Program - Perfusion.com

PROGRAM
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FACULTY
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PRESENTERS
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0630-0900 Registration Open
0700-0800 Sorin Sponsored Breakfast
PATIENT SAFETY SESSIONS
Thursday February 16 th , 2012
Moderator-Susan Englert
0800-0805 Bryan V. Lich, CCP, CPMT Opening Remarks
0805–0855 Bruce Searles, BS, CCP Case Studies in Catastrophe: Could This
Have Happened to you?
0855-0945 David Fitzgerald, BS, CCP Implications & Certification Requirement for
a VAD Program
0945-1000 Break & Exhibits Open
1000-1050 Bill DeBois Keeping the Cycle of Change Safe
1050-1130 Robert Dunton, MD, FACS Update on Bioethics: Information for
Perfusionists
1130-1230 Nonin Medical Sponsored Lunch
1230-1320 Bruce Searles, BS, CCP Simulation Training for Perfusionists:
Justification & Implementation
1320-1410 Steve Montague Jumpseating in the OR: The Perfusionist
as Safety Observer
1410-1430 Break & Exhibits Open
1430-1520 Robert Dunton, MD, FACS Flying Safely on Bypass
1520-1610 Steve Montague Lifewings: Patient Safety
1610-1700 David Fitzgerald, BS, CCP The Age of Innovation- This is not your
Father’s ECMO Circuit
18:00 – 20:00 Vendor Reception
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BLOOD MANAGEMENT SESSIONS
Friday February 17 th , 2012
Moderator-Tunisia Ellis
0700-0800 Cytomedix Sponsored Breakfast
Al Stammers, MSA, CCP, CPBMT
An Update on Autologous Platelet-Gel:
Results from Our First 7,000 Procedures
0800-0805 Tunisia Ellis, MS, CCP Announcements
0805-0855 Peter Everts, PhD PRP in Musculoskeletal
0855-0945 David Palmer, EdD, CCP, LP Jefferson Regional Medical Center’s
Experience Using The Viper Perfusion
Charting System
0945-1000 Break & Exhibits Open
1000-1050 Al Stammers, MSA, CCP, CPBMT Blood Sweat and Fears: Hemostasis
Management Techniques during Cardiac
Surgery
1050-1130 Susan Englert, RN, CCP, CPBMT Blood Management: Tug of War
1130-1230 Covidien Sponsored Lunch
1230-1320 Peter Everts, PhD The Synergy of PRP & Fat Tissue in
Reconstructive Surgery
1320-1410 Dr. Paul DiGiorgi, MD, FACS Minimally Invasive Surgery
1410-1500
Jeffrey Travis, MD, FACS &
Ty Walker, CCP
Eat More Chicken (Open Forum
Discussion)
1500-1515
Break
1515-1605 Charles Roberts, MD CABG in the Setting of Carotid Stenosis:
How to Avoid Stroke
1605-1655 Robin Zappocosta, RN The Time is Right and Size Matters
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BLOOD MANAGEMENT & NEW TECHNOLOGY SESSIONS
Saturday February 18 th , 2012
Moderator-Ty Walker
0700-0800 Hospira Sponsored Breakfast
Dr. Richard Juda
New Options in Plasma Volume Expansion
In the OR & ICU
0800-0805 Ty Walker, CCP Announcements
0805-0855 Dennis Borne Medical Malpractice Insurance & the
Perfusionist
0855-0945 Jeffrey Travis, MD, FACS Use of a TEG in Cardiac Surgery
0945-1000 Break & Exhibits Open
1000-1100 Keynote Address
James Lonquist, MD, FACS
How to Succeed in Blood Management
1100-1150 Al Stammers, MSA, CCP, CPBMT ProvenCare Medicine: A Primer for Future
Health Care Delivery Models
1150-1250
1250-1340
Haemonetics Sponsored Lunch
Alan Heldman, MD, FACS
Transapical AVR in the Hybrid OR Setting
1340-1430 John Rivera Autotransfusion Quality Control
1430-1445 Break
1445-1535 Gary Allen, MD, FACS Heparin Management During OPCAB
1535-1625 Susan Englert, RN, CCP, CPBMT Patient Safety Issues: Leave Your Ego Out
of the Room
1625-1715 Ty Walker, CCP Simulation Stimulation
1715-1730 Robert Pascotto, MD Heart to Heart Mission: A Tribute to
Volunteers
1900-2200 Party On The Gulf
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19:00 – 22:00
Sanibel Perfusion Symposium’s
Party On The Gulf
LIVE ENTERTAINMENT
SPEAKER EVALUATION & CERTIFICATE LINKS
Online Speaker Evaluations
Online CME Certificates
Note: CME Certificates will be available online 2 weeks after the conference.
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Faculty
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BRYAN V. LICH, CCP, CPBMT
I was born in Omaha, Nebraska and attended the University of Nebraska-Lincoln. In college, I first learned about perfusion
while working as a phlebotomist at Bryan Memorial Hospital. After graduating from the University of Nebraska, I went on to
the Texas Heart Institute to study Perfusion. I began Perfusion.com as a student project in 1995 while attending perfusion
school in Houston, TX. After graduation, I moved to Ft. Myers, Florida to begin my career.
Presently, I reside and work in Ft. Myers, Florida as the owner of Perfusion.com, Inc. I presently serve on the AmSECT
board or directors and the board of directors for the Florida Perfusion Society, and I am involved in a number of other
professional societies.
PROFESSIONAL AFFILIATIONS & ACHEIVEMENTS
• Certified by The American Board of Cardiovascular Perfusion
• Fellow, The American Society of Extracorporeal Technology
• Member, AmSECT Perioperative Blood Management Committee
• Director Zone 3, The American Society of Extracorporeal Technology
• Treasurer, Florida Perfusion Society
• Chairman, The International Perfusion Association
• Board Member, Perfusion Research & Education Foundation
• Director, Heart-to-Heart Mission
• Perfusionist of the Year, Nominee, AmSECT 2007
• Award of Excellence Nominee, AmSECT 2008
• Perfusionist of the Year, AmSECT 2009
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IRIS J. CHACON, RRT,CCP
Hi, my name is Iris J. Chacon. I was born in Honduras Central America, and at the age of 14 my parents, siblings and I
moved to the United States. It was a very difficult adjustment to make as a teenager. I was unable to speak the English
language and at the same time had to adjust to a different culture. Nevertheless, I survived my first year of school, and
eventually finished High School. After High School, I enrolled as a freshman at Loyola University, in New Orleans. I
graduated from Loyola University with a biology degree, and a minor in both Chemistry and Psychology. Soon after College,
I decided to be in the medical field, and went on to Respiratory School to become a respiratory therapist. While working as
respiratory therapist, I worked in the NICU unit at Ochsner Hospital in New Orleans. During this time I became involved in
ECMO and became interested in perfusion. After three years as a respiratory therapist, I applied to the perfusion program at
Ochsner Hospital in 1993. I was accepted in the program out of 100 applicants. The Perfusion curriculum consisted of a two
year program with only two perfusion students per year accepted into the program. After graduating from the Perfusion
program, I came to north Florida for my first job. I worked in the Gainesville area for seven years. Subsequently, my
husband and I relocated to Texas for a year. Thereafter, I returned back to Florida, and applied for a job to travel with
perfusion.com. I started traveling with PDC in Jan 2003. Since then, I have worked my way up the ladder to become the
Vice President of perfusion.com. I can sincerely state that since then, I have enjoyed every moment of this great adventure
at perfusion.com.
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TUNISIA ELLIS, MS, CCP
Greetings everyone, my name is Tunisia A. Ellis. I was born in Bellevue, NE and grew up in a military family. I spent my
childhood living in Berlin, Germany and Bellevue, Nebraska. I attended The University of Nebraska-Omaha, where I ran
track and studied Biology.
I received my Masters of Perfusion Sciences from The University of Nebraska Medical Center and performed my clinical
rotations in Peoria, IL, Kansas City, MO, Omaha, NE and London, England.
After graduation, I accepted my first Perfusion position in Orlando, FL. I now reside in Naples, FL working with
Perfusion.com, Inc. in the Naples, Punta Gorda, & Fort Myers area. I also enjoy traveling as a Perfusionist to accounts
throughout the United States. Thank you for coming to the first Sanibel Perfusion Symposium. ENJOY!!
PROFESSIONAL AFFILIATIONS & ACHEIVEMENTS
• Sanibel Perfusion Society Meeting Coordinator, Perfusion.com, Inc. 2011+
• AmSECT Chairman of the 50 th Celebration Committee 2011+
• Perfusionist of the Year, Nominee, AmSECT 2012
• Certified by The American Board of Cardiovascular Perfusion
• Member, The American Society of Extracorporeal Technology 2000+
• Member, Florida Perfusion Society 2008+
• Secretary, Florida Perfusion Society 2010
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C. TY WALKER, CCP, CPBMT
Ty Walker has been a pioneer and vocal advocate for blood management for the last 20 years. Ty has shared his research
and ideas with the perfusion community at countless meetings throughout his career in perfusion. Recently, Ty’s institution
(St. Francis Hospital, Columbus, GA) has received a PHA Quality and Patient Safety Award and the ITC Award for Patient
Safety & Quality, directly as a result of Ty’s involvement is spearheading a blood management program.
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SUSAN J. ENGLERT, RN, CNOR, CCP, CPBMT
Having grown up in the small northwestern town of Hill City, Kansas I attended the nearby college of Fort Hays State
University. This gave me the opportunity to participate on the college softball team and the Tiger Deb Dance Drill Team.
After deciding to study nursing, I transferred to St. Mary of the Plains School of Nursing located in Wichita, Kansas. Given
the opportunity to work on the CVOR team, I quickly fell in love with the perfusion profession and enrolled in the St. Mary of
the Plains School of Perfusion.
Upon successful completion of St. Mary's perfusion school, I continued working as a perfusionist for Via Christi Medical
Center and Specialty Care. My 30 years of employment in the Wichita area came to an end when I transferred to Tavares,
Florida for my dream job and a golden opportunity of starting a brand new open heart program at the prestigious Florida
Hospital Waterman and am employed by Perfusion.com.
I have been happily married for 28 (or 22 depends on who you ask, LOL)...and out of 31, that's not too bad!!! My husband,
John, is currently working in the Afghanistan warzone as the in-county managing auditor on all DoD contracts. I have three
beautiful children, Danielle, 26, obtained her accounting degree and is currently working for the IRS as an tax law research
analyst and instructor. Whitney, 24, also obtained an accounting degree and is currently working toward her MBA. In
addition, she is a certified yoga instructor and is working part time, instructing yoga. My youngest child is my son, Johnny,
21 who is currently attending Kansas State University and is actively applying to perfusion school.
As current President of AmSECT, I am anxiously looking forward to celebrating AMSECT's 50th International Conference at
the Hilton Bonnet Creek Resort in Orlando, Florida, March 28-31. 2012. I would like to extent to all my colleagues, an
invitation to join us for this exciting celebration!!
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MARCO POLIZZI, RN, MHA, LHRN
I was born in Lucca, Italy and grew up between Florence, Italy & Brussels, Belgium. I spent my childhood living in Belgium
and Italy, and often traveled from England to North Africa. I attended The Brussels State Technical School for Electrical
Engineering, and lived in Belgium till the end of 1989.
I received my Nursing Degree from Edison College, and my Master of Health Care Administration from National-Louis
University, Chicago.
I have more than 10 years of diverse leadership experience as a clinical/administrative manager, educator and perioperative
nursing while promoting professional healthcare delivery, supported by progressive clinical coaching, and
clinical/administrative staff development.
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PETER M. ZUCK, RN, CCP
I was born and raised in St. Louis, Missouri and graduated from Washington University with a major in Architectural
Design. I received my RN from Barnes Hospital, part of the Washington University Medical Center, where I worked in
open heart as a scrub nurse. I graduated from Texas Heart Institute in 1988 and received a BS from the University of
Texas in perfusion technology. I’ve worked in Southwest Florida as a perfusionist ever since and am currently employed
as the credentialing officer and service manager for Perfusion.Com. I’m a former executive board member of the Florida
Perfusion Society and the clinical coordinator and chief perfusionist at Gulf Coast Medical Center. I’m a retired rugby
player, advanced scuba diver, and avid golfer. I also volunteer my time with the Boy Scouts of America and have two
sons active in scouting.
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Presenters
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Thursday, February 16 th , 2012
Patient Safety Sessions
Moderator-Susan Englert
Bruce Searles, BS, CCP
Case Studies in Catastrophe: Could this have
happened to you?
Through the careful dissection of real life
perfusion catastrophes and the system failures
that made them possible, this presentation will
illuminate aspects of every professionals practice
and illustrate how they can contribute, positively
or negatively, to the safety of your patients.
Audience participation will be encouraged and
practical suggestions will be made to help reduce
the risk of crisis for the cardiac surgery patient.
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David Fitzgerald, BS, CCP
Implications & Certification Requirement for a
VAD Program
Despite aggressive pharmacological therapies,
nearly 280,000 patients die every year from
advanced heart failure. Although heart
transplantation remains the standard of care for
this patient population, the demand for organs
greatly exceeds the number of suitable donors.
As a result, clinicians have turned to
alternative options in the treatment of advanced
refractory heart failure. The recent emergence of
second and third generation ventricular assist
devices (VAD’s) may seemingly improve longterm
patient outcomes, as the large and pulsatile
implantable devices give way to smaller and
more durable pumps designed to reduce devicerelated
complications and optimize patient quality
of life. Improvements in mechanical pump design
would benefit patients waiting for an organ as
well as those who do not qualify
for transplantation, referred to as Destination
Therapy.
Over the last couple years, several new
technologies have been introduced to treat
advanced heart failure, with many more
anticipated devices on the horizon.
Cardiovascular Perfusionists should be expected
to be key members of an institutional
mechanical circulatory assist program, as our
formal education provides a perfect complement
of patient physiology and extracorporeal
technology. But the challenge will be maintaining
our proficiency with each new device in this
rapidly growing industry. In particular, continued
education for perfusionists,
Identifying practice guidelines and performance
measures, participating in the Joint Commission
certification process, and the creation of
appropriate standards all designed to optimize
patient safety and outcome.
Affiliation:
Chief of Cardiovascular Perfusion
INOVA Heart and Vascular Institute
INOVA Fairfax Hospital for Children
(703) 776-3728 voice
(703) 776-2830 fax
david.fitzgerald@inova.org
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Bill DeBois, CCP, MBA
Keeping the Cycle of Change Safe
Abstract:
Continuous change is a key ingredient in the
improvement process. The desire for such
change can come about either by a need to
improve current conditions, implementation of
best practices or just a quest to be the best. In
which case you will not follow the pack, but rather
blaze your own trail. The important concept is to
track both the changes and results very closely.
The goal of change should be an improved state.
Occasionally though, the goal or aim may be
overlooked or the constraints and barriers not
fully understood. While change may be desired,
it may not be communicated well enough to
those who are needed to assist in the change.
Also overlooked is the recruitment of
knowledgeable and enthusiastic stakeholders
who will help to drive the change forward, and
most importantly they will help identify any
potential problems that may result from the
change.
Techniques used by behavioral psychologists
may be helpful in easing the cycle of change
process. A technique known as motivational
interviewing is based on the assumption that our
behaviors are a product of our thoughts and our
feelings. Individuals may understand that while
something
may be bad for us it may not necessarily lead us
to change our behavior. To change one’s
behavior it may also be necessary to change the
feelings as well. For example, process
participants must become uncomfortable with the
current state.
The key to healthcare organizations
implementing change is their ability to rapidly
spread innovations and new ideas, which are
generated from projects. As an example,
improvements in glucose control in a cardiac
intensive care unit may not be implanted into
other areas of the hospital. Leadership needs to
assure that these best practice methods are
universally accepted throughout the organization.
When considering opportunities, improvement
teams are organized to focus on a project to
solve problems that are crippling organizational
performance. The results however should be
considerably greater than the required effort of
the project. The performance elements that need
to be considered are:
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1. Cycle Times (Turn-around times)
2. Costs (Inventory costs)
3. Output capacity (Improved, outcomes,
caseloads)
4. Satisfaction (Both employee and patient)
5. Revenue Potential
Plan, Do, Check, Act is an elegant methodology
for change. It starts with a problem statement,
proceeds through a planning and data collection
phase and re-evaluation. For continuous
improvement, this cycle must be forward moving
and permanently adjusted.
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Dr. Robert Dunton, FACS
Update on Bioethics: Information for
Perfusionists
Perfusion, as a medical profession, is an
important component of the overall care team of
patients, and as such is subject to the same
ethical expectations as all healthcare providers.
A brief overview of the basic principles of medical
ethics is presented, with special reference to the
role provided by perfusionists.
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Bruce Searles, BS, CCP
Simulation Training for Perfusionists:
Justification & Implementation
High fidelity simulation is being increasingly
utilized to educate health professionals for both
students preparing to enter the field and
professionals in clinical practice. The scope of
practice of the cardiovascular perfusionist is very
technical and based on physiologic data that is
becoming easier to simulate. This combination
makes perfusion ideally suited for very high
quality simulation training. This presentation will
review the justification for integrating simulation
training into the perfusionist’s professional life,
starting in school and continuing throughout your
career. Models of successfully implemented and
proposed simulation training programs will be
reviewed. Perfusionists’ with more than 10 years
left in their career may find this presentation’s
closing predictions to be very interesting.
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Steve Montague
Jumpseating in the OR: The Perfusionist as
Safety Observer
Crew Resource Management (CRM) is a human
factors “bundle” that evolved in
commercial aviation to address shortcomings in
teamwork and communication. As
CRM evolved, crews realized that their
contribution to flight safety exceeded just their
own particular flight responsibilities. Every
crewmember is responsible for overall
flight safety as a collateral duty. Because
perfusionists are normally prepared to go on
bypass well in advance of the rest of the OR
team, they are a knowledgeable clinician
with a temporarily low task loading. During this
time, the perfusionist is ideally suited
to assist the team, and ultimately the patient, by
serving as a safety observer.
During this interactive session we’ll discuss the
background of CRM, its application in
healthcare, and recent results. We’ll also provide
context for specific applications of
CRM behaviors and orient these behaviors to
standardized actions or events (checklists,
protocols, etc). Finally, we’ll discuss how the
perfusionist can further integrate
themselves into the OR team and foster effective
teamwork.
Overall Course Objectives: Upon completion of
the seminar, participants should be
able to improve patient outcomes by being able
to:
• Discuss the results that have been achieved by
organizations who have
implemented CRM.
• Demonstrate a simple technique to make an
assertive statement to address a
perceived patient safety concern.
• Identify specific performance improvements
that perfusionists can expect to see
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when teams routinely implement CRM behaviors.
CRM teaches universal skills that enhance
communication and collaboration among
members of teams engaged in high consequence
endeavors.
Affiliation:
LifeWings Partners, LLC
1163 Halle Park Circle
Collierville, TN 38017
Biography:
Steve Montague serves as the Executive Vice
President for LifeWings and has over 30 years
experience in aviation. Captain Montague is an
engaging facilitator and TeamSTEPPSTM Master
Trainer with a vast amount of experience in the
design and implementation of CRM-based
patient safety programs. He has provided
program implementation for over 45 clients

