Sainte-Justine Hospital is the biggest mother-child center in Canada and one of the 4 most important pediatric centers in America with it’s 5 000 employees and 500 doctors, dentists and pharmacists. It is affiliated with the University of Montreal and trains more than 4 000 students per year, including those of the perfusion program for the 3 months rotation in pediatrics.
As a general hospital devoted to mother-child care, one operating room is dedicated exclusively to pediatric cardiac surgery with an additional room for hybrid procedures, where the cardiac interventions take place usually. Around 120 open heart surgeries, 10 ECMOs, 25 pacemakers, 2 Berlin hearts and 2 heart transplants are done annually. The complex cardiac surgeries mainly include arterial switch, tetralogy of Fallot or atrio-ventricular canal corrections, anomalous pulmonary venous drainage reorientation, 3-steps Norwood procedures and many more. Three perfusionists are hired full time in order to cover for the on call duties, administrative tasks (orders, follow up with sales rep, management of ECMO specialists, etc.) and train perfusion students or other healthcare providers about perfusion technologies (Berlin Heart, cardiopulmonary bypass, ECMO). Two perfusionists are on call to cover shifts, with some help from the Montreal Heart Institute.
In terms of equipment, System I with a Stockert SIII back up is used with centrifugal pump, INVOS, Hemochron Junior, Sorin 3T heather cooler and CDI 500 for all cases. Different tube sizes from ¼ x ¼ to ½ x 3/8 made by Livanova, different hemofilters (BC-20 and Capiox) and arterial filters (Pediatric Affinity, D733 and D734) as well as diverse oxygenators (Capiox RX-05, Capiox RX-15, EOS) are used depending on the patient size. Cardioplegia by gravity is used for smaller patients in a 3:1 cristalloid:blood ratio while the bigger will receive it with a roller pump in a 1:1 ratio with one of the surgeons, while the other is giving only Del Nido at the 4:1 cristalloid:blood ratio for all the patients. Modified ultrafiltration is used for all the cardiopulmonary bypass cases up to 20 minutes while the cardiologist does the echography.
For ECMO, the Sorin system with the centrigual pump, Lilliput ECMO or Quadrox-i, CDI-100 and Biocal heather-cooler is used. A team of ECMO specialists (respiratory therapists or nurses) is trained to monitor the patient at the bedside 24/7 and calls a perfusionist whenever an intervention is needed.
Many organizations exist to help sick kids in the hospital, but 2 are devoted to cardiac surgery. The first one, Kovalev and his friends offer summer camp activities for kids that went through cardiac surgery, while Sainte-Justine au Coeur du monde provides humanitarian help by giving surgeries in undeveloped countries including Morroco, Egypt and Ethiopia, up to now. Worth of mentioning, there is also En coeur, an organization devoted to help patients with cardiac problems all over the province in many ways, co-founded by a cardiologist from Sainte-Justine, who also implanted the first pacemaker to a small patient with the collaboration of a cardiac surgeon. Amongst other things, the first pediatric heart transplant in Canada was done in the establishment on July, 9th, 1984 and getting the best care to kids and mothers is still a top priority for Sainte-Justine. At the end of 2016, the transition in the new pavilion with the latest technology will help pushing the boundaries of pediatric medicine in the future of the establishment.
Perfusionists working here: