Quick Fox – San perfusionists invent new process for oxygenator change-out

Some creative thinking during a stretch of insomnia lead to an innovation whereby a life-critical procedure that generally took three minutes can now be done in around 10 seconds.

The San was the first stand-alone private facility in Australia to undertake cardiac surgery in 1979. Now, two members of its perfusion department have invented Quick FOX, an ultra-fast new process of changing-out failed oxygenators during cardiopulmonary bypass procedures.

During cardiac bypass surgery, a rare but critical emergency situation can arise if the heart-lung machine’s oxygenator fails during the procedure. Up until now, the change-out process of removing the failed oxygenator and replacing it with a new one could take up to three minutes. This resulted in unplanned halts to surgery, high risks for the patient and stress for the surgical team. With every passing second the risk of neurological injury and death increase.

“A failed oxygenator during surgery is a very rare event, but it does happen and we have to be prepared for it,” said Sally McLeod, co-inventor of Quick FOX and Head Perfusion Technician at Sydney Adventist Hospital (the San). “Some perfusionists never have to deal with this in their whole career, while others have had it happen to them a couple of times. When it happens, decisions have to be made instantly and the oxygenator change-out done as quickly as possible.”

What sparked the invention of Quick FOX was that one of the products used in circuitry of the bypass machine was being discontinued, and the perfusion team were looking for solutions.

“We currently use LivaNova oxygenators for all our heart surgery, but we had a Getinge arterial filter in the pack which Getinge is discontinuing, so we needed another filter,” said Sally. “While looking into this, we decided to go with a fully-integrated oxygenator which has the arterial filter incorporated in it.” 

“This meant that for any emergency changing of the oxygenators while on bypass we needed to modify the ‘change-out’ kit and the arterial line, because the transducer would come off the arterial line in a different spot. Each hospital has its own unique drawings of the lines – the circuit – that connects the patient to the oxygenator and the reservoir. You want the lines as short as possible and the most direct way you can do it.”

Sally woke at 2am one morning and, unable to sleep, started designing new line drawings for how a new setup could work. “I dreamt up a new line I thought would probably make the change-out of a failed oxygenator quicker, easier and safer. After modifying the line drawings and making the new line, we needed to test it.”

Sally worked with perfusion colleague, Dr David D’Silva, to perfect the new process, bouncing ideas off each other, trying various options over a number of hours. 

“We went through a process of troubleshooting and trial and error,” said Dr D’Silva, medical perfusionist at the San, and President of the Australasian Society of Medical Perfusion. “The ultimate aim when doing an oxygenator change-out is to limit how much disruption you have to the life support given to the patient.”

“With the old way, it was a really big deal if the oxygenator failed. The surgeon had to decide whether to cool the patient down or rush off bypass; it was a whole-of-theatre crisis. Whereas with the Quick FOX process, it’s easily manageable with one or two people and takes only seconds. It has taken a rare but high-risk event and removed almost all of the risk. It has essentially eliminated any of the harm that could be associated with failure of that component of the heart lung machine,” noted Dr D’Silva.

When cardiac surgeons and perfusion colleagues heard about Quick FOX, they were astounded. “They think it’s wonderful and they’re amazed it’s taken someone this long to come up with this solution,” said Sally. “It gives them confidence that if an oxygenator failure were to happen in their theatre, the change-out will take only seconds and not be the huge deal that it used to be.”   

For Dr D’Silva, the ready acceptance of this new process and the ease to which perfusionists could master it was a pleasant surprise. “People can be very resistant to change with these sorts of things, but when we showed other people, everyone was very accepting of it. And literally after 15 minutes of teaching, people could do the Quick FOX process in under 30 seconds on their very first attempt.”

Word has spread, and already a few hospitals in Sydney and elsewhere in Australia have adopted the Quick FOX change-out method.

“I took the Quick Fox video over to Italy a few weeks ago where I attended the launch of a new heart-lung machine, and showed it to perfusion colleagues there, and they were pretty amazed as well,” said Sally.

Dr D’Silva noted that one of the benefits of the Quick FOX method is it can be adopted anywhere in the world. “Some components will be slightly different in other countries, but there are many things that are standard around the world, so yes this can be replicated in other countries.”

And that makes the Quick FOX inventors happy. “I’ve had to change-out a failed oxygenator in an emergency situation a couple of times in my 20 years of being a perfusionist, and the stress and knowing what it could mean for the patient is extremely hard,” said Sally. “The more people this new method can help the better. It takes considerable pressure off us as perfusionists. And if you can get it done safely and quickly, and know the patient safe, that’s a fantastic outcome.”

Sally and Dr D’Silva have co-written a paper about Quick FOX which has been accepted into a journal. They’ve also made a YouTube video of Quick FOX in action 

We called it Quick FOX, as it stands for:

  Quick connectors

  Fast                                                           

  Oxygenator

eXchange

“Quick FOX speaks to the rapidity of the oxygenator change-out process and also pays respect to the San hospital on Fox Valley Road (Wahroonga), the hospital where we both proudly work,” said Sally.

 

About Sydney Adventist Hospital:

Sydney Adventist Hospital, fondly known as ‘the San’, is operated by Adventist HealthCare Limited. The hospital was the first private hospital in Australia (1979) to offer a comprehensive cardiac program that included diagnostic, medical, surgical and rehabilitation services. The hospital has been a leading healthcare provider for 120 years (since opening in 1903) and has grown to become NSW’s largest not-for-profit private hospital with more than 700 beds.