including Vanderbilt University Medical Center,
Rush University Health Center, Vassar Brothers
Medical Center, Ohio State University Medical
Center, and University of California—Los
Angeles.
Prior to joining LifeWings, Mr. Montague was a
Naval Aviator and served as a fighter pilot, flight
instructor, course developer, procurement
consultant, and Program Model Manager at the
U.S. Navy’s Landing Signal Officer School. He
has over 15,000 flight hours and more than 350
carrier landings. Mr. Montague currently serves
as a Captain and First Officer for a major
international airline. He has an Airline Transport
Pilot rating and is qualified in the MD80, B757,
B767, DC10, and MD11.
Captain Montague is an internationally sought
after keynote speaker whose most recent
engagements include the National Council of
State Boards of Nursing, the International
Meeting on Simulation in Healthcare, the
Karolinska Institute, and the Western Graduate
Education Association.
Mr. Montague graduated from the U.S. Naval
Academy with a Bachelor of Science degree in
Aerospace Engineering, and is currently pursuing
his Master of Science degree in Human Factors
and System Safety.
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Robert Dunton, MD, FACS
Flying Safely on Bypass
Critical to the safe conduct of cardiopulmonary
bypass is adherence to the use of checklists.
Following proscribed procedures in an orderly
and well-documented fashion leads to
predictable and safe outcomes. Such practice is
well associated with improved outcomes in other
endeavors, most notably in aviation. The
parallels between safe flying and safe perfusion
have been documented previously, and are
worthy of further consideration.
Biography:
Dr. Dunton is a board-certified cardiothoracic
surgeon. Prior to joining Bon Secours, he had
been a cardiothoracic surgeon at Dartmouth
Hitchcock Medical Center in Concord, N.H. since
2001. He has served as the medical coordinator
of the Concord Hospital Open Heart Program
and as an assistant professor of surgery at
Dartmouth Medical School. He has been involved
in academic activities at Northeastern University
Perfusion Training Program and research
activities for the Northern New England
Cardiovascular Disease Study Group.
Dr. Dunton received a Bachelor’s degree in
biology from Baldwin-Wallace College in Berea,
Ohio, and his medical degree from Albany
Medical College in Albany, N.Y. He did a general
surgery internship and residency at Hartford
Hospital in Hartford, Conn., where he received
the Upjohn Outstanding Intern Award. He was a
senior resident in cardiac surgery at Boston
Children’s Hospital and completed a fellowship in
cardiothoracic surgery at New England
Deaconess Hospital in Boston. Dr. Dunton has
also earned a Master's degree in Bioethics from
the Union Graduate College and the Mt. Sinai
School of Medicine in New York, NY.
He has co-authored and published numerous
articles and has presented papers to many
surgical societies. He has been a member of the
American Heart Association Council on
Cardiovascular Surgery and Anesthesia since
2004. Dr. Dunton is a Fellow in the American
College of Surgeons and the American College
of Chest Surgeons and a member of the Society
of Thoracic Surgeons.
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Steve Montague
Lifewings: Patient Safety
Patient safety is the responsibility of every
clinician, but organizations also have a
responsibility to put safe systems into place to
support safe practices. These safe practices
must take place in an environment that includes
competing pressures such as production, cost,
equal access, confidentiality, etc. High Reliability
Organizations (HROs) such as aircraft carrier
flight deck crews, nuclear submarines, and wild
land
firefighting crews have learned some important
lessons that should be implemented in
healthcare.
Several case studies will be discussed, with
critical lessons learned from High Reliability
Organizations applied to healthcare settings.
Among the results published in peer-reviewed
literature, are these:
Surgical death rate decreased 47%
Inpatient complications decreased 36%
Surgical Site Infection rate decreased 45%
Unplanned return to OR rate decreased 25%
Conclusion: Thoughtful application of evidence
based practices from other high consequence
professions can yield substantially better patient
outcomes.
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David Fitzgerald, BS, CCP
The Age of Innovation- This is not your
Father’s ECMO Circuit
Over the last several years, many ECMO
clinicians have experienced a significant change
in both circuit technology and design. Large
silicone oxygenators and roller pumps have given
way to smaller, more biocompatible and reliable
components, as evidenced by the ELSO
Registry. In both pediatric and adult ECMO, the
new design in extracorporeal circuitry has been
credited to improved patient care, as less
hemolysis, blood transfusions, and mechanical
disturbances have helped clinicians optimize safe
outcomes for this critical population of patients.
Anecdotally, these improvements have also not
only lead to not only the expansion of indications
for support, but also may allow for prolonging the
duration of ECMO support.
Affiliation:
Chief of Cardiovascular Perfusion
INOVA Heart and Vascular Institute
INOVA Fairfax Hospital for Children
(703) 776-3728 voice
(703) 776-2830 fax
david.fitzgerald@inova.org
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Friday, February 17 th , 2012
Blood Management Sessions
Moderator-Tunisia Ellis
Peter Everts, PhD
PRP in Musculoskeletal Injuries
Abstract:
Musculoskeletal injuries represent a large
number of both professional, and recreational
sports injuries. In the US, The prevalence for
sports injuries is more than 11% in the
Netherlands, with approximately more than 2.5
million injuries per year. These injuries are often
located in the myotendinous junction. Treatment
options are extensively, depending on the
severity of the trauma, but has remained limited
mostly to immobilization, cooling, compression,
elevation, pain medication, anti-inflammatory
drugs, and ultimately mobilization.
At present, new biological treatment strategies, to
enhance muscle and tendon healing, have come
available. Furthermore, patients expect faster
and less invasive treatment options.
Autologously prepared platelet rich plasma (PRP)
is a volume of plasma with, among others, high
concentrations of platelets containing several
growth factors. PRP applications have been
extensively described in the literature as a
Potential PRP application techniques in patients
with musculoskeletal injuries, relevant to
physicians who treat musculoskeletal injuries,
like lateral epicondilitis of the elbow, Achilles
tendon tendinopathies, patella tendon
tendinopathies, and other regions will be
described.
PRP matrix grafts along with other biologic
grafting techniques are becoming more prevalent
in the treatment paradigms of musculoskeletal
medicine. These PRP matrix grafts provide
effective, safe, relatively low- cost treatment.
Potential PRP application techniques in patients
with musculoskeletal injuries, relevant to
physicians who treat musculoskeletal injuries,
like lateral epicondilitis of the elbow, Achilles
tendon tendinopathies, patella tendon
tendinopathies, and other regions will be
described.
PRP matrix grafts along with other biologic
grafting techniques are becoming more prevalent
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in the treatment paradigms of musculoskeletal
medicine. These PRP matrix grafts provide
effective, safe, relatively low- cost treatment
options to patients who have the time and
wherewithal to allow collagen synthesis and
maturation at the graft site. PRP matrix grafts
appear to restore tissue homeostasis and
biotensegrity of collagen. Other pain inhibiting
effects are also present in PRP matrix grafts
which allow earlier resumption of pain free
activity. It is the author’s experiences that these
grafts, along with other regenerative grafting
options, are at times the only viable treatment
option for a select group of patients with
degenerative myofascial tissue injuries. The
authors recommend appropriate first line
therapies such as relative rest, appropriate
bracing and kinesiotaping, evaluation of kinetic
chain mechanics, and physical therapy with or
without eccentric loading protocols be utilized
prior to the use of these PRP matrix grafting
protocols.
Reduction in pain after PRP applications has
been observed by several authors. However, an
explanation of this phenomena has not always
been given. The authors believe that serotonin
released from activated platelets might be
responsible for decreased pain, as described by
Everts and Fanning. Except for the growth
factors in the Alpha-granules, large amounts of
serotonin are contained within the dense platelet
granules. Since platelet counts of the PRP are
generally almost six fold higher, when compared
to whole blood levels, serotonin levels are
therefore also significantly increased at the
wound site. This phenomena has been explained
in detail by, Sprott et al. who reported on pain
reduction following acupuncture and measured a
decrease in serotonin concentration in platelets
from these patients and an increase in serotonin
levels in plasma, suggesting normalization of
plasma serotonin levels due to the mobilization of
platelet serotonin.
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The use of PRP in tendinopaties in regenerative,
musculoskeletal, medicine still needs to find it’s
place, and we should be aware not to find a
disease that can be healed by PRP, but perform
solid evidence base studies to prove the right
directions for use, efficacy, and costs benefits.
Affiliation:
The Da Vinci Clinic in Geldrop, The Netherlands,
is an expert center for tissue regeneration and
hyperbaric medicine.
Email: everts@me.com

