4.+Resources

1. Receive Medtronic Outlook email 2. Access and use the Medtronic VPN 3. Connect to the Medtronic Wi-Fi || || 1. iRead PDF 2. iBooks 3. GoodReader || || Medtronic brochure for the BioConsole 560. This also includes product information with features and benefits of the BioPump BPX-80. || || Outlines the rationale and essential benefits for a hospital embracing the RBCi. || ||
 * **DESCRIPTION** || **LINK TO FILE** ||
 * Agenda: Overview of the 5-day Workshop Agenda || [[file:WORKSHOP AGENDA.pdf]] ||
 * Training Module: A scripted Self-Learning Module on how to connect the iPad to a Wi-Fi Network. || [[file:Connecting to a Wi-Fi Network.pdf]] ||
 * Training Module: A scripted Self-Learning Module on how to configure the iPad to
 * Training Module: A scripted Self-Learning Module on how to create an iTunes account. || [[file:How to create an iTunes account.pdf]] ||
 * Training Module: A scripted Self-Learning Module on how to use different features in the iPad. || [[file:Exploring the iPad.pdf]] ||
 * Training Module: A scripted Self-Learning Module on how to open a PowerPoint file in the iPad, convert it to Keynote, and then email the file. || [[file:Converting PowerPoint to Keynote.pdf]] ||
 * Training Module: A scripted Self-Learning Module on how to open a text document and then email the document using either;
 * Training Module: A scripted Self-Learning Module on how to upload and access documents using Dropbox. || [[file:Using Dropbox.pdf]] ||
 * Training Module: A scripted Self-Learning Module on how to access product information and technical references using the Medtronic website for Perfusion. || [[file:Using Safari for MDT Website.pdf]] ||
 * Training Module: A scripted Self-Learning Module on how to access the SharePoint Site Perfusion Technology Learning Resources. || [[file:Using iPad for MDT SharePoint.pdf]] ||
 * Case Study: This is the background information on the hospital Mercy Medical Center and will be used as the Case Study for this workshop. || [[file:Mercy Memorial DOSSIER.doc]] ||
 * Brochure: The Medtronic RBC Initiative is an evidence-based educational program that is used with targeted customers to help them devise strategies and tactics for improving patient outcomes, reducing the lenght of ICU and hospital stays, and minimizing complications related to blood use. || [[file:RBC Initiative Brochure.pdf]] ||
 * Brochure: This is a summary with key messages taken from a recent paper published by Marco Ranucci, MD, on the importance of a multiple technique and product approach to cardiopulmonary bypass. The study demonstrated reduced morbidity and shorter hospital care times.  || [[file:Summary_Ranucci Study.pdf]] ||
 * Compendium: The Ranucci paper is full of valuable and usable data that suggests reducingpost operative complications in CPB may be linked to using minimally invasive CPB strategies and systems. This compendium will help you explain to surgeons, perfusionists, hospital administrators and patients the relevance of how a MICPB strategy can reduce health care costs by preventing complications. || [[file:Benefits_Ranucci Study.pdf]] ||
 * Brochure: This is a summary of a cardiac surgery procedure conducted on a Jehovah Witness patient at St. Joseph Hospital in St. Paul, Minnesota and the benefits that resulted using the Medtronic Resting Heart System. || [[file:RHS_JW Case Report.pdf]] ||
 * Brochure: This Medtronic brochure explains how the Resting Heart System complements other technologies that help clinicians rethink new ways for conducting heart bypass surgery. || [[file:Resting Heart System.pdf]] ||
 * Brochure:
 * Brochure: Medtronic brochure for the autoLog || [[file:autoLog Brochure[1].pdf]] ||
 * Brochure: Medtronic brochure on Autotransfusion || [[file:AUTOTRANSFUSION BROCHURE[1].pdf]] ||
 * Brochure: Medtronic brochure on the HMS Plus Heparin Management System || [[file:HMS Plus Brochure.pdf]] ||
 * Compendium: Medtronic compendium on Carmeda Bioactive Surface; clinical and scientific information. || [[file:Carmeda Compendium.pdf]] ||
 * Compendium
 * Journal Article:Ranucci, M., & Isgro, G. (2007). Minimally invasive cardiopulmonaty bypass: Does it really change the outcome? Critical Care, **11**:R45

Many innovative cardiopulmonary bypass (CPB) systems have been recently proposed by the industry. With few differences, they all share a philosophy based on priming volume reduction, closed circuit with separation of the surgical field suction, centrifugal pump and biocompatible circuit and oxygenator. These minimally invasive CPB (MICPB) systems are intended to limit the deleterious effects of a conventional CPB. However, no evidence exists with respect to their effectiveness in improving the postoperative outcome in a large population of patients. This study is aimed to verify the clinical impact of a MICPB in a large population of patients undergone coronary artery revascularization. || || Background. Hemodilutional anemia during cardiopulmonary bypass can lead to inadequate oxygen delivery and, cxonsequently to ischemic organ injury. In adult bypass, the nadir hematocrit can vary widely with body size and prebypass hematocrit variations, yet its effects on perioperative organ dysfunction and patient outcomes remain largely unknown. Methods. To elucidate the effects, we retrospectively analyzed operative results and resource utilization data from 5000 consecutive cardiac