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Perfusionist or Extracorporeal Therapy Specialist

Perfusionist or Extracorporeal Therapy Specialist. The future of our profession. Cases are there!. Cases will be there!. So WT*?. STS Participating Sites 2004-13. Cardiac Open Heart Surgery

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Perfusionist or Extracorporeal Therapy Specialist

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  1. Perfusionistor Extracorporeal Therapy Specialist The future of our profession

  2. Cases are there!

  3. Cases will be there!

  4. So WT*?

  5. STS Participating Sites 2004-13

  6. Cardiac Open Heart Surgery • The NHDS (NCHS) estimates that in 2010, in the United States, 219,000 patients underwent coronary artery bypass procedures (defined by procedure codes). CABG volumes have declined nationally since 1998. • + 700,000

  7. In 2010, an estimated 492,000 patients underwent PCI (previously referred to as percutaneous transluminal coronary angioplasty, or PTCA) procedures in the United States (NHDS, NHLBI tabulation).

  8. Looking ForwardThomas C. Ricketts III, MD, PhD MPHV99 No 5 Bulletin American College of Surgeons • “Coronary bypass graft operations decreased by 46% from approximately 395,100 procedures in 2001 to 213,700 procedures in 2011” • Goes on to add that this will have profound impact on the workforce.

  9. Even more questions • Composite Outcomes in Coronary Bypass Surgery Versus Percutaneous Intervention Fred H. Edwards, MD, David M. Shahian, MD, Maria V. Grau-Sepulveda, MD, MPH, Frederick L. Grover, MD, John E. Mayer, MD, Sean M. O’Brien, PhD,ElizabethDeLong, PhD, Eric D. Peterson, MD, MPH, Charles McKay, MD, Richard E. Shaw, PhD, Kirk N. Garratt, MD, George D.Dangas, MD, John Messenger, MD, Lloyd W. Klein, MD, Jeffrey J. Popma, MD, and William S. Weintraub, MD In conclusion, in the largest study comparing CABG and PCI outcomes, 4 years after revascularization there is a PCI advantage for stroke and a CABG advantage for MI. A composite of stroke, MI, and death demonstrates a 19% advantage for CABG compared with PCI. This informa- tion is largely consistent with previous findings and should be shared in a “heart team” approach, with full engagement of patients, surgeons, and cardiologists focused on a collegial search for optimal treatment.

  10. How are surgeons adapting? • You heard the previous speaker, Dr. Lumsden describe the concept of the Cardio-Vascular Specialist. • Most Cardiac Docs I know do everything. • CABG • Valves – adapting to accommodate TAVR • Thoracic • AAA • Stents • Fem – Pops • Carotids • TAVR • Access for Anterior Approach • Even amputations • What do we have?

  11. 1979 • Completed training • Training included • 1st Assisting • Open Vein Harvest • Insertion of radial art lines • Floating Swans

  12. Additions • ~1981 ATS • Heard of new independent business ops • Never heard of anyone but a perfusionist doing • ~1985 VAD • Flew all over and I was in really high demand • ECMO • Again, never heard of anyone but perfusion doing • *** PSI • 1988 was the first time I used CVVH in the ICU • Now today, this is almost exclusive a nursing function

  13. Cases involving perfusion only • CPB procedures • ECMO/VADS • Resp. Therapy and Nurses and PBMT • Isolated Limb • Clinical Perfusion Specialist specially trained for this • ATS • Autotransfusionists/Nurses • Other Autologous Blood Therapies • Even Sales Reps

  14. What is the market? • CPB Procedures – On the decline, OpCAB • VAD/ECMO • Isolated Limb • ATS • PG/BMA • IHD* • CVVH/UF • TPE • Angio-Vac • Therapeutic Hypothermia • Other New Developing Technologies

  15. ABCP Data 69.72 - 62.28 – 48.37

  16. Additional Stress • Off Pump CABG (next slide) • TAVR • ENDO AAA

  17. In 1973, Benetti, Calafiore, and Subramian successfully completed anastamoses on a beating heart • J. Cremer and S. Fraund, Beating Heart Bypass Surgery and Minimally Invasive Conduit Harvesting, Steinkopff, 2004.

  18. What I have Noticed • Major change in attitudes towards work • ATS – ECMO as examples • Work ethic and relationships • Licensure has been of no value whatsoever • Training centers have not adapted • The future of our profession is at risk • MD/PA/NP/CRNA

  19. My Suggestion • Develop the Extracorporeal Therapy Specialist • Training programs need to provide more exposure • Not just pump cases • ATS • Autologous Blood Therapies • CHF Therapies • CRRT/CVVH • TPE • Isolated Limb • ECMO/VAD • Angio-Vac • New developing therapies • We have to have more than just on pump cabg and ecmo to maintain our certifications.

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