David Palmer, EdD, CCP, LP
Jefferson Regional Medical Center’s
Experience Using the Viper Perfusion
Charting System
Abstract:
Advantages associated with utilizing electronic
medical records for perfusion charting include
patient care documentation, research and quality
improvement. Enhanced ability for ongoing
perfusion practice modification is a key attribute
leading to improved patient outcomes. The
electronic medical record (EMR) provides the
opportunity for the average perfusion department
to improve the quality of care and patient safety.
An EMR can decrease charting time and charting
errors providing increased productivity along with
reduction of medical errors. Perfusion leadership
requires a prerequisite of IT knowledge about
computers to implement and manage this
challenge since EMR can have a difficult learning
curve. Perfusionists are also faced with learning
another practice associated with quality
assurance realities and the approach used to
implement these new perspectives can impact
the perfusion team. Our department offers an
exception to some negative IT assumptions while
positively challenging perfusion paradigms.
Jefferson Regional Medical Center’s experience
implanting the Spectrum Medical electronic chart
and quality assurance plan into our normal
perfusion routine represents a story common to
most national perfusion departments. This
discussion will focus on our early efforts
justifying, implementing and integrating the
system into our perfusion practice.
Biography:
David Palmer received an undergraduate degree
in biology and master’s degree in educational
leadership from Carlow University in Pittsburgh.
His Doctorate is in Education from Duquesne
University in Pittsburgh. He is a graduate from
Shadyside Hospital’s School of Perfusion and is
27

employed by Procirca, an affiliate of the
University of Pittsburgh Medical Center. David
volunteers as a paramedic in his community and
serves with the ABCP, AC-PE and CAAHEP as a
Board member. David and his wife Alane, who is
also a perfusionist, live just outside the city of
Pittsburgh in Green Tree with their three children
and dog Penny.
Affiliation:
University of Pittsburgh Medical Center
200 Lothrop Street
Pittsburgh, PA 15213-2582
Email: palmerda@upmc.edu
28

