Quantum Directed Perfusion
The Tools to help Improve Outcomes
Quantum Directed Perfusion provides the next generation capabilities beyond traditional Perfusion monitoring and basic Goal Directed Perfusion (GDP) techniques. Quantum Directed Perfusion (QDP) from Spectrum Medical goes well beyond the simplistic approach of measuring DO2. This multifaceted approach to QDP provides the clinician team with the methodologies to develop best practice strategies that can lead to the reduction of AKI, and the higher costs associated with extended I.C.U. Time. 1,2,3,4
The Principles of Quantum Directed Perfusion (QDP)
• The starting point for QDP is the use of Spectrum Medical’s non-invasive diagnostic technology for the measurement of Oxygen Delivery (DO2), Oxygen Consumption (VO2), CO2 Production (VCO2), and multiple other calculations and indices.
• The monitoring of real-time total Oxygen Deficit is a completely new and critically important concept to the world of Perfusion. The Quantum technology displays the real-time reporting of total time and percentage of case time when actual DO2 is below target DO2. Having this information intra-operatively and in real-time significantly increases the quality of bypass management.
However, more importantly Quantum Directed Perfusion calculates Oxygen Deficit or a total “area under the curve” calculation which is generated by the accumulation of an actual deficit value (i.e. target DO2 minus actual DO2) multiplied by a unit of time.
It is accepted that the potential of AKI is significantly increased with large DO2 deficits.4 Calculating the Oxygen Deficit and then equating it to outcomes is a relatively straight forward process using Quantum’s Informatics technology. Such an analysis can be useful in determining intra-op best practice.
To further increase the precision of patient DO2 requirements Spectrum Medical includes the capability to apply a percentage reduction per degree C to reflect decreasing metabolic activity as patients are cooled during Cardiac Bypass Surgery. The reduction per degree C is fully programmable and dependent on hospital based protocols. For example, if a DO2 of 270mL/kg/m2 at 37°C is the standard target and hospital protocols indicate a 7% / degree C as the change in Oxygen demand, the target DO2 would be 251mL/kg/m2 when the patient is at 36° C.
• Spectrum Medical’s Critical Care Scoring technology supports a pro-active clinical risk assessment using recognized AKI markers such as age, gender, Pre-op Hct /Hb. EF, DM, and existing renal issues, and the subsequent deployment of an individual patient care strategy.
• Quantum Informatics and its LIVE VUE technology improves patient care with the seamless integration of “multiple information feeds” into central viewing systems that are available to everybody in the Operating Room.
Some form of AKI occurs in nearly 10% of patients including 8% during cabg, 11.4% during valve procedures, and 17% of valve/cabg cases. 1
The impact on the patient and hospital include:
• Increased Negative Outcomes and Length of Stay in the I.C.U.
• Increased Mortality & Morbidities
• Increased costs & drain on hospital resources
• Increased requirement for RRT
Even in its mildest form, AKI more than doubles Morbidity, and increases LOS and Post-op costs by more than 50% 1,2,3
The average cost of AKI Vs Non-AKI in Cardiac Surgery is over $38,000 per patient, in the United States over $1 Billion annually is spent on increased hospital cost. 1
1. Alshaikh, et al. Financial Impact of Acute Kidney Injury After Cardiac Operations in the United States. Ann Thorac Surg. 2018 Feb;105(2):469-475.
2. de Somer, et al. O2 Delivery and CO2 Production During Cardiopulmonary Bypass as Determinants of Acute Kidney Injury: Time for a Goal-Directed Perfusion Management? Critical Care 2011; 15:R192.
3. Dasta JF, Kane-Gill SL, Durtschi AJ, et al. Costs and Outcomes of Acute Kidney Injury (AKI) Following Cardiac Surgery. Nephrol Dial Transplant. 2008;23:1970-1974.
4. Ranucci M, Romitti F, Isgro G, et al. Oxygen Delivery During Cardiopulmonary Bypass and Acute Renal Failure After Coronary Operations. Ann Thorac Surg. 2005;80:2213-20.