Access to technology, integrated systems and data reign supreme in the new era of perfusion.
By Marco Dolci, LivaNova
LivaNova’s Essenz Perfusion System [Image courtesy of LivaNova]
Perfusionists are essential players on a cardiac surgery team, ensuring patients receive critical clinical support to maintain vital functions during a procedure. In short, the breath and heartbeat of patients’ lives rest in the hands of perfusionists operating a perfusion system, while the surgical team intervenes on the heart.
Today’s perfusionists need connected and real-time data in addition to effective technical and hardware functionality. Their clinical roles are evolving in the operating room (OR) and a new era is emerging in which access to technology, integrated systems, data analytics and actionable information will drive quality, efficiency and continuously improved patient care across all phases of a procedure, including recovery.
As a provider of perfusion systems, including heart-lung machines (HLMs) and cardiopulmonary equipment, LivaNova is ushering in this new era in response to what the worldwide perfusionist community requires.
Giving voice to the global perfusionist community
When the time came to transform our existing cardiopulmonary platform, we asked an important question: “How do we advance perfusion performance in the OR?” To address this, we launched a comprehensive, user-centric design process. More than 300 customers worldwide weighed in and worked alongside us during every step of development.
Perfusionists participated in one-on-one interviews, focus groups and surveys, offering open and candid conversation with our product development team. This uncovered some of their critical needs to be addressed with a next-generation perfusion system, including:
- Unobstructed visibility of the OR and patient area
- Centralized monitor displaying patient vitals and procedure parameters with an intuitive user interface
- Customized settings that can be saved and serve as a baseline for future procedures
One piece of feedback collected during the discovery phase reigned supreme: Access to integrated and comprehensive data, especially intra-operatively, was a requirement.
Perfusionists ensure blood remains adequately oxygenated throughout the procedure to support organ function when the patient’s heart is placed in cardiac arrest. To do this, perfusionists use continuous monitoring of Oxygen Delivery index (DO2i) during cardiac perfusion, which perfusionists maintain above a set threshold to keep the patient in a specific aerobic zone.
This monitoring is possible through paper charting or electronic data monitoring. Paper charting can lead to transcription errors and issues with data interpretation. Perfusionists using electronic data monitoring systems instead want intuitive and centralized data visualization to facilitate more informed decision-making.
Designing for an improved user experience
Our main goal in designing our next-generation perfusion system was to build on existing features while adding advanced technology and intelligence to improve the user experience.
We asked perfusionists to get creative and build the new system using cardboard boxes, sticky notes and virtual reality. For example, perfusionists used a mock-up screen, indicating how and where key parameters should appear on the screen to improve data visualization.
As we finished the prototypes, perfusionists challenged the creations. From this process, we derived hundreds of ideas on how to improve the existing cardiopulmonary platform and worked jointly to test each one.
A holistic perfusion system
LivaNova’s Essenz Perfusion System patient monitor [Image courtesy of LivaNova]
The entire process resulted in the Essenz Perfusion System, which consists of a next-generation HLM and a new patient monitoring system that directly address the feedback and challenges raised during the discovery phase.
The HLM features an ergonomic design and advanced cable management, which minimizes distractions during the procedure. The pumps are mast-mounted to optimize the position of the disposables (i.e., oxygenator and perfusion tubing set), which minimizes priming volumes and reduces hemodilution. It also helps improve visibility of the surgical area and keeps the perfusion space clean and hygienic. Each pump is controlled individually for simple, straightforward operations. Plus, HLM sensor checks confirm readiness before the cardiopulmonary bypass procedure begins.
The new patient monitor features a high-resolution, graphical user interface that is intuitive, easy to use and designed around the perfusionist’s workflow for quick deployment. A Quality Indicators Dashboard allows perfusionists to implement an individualized patient care strategy during the case. Data is automatically and seamlessly transferred to the patient monitor, minimizing manual data entry and freeing up valuable time for the perfusionist. Official formulas help perfusionists implement goal-directed perfusion, a therapy effective in reducing the risk of acute kidney injury.
Integration within the OR environment and beyond
Data can dramatically enhance patient care outside of the OR. The patient monitor sends procedure data to external devices (e.g., electronic medical records, hospital information systems, middleware) during surgery. Perfusionists and anaesthetists can view the procedural parameters parallel to the surgery, thereby supporting the on-bypass perfusionist in intra-op decision-making. Plus, parameter data can be exported for input into statistical tool packages and patient data registries for research and publications.
All parties working toward the same shared goal
The digitization of hospitals is redefining the delivery of care. Hospitals no longer look at companies such as ours simply as suppliers, but as partners contributing to the delivery of care.
By advocating the perfusionists’ point of view, addressing requirements in the OR and ensuring seamless integration of systems and data, it resulted in a new platform designed for all parties (manufacturers, clinicians and hospitals) to attain their most important, shared goal — offering patients favorable outcomes during and after life-saving cardiac surgery procedures.
Marco Dolci is president of the Cardiopulmonary Business Unit for LivaNova. [Photo courtesy of LivaNova]
Marco Dolci is president of the Cardiopulmonary Business Unit for LivaNova. He joined the company in 2017. Dolci has more than 30 years of experience working in the healthcare and medical device industries.
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The opinions expressed in this blog post are the author’s only and do not necessarily reflect those of Medical Design & Outsourcing or its employees.