump is run on bypass can affect your work in coming off pump.

Especially if you're ultimately supervising them.

 

[12th man]

Coordinated effort to come off pump, however, we have final say as surgeons ask if we are "happy and ready to come off". As far as drugs, they don't really care as long as the numbers look good. Some have preferences for meds in the ICU, but as long as patient is doing well, they really don't care. I must say we have a great relationship, first name basis, with our rockstar surgeons. 👍