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St. Joseph Hospital Health System
Cardiac Surgery Program
St. Joseph Hospital Health System Perfusion Staff, (l–r): Bob Culver, CCP; Carl Foriero, CCP; Tony Guardino, CCP; Jeff Wilson, CCP; Rich Rowlinson, CCP.
- 1050 adult cases: 900 on–pump, 150 on standby, 5% OPCAB
- Five perfusionists
- Five surgeons
- All procedures except transplants
The perfusion staff achieves lower prime volume by using low prime oxygenators, remote mounted pumps with rotated raceways, RAP and VAVD.
Related Terumo Products
Terumo® Advanced Perfusion System 1
CAPIOX® RX Oxygenators
CAPIOX® AF125 Arterial Filters
High Flow, Low Prime Oxygenator Contributes to Blood Management Program
Product choice combined with protocol reduces hemodilution
When the perfusion team at St. Joseph Hospital Health Center converted to Terumo’s CAPIOX® RX Oxygenator platform two years ago, they ordered two membrane sizes –– 1.5 and 2.5 square meters –– to span the size range of their adult patient population. Given the oxygenators’ low prime profiles, the team members expected to see the subsequent reduction in prime volume they achieved with either circuit:
| Prime volume: Former circuit |
Prime volume: Circuit with CAPIOX® RX Oxygenator1 |
| 1800 mL | 850 mL (1.5 m2) |
| 1125 mL (2.5 m2) |
However, they were a bit surprised to find that they could potentially use the smaller membrane on as many as 75% of their patients.
“The CAPIOX RX15 (1.5 square meter) oxygenator is indicated for up to 5.0 liters of flow which has proven sufficient for a far greater percentage of our population than we expected,” says Jeff Wilson, CCP, Chief of Perfusion. “I would have anticipated that we would have been able to use if for as much as 60% of our patients.”
Like many institutions, St. Joseph Hospital Health System is encouraging its surgical teams to adopt best blood management practices in an effort to reduce homologous blood transfusions. Accordingly, the perfusion team studied blood usage as part of the oxygenator evaluation. Its initial 84–patient comparison between the CAPIOX RX oxygenator and the oxygenator it had been using demonstrated a significant enough difference in blood usage to merit the conversion.
| Total units of blood used | % of patients transfused | Average units⁄patient | % patients transfused during CPB | |
| Former circuit | 117 | 73.8 | 2.78 | 23.8 |
| Circuit with CAPIOX® RX Oxygenator2 (either size) |
73 | 57.1 | 1.73 | 16.6 |
In addition to reducing circuit size, the perfusion team employs other strategies to reduce hemodilution:
- Use of retrograde autologous priming (RAP)
- Remote mounting of arterial pump
- Vacuum–assisted venous drainage (VAVD) allows reduction of venous line from 1/2” to 3/8”
- Working with surgeon to minimize size of A/V loop
1 With CAPIOX® AF125 Arterial Filter
2 With CAPIOX® AF125 Arterial Filter