Al Stammers, MSA, CCP, CPBMT
Blood Sweat and Fears: Hemostasis
Management Techniques during Cardiac
Surgery
As long as there has been extracorporeal flow
there has existed a need to understand the
various influences that affect hemostatic
imbalance. Indeed, the pathophysiologic
consequences of uncontrolled coagulation have
been the nemesis for both thrombotic and
hemorrhagic disorders. Cardiovascular disease
often results from imbalances in both
procoagulant and anticoagulant forces, and the
conduct of extracorporeal circulation results in
the disruption of protein derived coagulation
systems as well as, and concentration and
function of circulating thrombocytes. The
endothelial lining also plays a key role in
maintaining key hemostatic balances. The cross
talk between hemostasis and coagulation is seen
by the interconnected relationship between these
two diverse, yet linked, phenomena.
Cardiac surgery with cardiopulmonary bypass
(CPB) has been ground zero for studying
hemostatic imbalances. The majority of surveys
on safety and CPB have identified bleeding and
coagulation disturbances as the number one
incident associated with its application. This has
resulted in the publication of numerous
systematic reviews on various techniques utilized
to diminish the consequences of excessive
haemorrhage while limiting patient exposure to
allogeneic blood products and judiciously
administering costly pharmaceutical agents. The
incorporation of methodologies based upon
utilizing the best available evidence and
comparative effectiveness has refocused
strategies for blood conservation. Indeed, an
entire discipline has emerged dedicated to
improving the knowledge of blood management
29
that has transcended into multiple surgical and
medical clinical situations.
Perhaps nowhere else in medicine does such a
critical evaluation of the forces impacting the
development and clot stabilization exist. The
ability to easily quantify the effects of
interventions by measuring blood loss, blood
product infusion and resource consumption
creates a touchstone for measuring interventions.
This has necessitated a continued evaluation of
the methods that are incorporated in blood
conservation. Each center performing cardiac
surgery with CPB is uniquely able to assess the
efficacy of interventions at a fundamental level.
The incorporation of information technology and
the expansion of the electronic medical record in
hospitals will serve as an effective tool to quantify
performance and benchmark local results to
regional and national data.
Research on the effectiveness of interventions
that make up a comprehensive blood
management program are often hindered by the
complexities of variable-to-variable interactions
that may obscure subtle benefits, and hence,

under emphasize contributions that occur
through amalgamation. The present report will
review the results obtained from formalizing
blood management techniques at a regional
medical center.
Comprehensive Patient Blood Management
Program at Geisinger Health Systems
1. Preoperative Management
a. Preoperative Blood Management
Services
b. Anemia Correction
c. Pharmacologic Control
2. Intraoperative Management
a. Transfusion Algorithms
i. Preoperative Coagulation
Assessment
ii. Microvascular Bleeding
Protocols
iii. Long Term Assist
Management
b. Coagulation Assessment using
Point-of-Care Devices
c. Cross Discipline Volemic Control
d. CPB Circuit Configuration and
Management
i. Oxygenator
ii. Cardioplegia
iii. Intraoperative
Autotransfusion
iv. Ultrafiltration
e. Autologous Priming
f. Plasmapheresis with Platelet
Concentration
g. Utilization of Anticoagulants and
Procoagulants
h. Placement of Autotransfusion
Devices in Obstetrics
3. Postoperative Management
a. Mediastinal Blood Collection and
Postoperative Autotransfusion
b. Utilization of Procoagulants
Select Reference List
1. Yazer MH, Waters JH. How do I
implement a hospital-based blood
management program? Transfusion Nov
21, 2011 [Epub ahead of print].
2. Geisinger Health Systems Blood
Conservation Programs.
http://www.geisinger.org/services/blood_c
ons/
3. Ganter, MT, Spahn DR. Active,
personalized, and balanced coagulation
management saves lives in patients with
massive bleeding. Anesthesiology 2010;
113:1016–8.
4. Levy JH, Tanaka KA. The anticoagulated
patient: Strategies for effective blood loss
management. Surgery 2007;142:S71-S77.
5. Moskowitz DM, McCullough JN, Shander
A, et al. The impact of blood conservation
on outcomes in cardiac surgery: Is it safe
and effective? Ann Thorac Surg
2010;90:451–9.
6. Goodnough, LT, Shander A. Blood
management. Arch Pathol Lab Med.
2007;131:695–701.
30

7. Rivera JJJ, Iribarren JL, Raya JM, et al.
Factors associated with excessive
bleeding in cardiopulmonary bypass
patients: a nested case-control study. J
Cardiothorac Surg 2007:2;1-7.
McGill N, O'Shaughnessy D, Pickering R, et al.
Mechanical methods of reducing blood
transfusion in cardiac surgery: randomised
controlled trial. British Medical
31

Susan Englert, RN, CCP, CPBMT
Blood Management: Tug of War
Blood Conservation modalities will be discussed
and identified through literature review and
ethical issues. Areas for improvement will be
reviewed through the multidisciplinary players.
The future of blood management will be
discussed through the changing paradigm and
identifying blood management champions in your
facilities with take home messages.
Affiliation:
Susan J. Englert, RN, CNOR, CPBMT, CCP
Chief Perfusionist
Perfusion.com
Florida Hospital Waterman
1000 Waterman Way
Tavares, Florida 32778
Office 352-253-3333 ext 6715
sjenglert12@gmail.com
sjenglert@perfusion.com
32

Peter Everts, PhD
The Synergy of PRP & Fat Tissue in
Reconstructive Surgery
Abstract:
Tissue repair at wound sites begins with clot
formation, and subsequently platelet
degranulation with the release of platelet growth
factors, which are necessary and well-regulated
processes to achieve wound healing. Plateletderived
growth factors are biologically active
substances that enhance tissue repair
mechanisms, such as chemotaxis, cell
proliferation, angiogenesis, extracellular matrix
deposition, and remodeling. This review
describes the biological background and results
on the topical use of autologous platelet-rich
plasma and platelet gel in gynecologic, cardiac,
and general surgical procedures, including
chronic wound management and soft-tissue
injuries.
Affiliation:
The Da Vinci Clinic in Geldrop, The Netherlands,
is an expert center for tissue regeneration and
hyperbaric medicine.
Email: everts@me.com
33

Dr. Paul DiGiorgi, MD, FACS
Perfusion Pearls in Minimally Invasive
Cardiac Surgery
Abstract:
Minimally invasive cardiac surgery introduces
several advantages for patients but new
challenges can arise requiring careful planning to
optimize outcomes.
Case scenarios will be discussed focusing on
similarities and differences between minimally
invasive and standard sternotomy approaches to
cardiac surgery. Technical as well as
communicative factors will be discussed.
Biography:
Medical School: NYU School of Medicine,
General Surgery Training: University of
Connecticut, Cardiothoracic Research Fellow:
Columbia University, Cardiothoracic Fellowship:
NYU Medical Center
34

Jeffrey Travis, MD, FACS & Ty Walker, CCP
Eat More Chicken
Introduction:
a case that was presented to our group of a rare
allergy of both beef and pork. The reason for
consultation was aortic stenosis and coronary
artery disease. The patient presents with
cutaneous rash, hives and develops itching after
several hours post ingestion of either beef or
pork. He described one incident of massive
swelling of the hands and throat, making it
difficult to breathe. In general, this is a very
active, well-developed 65 year old white male
with no apparent distress. The patient has had a
known murmur for quite some time. A recent
echo revealed severe aortic stenosis which was
confirmed with catheterization. The cath showed
a valve area of 0.5 cm and a gradient of 67
mmHg and also a 70% LAD and 70% OMI
occlusion of the coronary arteries.
Methods / Case Report:
After reviewing the literature we found an actual
article in the Journal of Thoracic and
Cardiovascular Surgery “Heparin Allergy:
Successful Desensitization for Cardiopulmonary
Bypass”. This protocol uses a six day
desensitization strategy with cautious
intravenous doses of heparin, increased each
day. Once reviewed, and with direction from our
Chief of Cardiovascular Surgery, we proceeded
with this therapy and course of action. We felt
this was a safe choice for the patient and would
answer questions such as can we desensitize the
patient over time. Also, by monitoring platelet
counts, we can rule out the possibility of HIT.
Results / Discussion:
With a successful and slightly altered treatment
35
therapy course, we ruled out an allergy to
heparin and heparin-induced thrombocytopenia.
Cardiac surgery was scheduled and performed in
a routine fashion with no alteration in
anticoagulation strategy. A mechanical aortic
valve was placed, LIMA to LAD, and saphenous
vein to OMI was performed. Benedryl was given
as an added precautionary measure after
induction. The patient was extubated the same
day and up and talking the morning after surgery.
Conclusion:
This unique case provided a leading example of
a team approach to patient care and superior
patient outcomes. I would like to personally thank
our Chief of Cardiac Surgery for his passion and
team approach in patient care and a key leader
in our Blood Management Program.
Affiliation:
Lexington Cardiovascular Surgery

Biography:
Born and raised in SC. Undergrad at Clemson,
MD from USC. General surgery and Thoracic
surgery at Wake Forest University. Partner
Columbus Cardiovascular Surgery 6.5 years.
Just Starting heart program at Lexington Medical
Center
36

