Blood Management during Cardiopulmonary Bypass

							    Blood Management during
     Cardiopulmonary Bypass


                    Angelo Iatridis, MS
               Circulatory Support Systems
California Pacific Medical Center, San Francisco, CA, USA
• Measures clot formation

• Calculates affects of drugs
such as aspirin, Plavix, and
Ticlid on clotting times

•Intricate quality control
process

•Hemostsis trends and offline
reports
TEG tracings showing the effect of 50% platelet function reduction in three patients:
•   Heparin Dose Response
    (HDR)
    • With data, HMS can calculate
      individual response to Heparin
    • Determine heparin dose needed
      for certain ACT
•   Heparin Protamine Titration
    (HPT)
    • Measures amount of circulating
      heparin
    • Calculate protamine dose to
      counteract heparin
•   Provides accurate ACT values
Individual Response to Heparin
                700

                600

                500
ACT (seconds)




                400
                                                                                     Patient 1
                300                                                                  Patient 2

                200

                100

                  0
                      0   0.5   1   1.5   2     2.5    3   3.5   4   4.5   5   5.5
                                              Heparin (U/ml)
• Blood gases
• Electrolyte levels
• Body chemistries
• Coagulation times
• Hematology
• Glucose
• Stores over 5000 patient records
• Anticoagulation time (ACT)
•Anticoagulation Time – Lower Range (ACT-LR)
• Prothrombin Time (PT)
• Citrate Prothrombin Time (CPT)
•Activated Partial Thromboplastin Time (APTT)
• Citrate APTT
• Stores up to 400 QC results
• Stores up to 400 patient data
•Other models available: Hemochron Response, Hemochron 401, Hemochron
Signature Elite
           3 Modules
1st module:
  • collects demographic data
2nd module:
  • Set up for all extreme info
  • Pump and external device
     configuration
  • Report and graph designer
  • Data managing
3rd module:
  • Provide statistical
     information with
     additional programming
     tools
• Similar to JocapXL
• Electronic documentation
  of HLM data, blood
  gas/ACT data, patient
  monitor data
• Perform statistical queries
• Trending tables/graphs
• Patient record
• Quality indicator report
• Data can be converted into
  a text file such as Microsoft
  Word and uploaded into
  any computer
Role of Perfusionist has changed:
       • Blood Management
       • Data collection
       • QA (Quality Assurance)
       • Documentation
       • Biotechnician