1. Catastrophic Events Brian Schwartz, CCP April 8, 2004

2. Catastrophic Events As students you need to understand and anticipate the potential for a catastrophic event As students you need to understand and anticipate the potential for a catastrophic event As students, you need to learn the proper responses and actions to take in the event of a catastrophic event As students, you need to learn the proper responses and actions to take in the event of a catastrophic event

3. Important Statistics Concerning Catastrophic Events Research shows that on the average, 1/300 cases has some sort of incident…not necessarily a catastrophic event Research shows that on the average, 1/300 cases has some sort of incident…not necessarily a catastrophic event Research also shows that on the average, 1/1000 cases ends in patient death due to an event Research also shows that on the average, 1/1000 cases ends in patient death due to an event It is your responsibility as a diligent perfusionist to prevent these statistics from occurring in your institution It is your responsibility as a diligent perfusionist to prevent these statistics from occurring in your institution

4. Factors that Can Prevent Catastrophic Events from Occurring Education Education Experience Experience Training Training Motivation Motivation Communication Communication Ability to perform multiple tasks Ability to perform multiple tasks Preventative measures Preventative measures

5. Types of Catastrophic Events Oxygenator failure Oxygenator failure Water to Blood Leak Water to Blood Leak Air Embolism Air Embolism Blood transfusion reaction Blood transfusion reaction Protamine Reactions Protamine Reactions

6. Oxygenator Failure Signs of an Oxygenator Failure Signs of an Oxygenator Failure –Decreased PO2 –Decreased venous saturation –Elevated pCO2 Action Action –Notify surgeon and anesthesia –Take stat ABGO to verify –Get extra oxygenator ready and all other necessary equipment –Change out the oxygentor in a timely fashion

7. Water to Blood Leak Signs of a Leak Signs of a Leak –Sudden rise in blood volume (unexplainable) –Decrease in ph (patient getting acidotic) –Decrease in H/H –Blood in urine (hematuria) Action to be taken Action to be taken –Notify Surgeon and Anesthesia –Get necessary help –Change out the oxygenator

8. Massive Air Embolism Safety Devices to Prevent the Introduction of Air to the Patient Safety Devices to Prevent the Introduction of Air to the Patient –Level sensors –Arterial filters –Bubble sensors

9. Things to do to Prevent the Introduction of Air Embolisms Steps to take: Steps to take: –CO2 Flush the circuit before priming –Use albumin to coat circuit –Keep adequate volume status –Communication with surgeons

10. Actions to take: Immediately turn off the pump and clamp out your lines Immediately turn off the pump and clamp out your lines Notify surgeons Notify surgeons Place patient in trenelenberg Place patient in trenelenberg Pack head in ice Pack head in ice Give steroids Give steroids Re-prime circuit Re-prime circuit Hyperbaric Chamber Hyperbaric Chamber

11. Blood Transfusion Reactions Reason why patients develop transfusion reactions…. Reason why patients develop transfusion reactions…. –Recipient forms antibodies against donor RBC antigens –Reactions may be immediate or delayed Prevention of Blood Transfusion Reactions Prevention of Blood Transfusion Reactions –DOUBLE CHECKING BLOOD UNITS TO PATIENTS ID

12. Actions to Take if the Wrong Type of Blood is Given to a Patient Immediately stop the transfusion Immediately stop the transfusion Notify the surgeons and anesthesia Notify the surgeons and anesthesia Give steroids Give steroids Give diuretics Give diuretics Give a complete blood transfusion with the proper blood type Give a complete blood transfusion with the proper blood type Fill out incident report Fill out incident report

13. Protamine Reactions Protamine, which is derived from the sperm of salmon, is used to reverse the effects of heparin Protamine, which is derived from the sperm of salmon, is used to reverse the effects of heparin Patients at risk: Patients at risk: –Allergies to shellfish –Prior exposure to protamine –Men with vasectomies –Patients on NPH insulin

14. Types of Protamine Reactions Type I Type I –Hypotension related to the fast administration of protamine Type II Type II –Anaphylactic reaction resulting in decrease SVR, bronchospasm, and edema Type III Type III –Pulmonary vasoconstriction, RV distension, PA hypertension, decreased LV filling, and systemic hypotension

15. Supportive Measures to Stop Protamine Reaction Give Vasoactive Drugs Give Vasoactive Drugs Give Inotropic Drugs Give Inotropic Drugs Give Pulmonary Vasodilators Give Pulmonary Vasodilators Give Heparin to go back on CPB Give Heparin to go back on CPB

16. The Best Way to Prevent Catastrophic Events from Occurring Be Alert Be Alert Be Diligent Be Diligent Be Prepared for the Unexpected Be Prepared for the Unexpected Always Communicate with the Team Always Communicate with the Team Never Think it Won’t Happen on your Watch!!!!!! Never Think it Won’t Happen on your Watch!!!!!!