operations with cardiopulmonary bypass performed on adults (1994 to 2000). Rolling decile groups (500 patients each; 75% overlapping) of increasing lowest hematocrit values were used to characterize hemodilution-outcome relationships. Intermediate-term (0 to 6 years) survival was assessed for coronary artery bypass patients (n=3800) via Kaplan-Meier analysis in quintile subgroups based on lowest hematocrit. Multivariate logistic regression (operative mortality and morbidity) and Cox proportional hazard model (0- to 6-year mortality) analyses were used to determione independent predictors of poor outcomes. Results. Stroke, myocardial infarction, low cardiac output, cardiac arrest, renal failure, prolonged vedntilation, pulmonary edema, reoperation due to bleeding, sepsis, and multiorgan failure were all significantly and systematically increased as the lowest hematocrit value decreased below 22%. Consequently, intensive care requirements, hospital stays, operative costs, and operative deathjs wewre alos significantly greater as a function of hemodilution severity. Conclusions. Increased hemodilution severity during cardiopulmonary bypass was associated with worse perioperative vital organ dysfunction/morbidity and increased resource use, as well as greater short- and intermediate-term mortality. || || Background. Cardiac surgery patients' hematocrits frequently fall to low leves during cardiopulmonary bypass. Methods. We investigated the association between nadir hematocrit and in-hospityal mortality and other adverse outcomes in a consecutive series of 6,980 patients undergoing isolated coronary artery bypass graft surgery. The lowest hematocrit during cardiopulmonary bypass was recorded for each patient. patients were divided into categories based on their lowest hematocrit. Women had a lower hematocrit during bypass than men but both sexes are represented in each category. Results. After adjustment for preoperative differences in patient and disease characteristics, the lowest hematocrit during cardiopulmonary bypass was significantly associated with increased risk of in-hospital mortality, intra- or postoperative placement of an intraaortic balloon pump and return to cardiopulmonary bypass after attempted separation. Smaller patients and those with a lower preoperative hematocrit are at higher risk of having a low hematocrity during cardiopulmonary bypass. Conclusions. Female patients and patients with smaller body surface area may be more hemodiluted than larger patients. Minimizing intraoperative anemia may result in improved outcomes for this subgroup of patients. || || ABSTRACT: Blood transfusion has been widely studied and the risk/benefit ratio remains unclear. Focus historically has been upon viral transmission, particularly hepatitis and HIV. Today, with advanced screening for these viruses, the risk of such transmission has become vanishingly small. Immunosuppression, with consequent postoperative bacterial infection and ABO incompatibility are now risks that physicians should consider as associated with allogeneic blood transfusion. Other inflammatory events, such as transfusion associated lung injury, also occur. The benefits of transfusion have never been well studied and there is scant literature on that area. Therefore, in an evidence-based medical practice the physician should regard transfusion with a skewed risk/benefit ratio in the post-AIDS era. || ||
 * Journal Article: Boucher, B. A., Hannon, T. J. (2007). Blood management: A primer for clinicians. //Pharmacotherapy 27//(10), 1394-1411. ABSTRACT: Blood transfusions are common in hospital settings. Despite the large commitment of resources to the delivery of blood components, many clinicians have only a vague understanding of the complexities associated with blood management and transfusion therapy. The purpose of this primer is to broaden the awareness of health care practitioners in terms of the risks versus the benefits of blood transfusions, their economics, and alternative treatments. By developing and implementing comprehensive blood management programs, hospitals can promote safe and clinically effective blood utilization practices. The cornerstones of blood management programs are the implementation of evidence-based transfusion guidelines to reduce the variability in transfusion practice, and the employment of multidisciplinary teams to study, implement, and monitor local blood management strategies. Pharmacists can play a key role in blood management programs by provising technical expertise as well as oversight and monitoreing of pharmaceutical agents used to reduce the need for allogeneic blood. || [[file:Blood Management_Primer for Clinicians.pdf]] ||
 * Journal Article: Habib, R. H., Zacharias, A., Schwann, T. A., et al. (2003, June). Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: Should current practice be changed? //The Journal of Thoracic and Cardiovascular Surgery 125//(6), 1438-50.
 * Journal Article: DeFoe, G. R., Surgenor, S. D., Forest, R. J., et al. (2001, March). Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. //The Annals of Thoracic Surgery 71//(3), 769-776.
 * Journal Article: Spiess, B. D. (2001). Blood transfusions: The silent epidemic. //The Annals of Thoracic Surgery 72//, S1832-1837.
 * Journal Article Rawn, J. D. (2007). Blood transfusion in cardiac surgery: A silent epidemic revisited. //Circulation// 116, 2523-2524.