Dr. Charles Roberts
CABG in the Setting of Carotid Stenosis: How
to Avoid Stroke
Brief Biography
Charles Stewart Roberts, MD, was born in
Washington, D.C., in 1960, and educated at
Vanderbilt (B.A., 1981) and Emory (M.D., 1986)
universities. He had general surgical training at
Barnes Hospital in St. Louis, and at the Medical
University of South Carolina in Charleston,
separated by two years in cardiovascular
research in the Surgery Branch of the National
Heart, Lung, and Blood Institute of the National
Institutes of Health in Bethesda (1988-90). He
completed a three-year fellowship in
cardiothoracic surgery at the University of North
Carolina in Chapel Hill in 1996, followed by one
year in pediatric and adult cardiac surgery at the
Royal Brompton Hospital in London.
In 1997 he was appointed Assistant Professor of
Surgery at the University of North Carolina,
where his practice consisted of pediatric and
adult cardiac surgery. In 2001 he went to
Winchester Medical Center (Valley Health
System) in Winchester, Virginia, where he has
been Chief of Thoracic and Cardiovascular
Surgery since 2004. His main interests are
coronary and carotid atherosclerosis and valvular
heart disease, and his practice consists of
roughly 300 cardiovascular operations a year.
Dr. Roberts has had three books published. The
first, An Olive Branch for the Conquered
(1990), is a collection of previously published
poems. The second is a biography of his
grandfather, Life and Writings of Stewart R.
Roberts, MD: Georgia’s First Heart Specialist
(1993), who was president of the Southern
Medical Association in 1924 and the American
Heart Association in 1933-4. The third book,
Stoking the Fire: A Surgical Memoir of
London (1999), describes his fellowship year
with Mr. Christopher Lincoln, a distinguished
cardiac surgeon.
Dr. Roberts is author or co-author of some 80
medical publications, the majority concerning
cardiovascular disease. Singular editorials
include one titled, “Postoperative Drug Therapy
to Extend Survival After Coronary Artery Bypass
Grafting” (Ann Thorac Surg 2000: 60; 1315-6),
and another titled, “Cardiovascular Surgery as a
Single Specialty: The Case to Unify Cardiac and
37

Vascular Surgery” (J Thorac Cardiovasc Surg
2008: 136; 267-70), two causes in which he
believes. Medical history is a related interest and
Dr. Roberts has presented at several annual
meetings of the American Osler Society, of which
he is a member.
38

Robin Zappacosta, RN
The Time is Right & Size Matters
Abstract:
Intra-aortic balloon pump (IABP) therapy is a
proven treatment in the stabilization of severely
compromised cardiac patients. The effects of
providing increased myocardial oxygen supply,
while also decreasing myocardial oxygen
consumption, are well documented. The
effectiveness of counterpulsation therapy is
dependent on optimal volume displacement,
synchronized within the cardiac cycle.
Objectives:
1. identify a method of improving
timing in an irregular cardiac
rhythm
2. explore alternative methods of
evaluating effectiveness of
therapy
3. discuss the effects of
augmentation and challenges
to optimal augmentation
Affiliation:
Global Clinical Sales Manager
Teleflex Cardiac Care
39

Saturday, February 18 th , 2012
Blood Management & New Technology Sessions
Moderator-Ty Walker
Dennis Borne
Medical Malpractice Insurance & the
Perfusionist
Abstract:
Definition of Medical Malpractice Insurance.
Components to Policy
Perfusionist's need for Product
Methods / Case Report:
MedPlus' involvement in Perfusion market
Texas Department of Insurance
Texas Heart Institute
Results / Discussion:
Available Markets and Products
Reason for Shortage of Markets
Conclusion:
Future of Perfusion Insurance
What to look for in a policy
Risk Retention Group
Affiliation:
President, Medical Professional Liability
Underwriting Solutions, LLC (MedPlus, LLC)
9555 W. Sam Houston Pkwy, STe 475
Houston, TX 77099
Email: dennis@medplusllc.com
40

Jeffrey Travis, MD, FACS
Use of a TEG in Cardiac Surgery
Abstract:
TEG is a powerful tool in the use of blood
management. In this presentation, we outline all
the settings we have found it to be clinically
useful in a community hospital setting.
Methods / Case Report:
We have recently introduced blood management
into our hospital. The TEG has had the most
broad reaching effect of any strategy employed
to date.
Conclusion:
The TEG is a point of care test that delivers vital
information to the practicing clinician that aids in
reducing blood product usage and resources.
Affiliation:
Lexington Cardiovascular Surgery
Email:jtravis007@charter.net
Biography:
Born and raised in SC. Undergrad at Clemson,
MD from USC. General surgery and Thoracic
surgery at Wake Forest University. Partner
Columbus Cardiovascular Surgery 6.5 years.
Just Starting heart program at Lexington Medical
Center
41

Dr. James Lonquist, MD, FACS
Keynote Address:
How to Succeed in Blood Management
Abstract:
Blood Management is a multi-disciplinary
process designed to promote the optimal use of
blood products. Cardiac surgery is uniquely
positioned to play a leadership role in the
implementation of a hospital wide blood
management effort. An effective program
encompasses preoperative optimization,
intraoperative conservation measures, and
careful postoperative management.
Communication and alignment with the blood
bank, laboratory, information technology, nursing,
and hospital administration all contribute to the
success of the program. Increasing awareness
of transfusion risks has resulted in a more
restrictive approach to transfusion triggers over
the past decade. Education of health care
practitioners in the current evidence based
guidelines plays a vital part in changing
transfusion practices. The ultimate goal is to
ensure safe and appropriate use of blood
resources.
42

Al Stammers, MSA, CCP, CPBMT
ProvenCare Medicine: A Primer for Future
Health Care Delivery Models
Introduction
Health care delivery is a complex process that
utilizes sophisticated integrated technologies to
provide society with a safe and reproducible
system of medical management. Its delivery is
intimately tethered by economic constraints
which have been emphasized in the United
States when the Patient Protection and
Affordable Care Act was signed into law by
President Barack Obama on March 23, 2010.
Although there are numerous factors that
influence how health care is delivered there is an
inherent expectation that patients will receive the
right care at the right time using the best
techniques so that outcome is related to the
severity of the illness, more so then the process
of how it is delivered. Although intuitive in nature
this has not been shown to be how care is
delivered in America. Clearly an evolving health
environment has established mandates for
change across the entire system that involves
and affects the providers, payors and patients.
Geisinger Health Systems (GHS) has undertaken
an innovative approach to dealing with this
changing health care environment. This system
redesign began six years ago starting with
cardiac surgery, and has since become an
integral philosophy that has been engrained as
the foundation for care across GHS.
The Geisinger System
Founded in 1915, GHS is an integrated delivery
system (IDS) located in central northeastern
Pennsylvania that serves 43 rural counties and
over 2.6 million residents. This area of
Pennsylvania is known for its industrial
development which occurred during the previous
century because of the abundance of resources
(anthracite coal, limestone, and iron ore)
necessary for the production of steel. GHS is
made up of three fully owned tertiary or
quaternary inpatient facilities employing over
14,000, including 800 physicians at 60 sites. It is
one of the largest non-medical school based
graduate medical education systems in the
country. The entire enterprise has been
connected with an electronic health record (EHR)
since 1995, which is used across all GHS
entities. The EHR has provided the foundation for
comprehensive longitudinal care across the IDS.
43

As an IDS Geisinger owns its own managed care
company termed the Geisinger Health Plan
(GHP), which serves over 230,000 members. In
addition to providing coverage to GHS providers
it also contracts with over 18,000 non-employed
physicians and 90 additional hospitals. It is rated
the best private and best Medicare health plan in
Pennsylvania and is ranked in the top five
nationally 1 .
ProvenCare
In 2005 the GHS board of directors challenged
senior leadership to reengineer the system under
which care is delivered. The impetus for this drive
was not entirely based upon improving outcomes
since the system had enjoyed good success
under the current care delivery system. Instead it
was a process designed to focus on innovation
leading to targeted strategies such as care
coordination and transitions, chronic care
optimization, illness prevention through the
engagement of patients, and a transformation of
how acute episodic care is delivered. This was
being done to enhance health care value while
emphasizing individualized patient care.
Accenting the preventative measures was a
commitment to improve diagnostic and treatment
efforts employing the best available evidence.
The reengineering of acute episodic care has
been termed the ‘warranty’ because one of the
basic tenets of this process is the proviso that if
all the steps in the care plan were followed GHS
would be financially responsible for any
complications that resulted within 90 days of
1 http://www.ncqa.org/
44
surgery. Since it is impossible to reduce
complication rates to zero, the historical cost (2-
year) of complications could be calculated and
added to the mean cost of the procedure that
purchasers would pay up-front, but not be
responsible for as in a traditional fee-for-service
system.
The initial patients were all enrolled in the GHP,
which assured a continuum of care and served
as the ‘sweet spot’ for the launch of the
ProvenCare initiative. The cost of the procedure
was a single-bundled payment mutually agreed
upon using a risk-based pricing process where
discounts would be given to either the provider or
payor based upon historical results.
The target care models that were identified as
potentially benefiting from the ProvenCare
methodology had the following characteristics:
1. Large impact by patient population or
resource consumption
2. A significant amount unjustified variation
3. Large amount of evidence based or
consensus derived best practice
guidelines
4. Presence of outcome metrics and
benchmarks
5. High interest from clinical champions or
consumers
6. Those with observed outcomes furthest
from expected performance
It was felt that the areas with the greatest impact
would be those seen with the management of
chronic disease states. Conditions such as

diabetes, congestive heart failure, chronic kidney
disease, hypertension and coronary artery
disease were all evaluated. The first application
using the ProvenCare methodology was focused
on acute episodic surgical care of patients
presenting with coronary artery disease who
underwent a coronary artery bypass graft
(CABG) procedure, and was termed ProvenCare
CABG.
Proven CABG
Geisinger’s cardiac surgery service line is
distributed between two hospitals (Geisinger
Medical Center - GMC, Danville, PA and
Geisinger Wyoming Valley – GWV, Wilkes Barre,
PA) separated by approximately 60 miles. There
are six adult cardiac surgeons, one pediatric
cardiac surgeon, and 8 perfusionists who provide
service for both facilities. The 2010 total cardiac
case number was 634 cases with 74% of them
performed at the GMC facility.
At GHS the surgical intervention for most patients
presenting with coronary artery disease has been
to use a beating heart, off-pump technique.
Although outcomes for patients treated with
CABG had been excellent, the surgical team
identified a number of idiosyncratic tendencies
amongst surgeons with how patients were
managed. Standardization of care was therefore,
a critical element driving the reengineering
process. The decision to standardize care
delivery was agreed upon amongst all surgeons
and a mechanism to accept a system wide
approach utilizing guidelines determined through
either an evidence-based best practice or
consensus opinion approach, utilized. The 2004
American College of Cardiology-American Heart
Association Guidelines was chosen as the
foundation for standardization. Each guideline
was reviewed and further defined with
measurable indicators for performance, as well
as individuals identified who took overall
responsibility. The group identified 20 adoptable
guidelines with 40 separate elements of care.
Patients were also required to sign a CABG
Patient Compact outlining their commitment to
the ProvenCare model.
Benchmarking results from the Society of
Thoracic Surgeons Database served as the
historical basis for performance and compared to
the results after the guidelines were
implemented. Primary metrics for analysis
included adherence to workflow guidelines and
financial impact. PC patients were enrolled for
one year (February 2007 through February 2007)
and compared to a conventional care (CC) group
(operated upon in 2005).
Results
The program began in February 2006 and by
August of that year 100% of all PC patients
(n=117) received all 40 elements of care. When
compared to the CC group (n=137) there was a
trend towards reduced adverse events in the PC
group as compared to CC. There was a
reduction in hospital charges by 5% in the PC
group as compared to the CC group that most
likely occurred by a drop in length-of-stay from
6.3 to 5.3 days.
45

