Perfusionist’s Role in Fast Track and Early Recovery Protocols

Abstract

Fast-track Minimally Invasive Cardiac surgery (MICS) is a multimodal approach to patient care using a combination of several evidence-based peri-operative interventions to expedite recovery after surgery. Perfusionists play a crucial role in optimizing patient recovery by managing cardiopulmonary bypass (CPB), regulating vital functions, and collaborating with the surgical team during Minimally Invasive Cardiac surgery. It entails a great partnership between a surgeon, anesthesiologist and perfusionists and other specialists to form a multi-disciplinary team, which may then engage in patient care.

Many of the historical challenges have been now overcome by the availability of new generation circuits, drugs, advancements in online monitoring and equipments. A successful fast track sequence include not only guaranteeing the adequate anaesthesia and analgesia levels but an overall intraoperative management limiting the occurrence of early post-operative complications, including an appropriate monitoring of neurologic and haemodynamic functions, as well as a careful management of haemostatic system.

Additionally, a close co-operation with the perfusionists and surgeons could greatly contribute for a successful fast track program. The practice of fast-track surgery has yielded excellent results and there has been a significant reduction in hospital stay without a rise in complications or re-admissions.

The effective implementation begins with the formulation of a protocol, carrying out each intervention and gathering outcome data. The care of a patient is divided into three phases: Before, during, and after surgery. Other than surgical technique and anesthetic drugs, perfusion techniques form the cornerstone in the ability to carry out a fast-track minimally invasive cardiac surgery safely and effectively.

It is also the role of the Perfusionist to keep abreast with the latest development in perfusion advancements and fast-track methodology and make appropriate changes to the policy, so to make this Fast track Minimally Invasive Cardiac Surgery a successful program.

Keywords: Fast Track, MICS, Protocol, Perfusionists, Cardiopulmonary Bypass, Minimally Invasive Cardiac Surgery, Multimodal Care, Patient Recovery