This is a summary of the Transfusion Requirements in Critical Care trail and addresses the decision making processes for a transfusion policy. || || This retrospective study, using the Medicare Provider Analysis and Review file, identified 114,233 Medicare beneficiaries who survived CABG without concomitant valve repair during a hospitalization for fiscal year 2005. The frequencies of seven complications were determined: hemorrhage or postoperative shock, reoperation, postoperative adult respiratory distress syndrome, new-onset hemodialysis, postoperative stroke, postoperative infection and septicemia. The observed and adjusted incremental hospital resources consumed (cost and length-of-stay) in treating beneficiaries experiencing each of the selected complications were estimated. Results. The mean cost of a hospitalization associated with a CABG procedure among Medicare beneficiaries was $32,201 $23,059, and the mean length of stay was 9.9 7.8 days. After adjusting for patient demographics and comorbid conditions, the 13.64% of Medicare beneficiaries experiencing any of the study complications consumed significantly more hospital resources (incremental cost, $15,468) and had a longer length of stay (incremental stay, 5.3 days). || || 199 patients were randomized to undergo coronary artery bypass grafting with a standard cardiopulmonary bypass circuit (Medtronic, Inc., Minneapolis, Minn) or a minimized bypass circuit, the Medtronic Resting Heart Circuit. Laboratory perimeters (hemoglobin and platelet count), were measured at baseline, after initiation of cardiopulmonary bypass, and on intensive care unit admission. Lowest values recorded were noted. Blood administration was controlled by study-specific protocol orders, (transfusion for hemoglobin <8mg%). Patient demographic data were retrieved from the Society of Thoracic Surgeons database. Blood product administration was recorded during hospital admission, and chest tube drainage as total output collected from operating room to discontinuation. Results: Hematocrit, equivalent at baseline, was higher in minimized circuit cohort at lowest point during cariopulmonary bypass (31.5% 3.9% vs. 25.5% 3.7%), after protamine (31.6% 3.9% vs 29.2% 3.7%), and on intensive care unit arrival (35.2% 4.1% vs 31.8% 3.5%, P<.001). Similarly, platelet count was higher in minimized circuit group on intensive care unit arrival, as was lowest platelet count recorded (170 3 103 48 cells/mm3 vs 107 3 103 28 cells/mm3, P<.0001). Time to extubation was shorter in minimized circuit group (848737 minutes vs. 526282 minutes, (P<.01), and total chest tube drainage was lower (1124647 mL vs. 506 214 mL, P<.01). Fewer red blood cells (148 vs 19 units) were given in minimized circuit group (P<.0001).  Conclusions: A minimized cardiopulmonary bypass circuit provides less hemodilution, platelet consumption, chest tube output and lower post-operative blood loss than standard cardiopulmonary bypass. Red blood cell usage was also less. All differences are advantageous.  ||  || Koch, C. G., Li, L., Sessler, D. I., Hoeltge, G. A., et al. (2008, March 20). Duration of red-cell storage and complications after cardiac surgery. //﻿New England Journal of Medicine 358//(12), 1229-1239.
 * Journal Article: Brown, P. P., Kugelmass, A. D., Cohen, D. J., Reynolds, M. R., et al. (2008). The frequency and cost of complications associated with coronary artery bypass grafting surgery: Results from the United Staes Medicare Program. //Annals of Thoracic Surgery// 85, 1980 - 1987.
 * Journal Article: Sakwa, M. P., Emery, R. W., Shannon, F. L., Altschuler, J. M., et al. (2009, February). Coronary artery bypass grafting with a minimized cardiopulmonary bypass circuit. A prospective randomized trial. //The Journal of Thoracic and Cardiovascular Surgery 137//(2), 481-485.
 * Journal Article: Koch, C. G., Li, L., Duncan, A. I., Mihaljevic, T., et al. (2006). Morbidity and mortality associated with red blood cell and blood component transfusion in isolated coronary artery bypass grafting. Critical Care Medicine 34(6), 1608-1616. The study objective was to quantify incremental risk associated with transfusion of packed red blood cells and other blood components on morbidity after coronary artery bypass grafting   Among the 11,963 patients who underwent isolated coronary artery bypass grafting, 5,814 (48.6%) were transfused. Risk-adjusted probability of developing in-hospital mortality and morbidity as a function of red blood cell and blood-component transfusion was modeled using logistic regression. Transfusion of red blood cells was associated with a risk-adjusted increased risk for every postoperative morbid event. Conclusions: Perioperative red blood cell transfusion is the single factor most reliably associated with increased risk of postoperative morbid events after isolated coronary artery bypass grafting. Each unit of red cells transfused is associated with incrementally increased risk for adverse outcome.  || [[file:Koch_MM with RBC Transfusion.pdf]] ||
 * Journal Article:

Stored red cells undergo progressive structural and functional changes over time. We tested the hypothesis that serious complications and mortality after cardiac surgery are increased when transfused red cells are stored for more than 2 weeks. In patients undergoing cardiac surgery, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival. || ||