physicians had an added incentive in the form of
a financial bonus when all elements of care were
provided. Insurance companies and third party
purchases would value the ‘warranty’ and share
in a proactive fee structure that limited the costs
for adverse events emphasizing the trend in
health care reimbursement towards pay-for-
Conventional Care
(n=137)
ProvenCare
(n=117)
N % N % P Value
Blood Products Used 32 23.4 19 16.2 0.17
Reintubated during hospital stay 4 2.9 1 0.9 0.38
Operative complication 8 5.8 5 4.3 0.78
Infection: Sternum - Deep 1 0.7 1 0.9 1.00
Neurologic complication 2 1.5 1 0.9 1.00
Pulmonary complication 10 7.3 3 2.6 0.15
Atrial fibrillation 31 22.6 30 25.6 0.58
Any complication STS Definition 53 39.0 41 35.0 0.55
Postoperative LOS (median) 4 4 0.25
Readmission to ICU 4 2.9 1 0.9 0.38
Operative Mortality 2 1.5 0 0.0 0.50
Discussion
The underlying principle of the PC model is a
strict adherence to either evidence-based or
consensus reached guidelines would result in a
consistency of care application assuring that
patients receive the current best-medicine
approach to acute episodic procedures such as
cardiac surgery. For CABG surgery the
performance. Most importantly patients would not
be seen as passive participants in their care
delivery but take an active role in their health
management. The success of Proven Care
CABG has led to its expansion in other service
areas across the GHS, which include cataract
surgery, hip replacement surgery, percutaneous
coronary intervention and perinatal care.
46

The utilization of PC methodology that
incorporates an evidence-based or consensus
reached guidelines for perfusion would
standardize how perfusion care is delivered and
result in a more consistent throughput of activity
amongst staff. The perfusion EHR will provide
the foundation by which data would be collected
and analyzed to allow performance review.
Variation from the clinical guidelines would
remain the judgment of the clinician who
assesses patient response avoiding the
‘cookbook’ tendencies that develop by strict
adherence to algorithmic principles.
1. Eagle KA, Guyton RA, Davidoff R, et al.
ACC/AHA 2004 Guideline Update for
Coronary Artery Bypass Graft Surgery:
Summary Article. Circulation.
2004;110:1168-76.
2. Casale AS, Paulus RA, Selna MJ, et al.
"ProvenCareSM": a provider-driven payfor-performance
program for acute
episodic cardiac surgical care. Ann Surg.
2007;246:613-21.
3. Berry SA, Doll MC, McKinley KE, Casale
AS, Bothe A Jr. ProvenCare: quality
improvement model for designing highly
reliable care in cardiac surgery. Qual Saf
Health Care. 2009;18:360-8.
4. Steele G Jr. Re-engineering systems of
care: surgical leadership. J Am Coll Surg.
2010;210:1-5.
Affiliation
Alfred H. Stammers, MSA, CCP, PBMT
Director of Perfusion Services
Geisinger Health System
ahstammers@geisinger.edu
Summary
The critical elements for success of the
ProvenCare model include a dedicated
committed support from senior leadership and
management; the engagement of clinical,
administrative and financial stakeholders to
agree to methodology; a precise identification of
workflow processes to standardize delivery
reengineered where necessary to overcome
hurdles; and a commitment from patients to
engage in the care process.
References
47

Dr. Allen Heldman
Transapical AVR in the Hybrid OR Setting
Abstract:
Alan W. Heldman, MD, FSCAI
Professor of Medicine
Cardiovascular Division
Clinical Research Building
1120 NW 14th Street, #1118
Miami, FL 33136
305-243-5138 Office
305-243-1731 Fax
University of Miami Miller School of Medicine
48

John G. Rivera, B.S., M.A.
Rethinking Blood Conservation; the Role of
Autotransfusion
Abstract:
Blood is in short supply and the costs to collect,
process, test, maintain and transfuse it will
continue to grow. Some authors have noted that
patients receiving allogeneic transfusions have
more adverse outcomes and longer lengths of
stay than patients who do not receive donor
blood. Insurance organizations are examining
surgical outcomes and have instituted a pay for
performance mechanism for reimbursement.
Consequently, these “never events” are not being
reimbursed by the insurers and the hospitals are
being forced to absorb those additional costs.
In 2007 the Society of Thoracic Surgeons, in
conjunction with the Society of Cardiovascular
Anesthesia, issued practice guidelines for
Perioperative Blood Transfusion and Blood
Conservation in Cardiac Surgery. Multiple
modalities were identified both in the
preoperative and perioperative setting that would
directly impact the practice of transfusion during
cardiovascular surgery. The goal of these
guidelines was to establish a consistent practice
of transfusion during cardiovascular surgery that
reflected the implementation of a written
algorithm which relied upon multiple clinical
factors including lower hemoglobin thresholds.
Unfortunately, compliance with these guidelines
was limited and written updates in 2010 and
2011 were created to take advantage of other
modalities that were now available. Many
clinicians have not reviewed these documents
and have not fully complied with these directives.
The latest update to these Guidelines in 2011
also identified clinical practices that were under
the auspices of the perfusionists such as: smaller
volume cardiopulmonary bypass circuits,
specialized tubing coatings, the use of centrifugal
pumps, advanced heparin management,
retrograde autologous priming (RAP),
hemodilution and autotransfusion.
Saving blood makes sense for everyone involved
in the practice of transfusion. The use of a
restrictive allogeneic transfusion practice has
directly resulted in improved patient outcomes
and lower treatment costs. A written transfusion
algorithm that is followed explicitly in the
49

perioperative and postoperative settings is a
critical first step. The use of multiple modalities
and evidenced based practices are well
documented and indicated per the STS Meta
analysis of 753 articles over a two (2) year time
period. Validation of all practices, along with
periodic quality control measurement, is
mandated by the appropriate regulatory bodies
including AABB.
In addition to a limited blood supply, the direct
costs to collect, test, process, store, monitor and
transfuse blood can vary from $500 to $1,200.
Hospital clinical performance is being reviewed
by CMS and reimbursement may be lowered for
poor performance. Several states are publishing
these results in local newspapers and internet
savvy patients are choosing hospitals and
surgeons based upon this data. Unfortunately,
patients are arriving at the hospital are in
exceedingly poor clinical condition. This includes
the ongoing use of anticoagulation and platelet
inhibitor therapy. The number
Rethinking Blood Conservation; the Role of
Autotransfusion (continued)
of high risk patients who are older males, obese,
diabetics, smokers and having a history of
previous surgery with blood transfusion is
increasing as compared to the same kind of
cardiovascular surgery patients from 10 years
ago. Many patients self medicate with nutritional
supplements such as garlic, Gingko Biloba,
ginseng, green tea, Red Yeast Rice, vitamin E,
St. John’s Wort, and aspirin. These agents can
cause resistance to anticoagulation therapies
and inhibition of platelet function. The bottom
line is that these “sicker” patients are subject to
50
significantly increased perioperative bleeding.
Even the heparin anticoagulant being used in
cardiovascular surgery is subject to variability.
Autotransfusion is one of the primary modalities
being recommended to limit allogeneic
transfusion. It is a relatively inexpensive
procedure with tremendous flexibility. The
process is safe, fast, efficient and easy to
implement. Available autotransfusion devices
are highly automated and can be rapidly
implemented and deployed. Autotransfusion is
the only transfusion alternative that is routinely
accepted by Jehovah’s Witness patients.
Validation and ongoing quality control of
autotransfusion devices require direct oversight
and testing in the laboratory setting. Written
policies and procedures should be reviewed by
the Laboratory Medical Director on an annual
basis and operator competencies need to be
frequently validated. There must be a medical
director responsible for the autotransfusion
program.
A wide variety of personnel are involved in the
operation of autotransfusion devices. Although
perfusion personnel are the primary operators of
autotransfusion devices during cardiovascular
surgery, other medical personnel are running
these devices in non-cardiovascular cases.
Anesthesia technologists and technicians,
nurses, surgical technicians, medical
technologist, respiratory therapists and other
personnel regularly present in Operating Rooms
are responsible for running autotransfusion
machines. These personnel must complete
annual autotransfusion training and certification.
The American Society of Extracorporeal
Technology has created a standardized

