News - StatesmanJournal.com
Doctors take recycling to heart
Device recycles patient's blood during surgery
BY TIMOTHY ALEX AKIMOFF
Statesman Journal
March 9, 2007
Out of the box it looks like a small plastic bag one might fill with water on a camping trip.
But for eight minutes during open-heart surgery, the deceptively simple-looking Hemobag is an instrument as vital as the surgeon's own hands.
After it is filled with blood so red it looks like a candied apple, the Hemobag is hung at the top of the heart lung machine.
Small tubes running to a hemo concentrator -- which acts like a kidney -- take the whole blood, run it through the filter where it loses liquids such as IV fluids, before returning it to the Hemobag in a concentrated form.
It is now perfect for the patient who is about to have their chest stitched back together and sent to the Intensive Care Unit to recover.
Best of all, it's the patient's own blood.
"I'm not really excited about getting blood from an unknown source," said Ken Hector, of Silverton, who recently underwent quadruple bypass surgery at Salem Hospital.
Hector, like 499 other people who have had heart surgery in Salem since the cardiac team started using Hemobag 2 1/2-years-ago, didn't realize what the unobtrusive little bag was doing for him.
But then heart surgery patients often have a lot on their mind before surgery.
"Technology is so fantastic," Hector said. "It is so great to be able to do that. Tainted blood has always been a problem, but I think they've overcome most of that. This takes any additional risks away."
The benefits of Hemobag are most easily seen by surgeons and nurses in the "golden hour," that crucial period of time just after surgery.
"I used to have to sit with the patient for 45 minutes or an hour after surgery until they stabilized," said Dr. William Shely a cardiothoracic surgeon at Salem Hospital. "This reduces the need for transfusion and blood exposure risks. It makes the patient more stable, easier to take care of."
While several studies have attempted to prove Hemobag's ability to improve coagulation and blood conservation during the golden hour just after surgery, other long-term benefits are harder to see.
"It's been hard to prove whether it's decreased the length of time a patient spends in the hospital after surgery," Shely said.
Before the cardiac surgery team at Salem Hospital began using Hemobag, the best way to capture human blood during surgery was a device called a cell saver, or cell washer.
The blood was collected and washed of many of the parts that can most aid in recovery.
Things like platelets, essential blood proteins and clotting factors, entire elements of whole blood were washed away.
"The Hemobag does in less than 10 minutes what it would take the kidneys hours to do," said Scott Beckmann, a perfusionist with the cardiovascular surgery department.
In a crowded open-heart surgery, someone calls Beckmann and another perfusionist blood shepherds.
And that is what they are, managing the patient's blood throughout the hours-long surgery.
The perfusionists stand behind the heart lung machine monitoring screens with constantly changing numbers.
During the 8-minute Hemobag procedure they move like martial artists, deftly moving between tubes of crimson blood, massaging the Hemobag to achieve a well-mixed concentrated blood to give back to the patient.
An average of one liter of concentrated blood is usually given back to a patient, according to Beckmann.
Three times that amount are usually given when it comes to using other blood.
The cardiac surgery team at Salem Hospital is the only one using Hemobag in the Northwest.
And the sheer number of surgeries performed using Hemobag make the team a nationally recognized leader in using the technology, according to a spokesman for Global Blood Resources LLC, the company that manufactures Hemobag.
Despite the new technology and it's effect on heart-surgery patients, there is still a tremendous need for blood donations.
Aside from significantly improving recovery times for heart-surgery patients, Hemobag may have an even bigger impact on an entire community.
"Our position on blood is basically non-negotiable," said Bradley Dean, a minister and member of the hospital liaison committee for Jehovah's Witnesses. "The Bible says no eating of blood."
And taking blood products is analogous to eating blood, Dean said.
Jehovah's Witnesses also do not take their own blood if it has been out of the body for a long time.
The principle comes from the Bible, where it is stated that shed blood should only be poured on the ground.
Surgical procedures for Jehovah's Witnesses can involve a complicated process whereby they must travel to medical centers that perform surgeries without using bloodbank blood or pre-donated blood.
The Hemobag offers a solution that may appeal to Jehovah's Witnesses, though Dean said it is an intensely personal decision for the individual.
"Basically the Bible does not comment on the machines," Dean said. "We have a theological description of blood that governs the use of any machine or technology."
Dean said many conversations have taken place between the liaison committee for Jehovah's Witnesses and physicians at Salem Hospital about Hemobag.
"But I'm not aware of any Jehovah's Witnesses who have had a surgery utilizing the Hemobag yet," Dean said.
For 500 people who have had their chests opened up, their breathing and heart functions run by a machine at Salem Hospital, physicians say Hemobag has given them a better chance at recovery simply because they get their own blood.
"When you're not using blood from another source it allows the body more time to repair itself," Beckmann said. "When you give your own blood back there is no inflammatory response, and that benefits a person for a lifetime."
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