autotransfusion testing program that can be
completed on line in a proctored setting. Passing
this test authorizes the participant to be
credentialed as a Perioperative Blood
Management Technologist (PBMT).
In the hands of an appropriately trained and
credentialed operator, autotransfusion generates
safe and high quality washed packed red cells.
The process of autotransfusion is fast and the
patient benefit is immediate. Blood is literally
being recycled and valuable allogeneic blood
supplies are conserved for use for other patients
who are not eligible for or are contraindicated for
autotransfusion. Autotransfusion is a highly
complementary activity that helps to conserves
the limited allogeneic blood supply.
Bibliography
Gorman-Koch, C, Liang, L, Duncan, A. I.,
Mihaljevic, T, Cosgrove, DM, Loop, FD, Starr,
NJ, Blackstone, EH. Morbidity and mortality risk
associated with red blood cell and bloodcomponent
transfusion in isolated coronary artery
bypass grafting. Critical Care Medicine
2006;34,6:1608-1616
Thoracic Surgeons and the Society of
Cardiovascular Anesthesiologists clinical practice
guidelines. Annals of Thoracic Surgery
2007;835(5 Suppl):S27-86
Ferraris, VA, et al. 2010 Update to the Society of
Thoracic Surgeons Blood Conservation
Guidelines
Ferraris, VA, Brown, JR, Despotis, GJ, Hammon,
JW, Reece, TB, Sibu, SP, Song, HK, Clough,
ER, Shore-Lesserson, LJ, Goodnough, LT,
Mazer, CD, Shander, A, Stafford-Smith, M,
Waters, J, Baker, RA, Perf D, Dickinson, TA,
Fitzgerald, DJ, Likosky, DS, Shann, KG. 2011
Update to the Society of Cardiovascular
Surgeons and the Society of Cardiovascular
Anesthesiologists Blood Conservation Clinical
Practice Guidelines. Annals of Thoracic Surgery
2011;91:944-82
Standards for Perioperative Autologous Blood
Collection and Administration, 4 th Edition, AABB,
2009
Guidelines for Blood Recovery and Reinfusion in
Surgery and Trauma, AABB, November 2010
Shander, A, Hoffman, A, Ozawa, S, Theusinger,
OM, Gombotz, H, Spahn, DR. Activity-based cost
of Blood Transfusions in surgical patients at four
hospitals. Transfusion 2010;50:753-765
Ferraris, VA, Ferraris, SP, Saha, SP, Haan, CK,
Royston, BD, Bridges, CR, Higgins, RSD,
Despotis, GJ, Brown, JR, Speiss, BD, Shore-
Lesserson, LJ, Stafford-Smith, M, Mazer, CD,
Bennett-Guerrero, E, Hill, SE, Body, S.
Perioperative Blood Transfusion and blood
conservation in cardiac surgery: the Society of
51

Gary Allen, MD, FACS
How Low can We Go, the Attenuation of
Heparin during OPCAB
Abstract:
Background: The optimum heparin dosing
strategy for off-pump coronary artery bypass
graft (OPCAB) surgery is not well described. A
review of the literature shows
Heparin dosages between 70 U/kg – 500 U/kg
and corresponding activated clotting times (ACT)
between 250 – 500 seconds (s). We
hypothesized that an ACT of 200 s would provide
satisfactory anticoagulation and possibly reduce
peri-operative blood loss. To achieve our ACT
goal we examined three different dosing
formulas.
Method: Twenty (estimated at this time)
consecutive OPCAB patients were studied at a
single institution. The HEPCON HMS (Medtronic
Minneapolis, MN) in conjunction with the Heparin
Dose Response (HDR) was used to derive
heparin dosages. Dosing strategies were as
follows: Formula 1. [heparin] to achieve ACT 200
s x total blood volume (TBV), Formula 2 (1/3)
[heparin] to achieve ACT 480 s x TBV , and
Formula 3 [heparin] to achieve ACT 480 s.
Protamine doses were calculated for full heparin
reversal.
Results: There were 11 males (55%) and 9
females (45%). Mean age was 69 + 4.5 years.
The mean number of grafts was 2.4 + 0.6.
Patients with a history of coagulopathy were
excluded. Mean anticoagulation data and
standard error of the mean are presented
52

In the table below:
HEPARIN
(UNITS)
Calculated
Additional
ACT (S)
Baseline
Post
heparin
End of case
PROTAMINE
(U)
Formula
1
Formula
2
Formula
3
Administered
Dose
A multiple-choice survey questionnaire was
developed and electronically distributed within
perfusion community in association with
Perfusion.Com. Patients undergoing OPCAB
procedures were assigned in a randomized
fashion. The HEPCON HMS, targeted levels for
ACT values and corresponding heparin
strategies, results obtain with this device were
used to develop the empirical formulas for
attenuating heparins affects, in addition the
HEPCON HMS is based on the maintenance of
individually determined heparin levels.
The HEPCON HMS in conjunction with the
Heparin Dose Response (HDR) produced the
parameters for the genesis of three different
calculations/formulas. The first formula evolved
based only on using one third of the total
recommended amount of heparin. The second
formula was based on one third of the calculated
heparin concentration in order to achieve an ACT
of 480sec, multiplied by the patients total blood
volume. The third formula encompassed the
manipulation of the HEPCON HMS parameter,
200sec replaced the original 480sec and the
computations were revised, reducing the heparin
concentration significantly, it was also multiplied
by the total blood volume. Each particular
equation proposed a total amount of heparin for a
given attenuation of anticoagulation. Based on
our objectivity, our prior experience and the
expectation of the calculated heparin dose, a
total amount of heparin would be determined,
respectively. In addition, we investigated the
protamine dose that would be required to return
to a normal hemostatic system and whether or
not that should actually be administered,
depended on the relative amount.
Ht/cm Wt/kg TBV
X = Heparin Concentration acquired to achieve
480sec ACT
Y = HEPCON HMS predicted Total Amount of
Heparin
Z = Heparin Concentration acquired to achieve
200sec ACT, after established baseline with HDR
53

1. Y divided by 3 = Total amount of Heparin
2. 1/3 of X multiplied by TBV = Total amount
of Heparin
3. Z multiplied by TBV = Total amount of
Heparin
54

Susan Englert, RN, CCP, CPBMT
Patient Safety Issues: Leave Your Ego Out of
the Room
Abstract:
Important identifiers promoting patient safety and
preventing complications will be discussed. The
importance of high reliability clinical teamwork
and decreasing risk will be stressed as key
components. I will be reviewing outcomes to
produce a better, safer, patient care and a better
experience of care for patients. Team factors
and a safety pyramid will be identified through
teamwork climate and trust.
Affiliation:
Susan J. Englert, RN, CNOR, CPBMT, CCP
Chief Perfusionist
Perfusion.com
Florida Hospital Waterman
1000 Waterman Way
Tavares, Florida 32778
Office 352-253-3333 ext 6715
sjenglert12@gmail.com
sjenglert@perfusion.com
55

Ty Walker, CCP
Simulation Stimulation
Abstract:
Perfusion.com takes great pride in the
continuous development & education of its
Perfusionist & PBMT’s.
One of the requirements of our organization is to
have documented monthly meetings. These
monthly meetings give us an excellent
opportunity to go over one situational event that
could potentially affect all of us in our practice.
These events could be structured to be
simulations in the OR, or verbal discussions on
treatments for patients with certain diagnosis’.
The goal would be constant stimulation of our
thought process, a structured team approach,
and continuous continuity of care.
What a better opportunity to continually raise the
bar and set standards which are superior to other
perfusion corporations. Each month we will
supply our group with a topic of discussion.
56

Breakfast &
Lunch
With
Vendors
57

THURSDAY
Sorin – Breakfast 0700-0800; Presenter Ty Walker, CCP, CPBMT
Nonin – Lunch 1130-1230; Presenter Ty Walker, CCP, CPBMT
FRIDAY
Cytomedix – Breakfast 0700-0800 Presenter Al Stammers, MSA, CCP,
CPBMT
Covidien – Lunch 1130-1230; Presenter TBD
SATURDAY
Hospira – Breakfast 0700-0800; Presenter Dr. Richard Juda
Haemonetics – Lunch 1130-1230; Presenter Mike Miller
58

Al Stammers, MSA, CCP, CPBMT
An Update on Autologous Platelet-Gel:
Results from Our First 7,000 Procedures
No idea is so outlandish that it should not be
considered with a searching but at the same time
a steady eye.
Winston Churchill
A person with a new idea is a crank until the idea
succeeds.
Mark Twain
Few areas of blood management have been
simultaneously so widely revered yet broadly
questioned as the process of autologous platelet
gel (APG). An equal balance of skepticism
tempers the degree of enthusiasm where a
believer’s passion is only surpassed by a critic’s
admonitions. APG is described as the process of
harvesting one’s own cells (platelets),
concentrating them, exposing them to an agonist,
activating them to release their intrinsic
substances, and applying them to an area of the
body in need of healing. Its growth over the past
decade can best be described as geographically
variant where certain locations have seen
explosive growth while others have seen little to
no acceptance. It is clearly a technology in
search of a science, which suffers from the
conventional wisdom of a lack of evidence-base.
Its origins can be traced to the techniques of
intraoperative plasmapheresis.
Although the process of plasmapheresis has
been in clinical use for over 50 years, its
application as a perioperative clinical tool was not
59
appreciated until the mid 1970’s. Initial research
focused on the separation of autologous whole
blood into fractions that could be administered
throughout the surgical procedure. In cardiac
surgery this technique became popular in the late
1980’s, but controversy surrounding its
reproducible efficacy led to its decline in the late
1990’s. Although a number of studies promoted
the benefits of plasmapheresis as a blood
conservation measure, an equal number failed to
show a reduction in allogeneic blood product
utilization.
During the past two decades, however, this
technique has reemerged not based upon its
original potential to improve hemostasis, but
instead related to the contribution of the platelet
and its biological affect on wound healing. A
secondary benefit of this process, and one that
has promoted its popularity is the derivation of
the product from an autologous source. It is

harvested from the same individual to whom it
will be applied. The growth of APG has occurred
most rapidly during the past decade both in the
United States and across Europe and is
beginning to expand in Asia. What makes APG
so attractive is the ease of which the platelets
can be harvested using point-of-care devices that
are utilized both in clinics and physician offices
as well as throughout operating theaters. The
technique for making APG begins with a modified
plasmapheresis procedure that yields a plateletrich
plasma (PRP) fraction either by a
centrifugation procedure or through the process
of ultrafiltration (the former being the most
utilized technique). Once the platelets are
harvested they are activated and degrannulate
releasing various intrinsic proteins primarily by
exocytosis from alpha granules. The PRP
fraction usually has a platelet count of 4 to 6
times that found in the unfractionated sample
with a normal concentration of fibrinogen. Hence,
APG can also be termed fibrin-platelet gel as a
result of combining coagulation with cellular
activation. Since white cells are retained as well
some have coined the term platelet-richleukocyte
plasma. The following review is not
intended to be neither comprehensive nor
inclusive and readers are directed elsewhere for
a more in-depth evaluation, but instead to
address several major clinical applications and
controversies surrounding the use of APG in
surgery.
Clinical Applications
One of the most attractive facets of APG is its
broad applicability for improving wound healing
across a diverse population of patients.
Estimates of its yearly potential use range into
the hundreds of thousands of patients in the
United States alone 2 . However, the majority of
cases reported thus far in the literature have
been focused on three main areas: dermatology,
orthopedics and maxofacillary surgery. Other
developing services that have reported on its use
include cardiac surgery and plastic surgery.
Autologous Platelet Gel Use at Geisinger
Health System
We began using the techniques of APG in 2002
with total figures for one of our hospitals shown in
Figure 1. From 2002 through December 2011 we
performed over 7,000 procedures where AGF
were applied. This represents various specialties
with the preponderance clustered in orthopedic
and cardiac and surgery. Within orthopedics we
began our experience with APG spine surgery
but have since shifted to the use of autologous
stem cells for spinal fusions. Presently the
majority of our orthopedic cases involve
regenerative injection therapy for rotator cuff and
shoulder surgeries (52.1% of non-cardiac cases
performed in 2008) followed by its use in anterior
cruciate ligament surgery (18.3% of non-cardiac
cases performed in 2008). APG is also applied
for non-union and tendon surgeries although to a
lesser degree (5.3% of non-cardiac cases
performed in 2008). 70% of these procedures
are performed in an outpatient basis with patients
60
2 Personal communications with Harvest Technologies,
Plymouth, MA, USA

eceiving this therapy for same-day surgery.
More recently we have expanded our application
of this technique in the area of wound
management for non-healing wounds.
We examined the effects of APG on infection rate
in cardiac surgical patients and reviewed
consecutive cardiac surgical patients. Of the
2,259 patients reviewed 382 had received APG
applied to all surgical incisions combined with a
mixture of 10% calcium chloride (5mL) and
bovine thrombin (5,000 units). The incidence of
superficial infection was significantly lower in the
APG group (n=0.3%) versus either a historical
group of 929 patients (1.5%) and a concurrent
group of patients (n=948) who did not receive
APG (1.8%), p

may yield a platelet concentrate of up to 10 times
the initial baseline level. During processing,
anticoagulated whole blood is automatically
separated into red blood cells and plasma. The
plasma along with the upper portion of the buffy
coat layer are decanted into separate collection
devices- a reservoir for platelet poor plasma
(PPP) and a syringe for platelet rich plasma
(PRP). Typically 3 to 10 mL of PRP provides a
sufficient volume of material for various
applications.
Conclusion
The use of APG has had a gradual and subdued
penetration as a clinical modality to enhance
wound healing. This tempered acceptance has
its foundation linked to the paucity of strong
evidence for its expansion, and although used in
centers throughout the world, is most often linked
to individual perceived notion of benefit. Its
growth, or decline, will most assuredly be linked
to the appearance of well-designed randomized
trials as they appear in the literature. Until then it
will remain a modality used passionately by those
convicted of its perceived benefit to enhance
healing.
Selected References
1. Stammers AH, Trowbridge C, Marko M,
Woods EL, Brindisi N, Pezzuto J, Klayman
M, Fleming S, Petzold J. Autologous
Platelet Gel: Fad or Savoir? Do We Really
Know? J Extra Corpor Technol. 2009;42:25-
30.
2. Rhee JS, Black M, Schubert U, Fischer S,
et al. The functional role of blood platelet
62
components in angiogenesis. Thromb
Haemost. 2004;92:394-402.
3. Everts PA, Knape JT, Weibrich G, et al.
Platelet-rich plasma and platelet gel: a
review. J Extra Corpor Technol.
2006;38:174-87.
4. Mehta S, Watson JT. Platelet rich
concentrate: basic science and current
clinical applications. J Orthop Trauma.
2008;22:432-8.
5. Singer AJ, Clark RA. Cutaneous wound
healing. N Engl J Med. 1999;341:738-46.
6. Charo IF, Ransohoff RM. The many roles of
chemokines and chemokine receptors in
inflammation. N Engl J Med. 2006;354:610-
2.
7. Soheil Y, Venters G, Vu S, et al. Role of
growth factors in scar contraction: an in vitro
analysis. Ann Plast Surg. 1995;34:495-501.
8. Feiz-Erfan I, Harrigan M, Sonntag VK,
Harrington TR. Effect of autologous platelet
gel on early and late graft fusion in anterior
cervical spine surgery. J Neurosurg Spine.
2007;7:496-502.
9. Tsai CH, Hsu HC, Chen YG, Lin MJ, Chen
HT. Using the growth factors-enriched
platelet glue in spinal fusion and its
efficiency. J Spinal Disord Tech
2009;22:246–250.
10. Zavadil DP, Satterlee CC, Costigan JN, Holt
DW, Shostrom VK. Autologous platelet gel
and platelet-poor plasma reduce pain with
total shoulder arthroplasty. J Extra Corpor
Tech. 2007;39:177-182.
11. Galasso O, Mariconda M, Romano G, et al.
Expandable intramedullaryu nailing and
platelet rich plasma to treat long bone non –
unions. J Orthopaed Traumatol.
2008;9:129-34.
12. Trowbridge CC, Stammers, AH, Woods E,
Yen B, Klayman M, Gilbert C. Use of
platelet gel and its effects on infection in
cardiac surgery. J ExtraCorp Tech.
2005;37:381–6.

13. Englert SJ, Estep TH, Ellis-Stoll CC.
Postoperative surgical chest and leg
incision sites using platelet gel: a
retrospective study. J ExtraCorp Tech.
2008;40:225-8.
14. Snyder EL, Calhoun BC. Topical platelet
growth factor therapy: of lotions and
potions. Transfusion. 2001;41:1186-9.
15. Mazzucco L, Balbo V, Cattana E,
Guaschino R, Borzini P. Not every PRP-gel
is born equal. Evaluation of growth factor
availability for tissues through four PRP-gel
preparations: Fibrinet, RegenPRP-Kit,
Plateltex and one manual procedure. Vox
Sang. 2009;97:110-8.
16. Giusti I, Rughetti A, D'Ascenzo S, Millimaggi
D, Pavan A, Dell'Orso L, Dolo V.
Identification of an optimal concentration of
platelet gel for promoting angiogenesis in
human endothelial cells. Transfusion.
2009;49:771-8.
17. Rademakers LM, Gründeman PF,
Bolderman RW, van der Veen FH, Maessen
JG. Stability of an autologous platelet clot in
the pericardial sac: An experimental and
clinical study. J Thorac Cardiovasc Surg.
2009;137:1190-4.
Affiliation:
Director of Perfusion Services
Geisinger Health System
100 North Academy Ave
M.C. 20-15
Danville, PA 17822-2015
(570) 214-2471 phone
(570) 271-7062 fax
ahstammers@geisinger.edu
63

Robert Pascotto, MD, FACS
Heart to Heart Mission: A Tribute to
Volunteers
This cardiac surgical program was initiated to
fulfill a void and need for cardiac surgery at Jose
Maria Cabral y Baez Hospital in Santiago,
Dominican Republic. This is a 520 bed public
hospital that cares for indigent patients and
serves a population greater than 4.0 million
people. There is no cardiac surgery in the area.
The hospital has a medical school and residency
program for postgraduate education affiliated
with it.
We did our first operative procedures September
2002. Since then we have operated on 262
patients with excellent results. The patients are
mostly young individuals with valvular heart
disease.
I started the Cardiac Surgical Program in Fort
Myers in 1975. Since then, our group has
expanded to 7 Cardiac Surgeons and operate at
3 centers, Southwest Regional Medical Center,
Naples Community Hospital and Lee Memorial
Health Park. These past 36 years have been
very fulfilling, however I felt that at this point in
my life helping to aid in the preservation of
human life in a country less fortunate than our
own was also an important calling. I have
recently retired and have dedicated my time to
further enhance the program.
Our team of usually 14 – 16 members is
comprised of nurses, technicians, and assistants,
as well as doctors, who are not only using their
personal vacation time to make these journeys,
but are also paying their own way to do so. While
there we have educated young doctors and
hospital staff in the care and treatment of the
cardiac surgical patient.
64
This program is strongly influenced by the
tradition of service that physicians and the
medical profession have. It provides a
mechanism to expand one’s horizons and gain
insight into the importance of a global vision and
understanding in today’s world. It also provides
another venue for continuing personal
enrichment and self-education necessary for a
well-rounded individual involved in the care of
cardiac surgical patients. This emotionally rich
and rewarding experience benefits not only the
patients and their families, but has dramatically
affected all team members personally.
I hope to continue this ongoing program with
donations from our hospitals, pharmaceutical
companies, manufacturers of medical products
and their distributors, as well as individuals.
Currently, the program is in need of assistance
from those people and organizations that are in a
position to help make this mission a continued
success.

If any individuals would like to discuss and learn
more or volunteer in this humanitarian endeavor,
i.e. cardiac surgeons, physician assistants, scrub
techs, OR or ICU nurses, anesthesiologists or
CRNA's, please contact me at (239) 851-0142 or
via email at rdpascotto@gmail.com .
Biography:
Dr. Robert D. Pascotto received his
undergraduate training at Manhattan College and
continued with his medical education at
Creighton University After completing his general
surgical residency at St. Vincent's Hospital and
Medical Center in New York City, he continued
with his Thoracic and Cardiovascular Surgery
residency at Methodist Hospital, Baylor College
of Medicine in Houston and Indiana University
Medical Center. While at Baylor, Dr. Pascotto
had the opportunity to train with one of the
pioneers of Cardiovascular Surgery, Dr. Michael
E. Debakey. Dr. Pascotto is board certified by the
American Board of Surgery and the American
Board of Thoracic Surgery. He is a Fellow of the
American College of Cardiology, American
College of Chest Physicians and American
College of Surgeons. He is active on many
hospital committees in a leadership position and
past president of the Medical Staff.
65