Hello and welcome to Scrubbing In a podcast powered by Specialty Care. I’m Todd Schlosser and today my guest is Bharat Datt the director of perfusion at children’s hospital of New Orleans. In this conversation, we discussed the beginning of his profusion career in India, his transition to North America and his passion for continued learning.

Todd Schlosser:            I think you’ll be very interested to hear what he has to say about bloodless perfusion and his goal of using that technique for pediatric cases. Enjoy the conversation.

Todd Schlosser:            So thank you for joining us today. I’d like to start off the podcast asking this. And you have 30 years in the industry of profusion. So you have a breadth of knowledge, but I want to start out with what sort of drove you to seek out that knowledge. So what was it that sort of generated a passion for healthcare for you early on?

Bharat Datt:                  Well, it’s 27 years.

Todd Schlosser:            Oh, I didn’t mean to date you.

Bharat Datt:                  But my father, my father and forefathers were from the military. And my dad’s fought in three or four wars and the consensus was that I was going to go to the military just like any other generation. But I think because of what my mom went through, she was very much against it. So I graduated with a science major, a master’s in biology. And I was doing some research I wrote my PhD exam, doing my PhD and unfortunately working actually with cardiac surgeons doing some research and my professor died of an MI. And he was the big guy in that topic, which is basically evolution of blood pigments, that was what I was working on.

Bharat Datt:                  And so I had the choice of having to change my topic and finding another professor or taking the advice of my friends who were heart surgeons and said, “Hey, you would be a good perfusionist because I was in the operating room. And I thought the job was really cool.” So I kind of went into profusion through serenity, if you know what I mean. And then I haven’t looked back. I really enjoyed and especially pediatric profusion, I really enjoyed and…

Todd Schlosser:            Yeah. You may have gone into it various serendipitously, but it seems like you took to it very naturally because not only did you progress in your education, you also moved throughout your career and have done multiple different things, which I’d like to talk about. So you transitioned into the perfusionist role. Was that like mid 90s?

Bharat Datt:                  1991.

Todd Schlosser:            1991 so early nineties. And where were you doing that at that time?

Bharat Datt:                  Well, I trained in New Delhi in one of the biggest academic centers, All India Institute of Medical Sciences. And I came down South to Bangalore and I worked at Sri Sathya Sai Institute of Higher Medical Sciences. We did about a thousand surgeries annually.

Todd Schlosser:            That’s a lot.

Bharat Datt:                  And a lot of them are pediatric. And then my family decision was to immigrate to Canada.

Todd Schlosser:            Sure. I did see that. You moved to Toronto around 2000, 2001.

Bharat Datt:                  Yes. 2000 is when I went.

Todd Schlosser:            And then you worked in the same capacity it looks like at some hospitals in Canada as well.

Bharat Datt:                  Well you know your qualifications aren’t really credentialed in Canada.

Todd Schlosser:            I wondered about that.

Bharat Datt:                  Yeah so I had to redo… I decided to redo my perfusion course. And I did that at University of Toronto, the Michener Institute.

Todd Schlosser:            And so you moved from New Delhi, Bangalore, wherever you were at the time in India and then moved to… And you had to restart your career sort of. You had to go through the education piece again and then… Oh wow.

Bharat Datt:                  Yes, and I don’t have any regrets because I had great clinical instructors in Canada. Many of them went on to become my mentors. I learned a lot. Even though I had about eight, nine years under my belt, I still learned a lot. There was a part where I wasn’t really comfortable like VADs and transplants and I took care of that part working in Toronto. And so I enjoyed every bit of it. It was hard. It was a struggle. But at the end, I think it was worth it.

Todd Schlosser:            As most struggles, hopefully are. So as you’ve sort of progressed through that, you eventually decided to move down to, well it was Orlando first, right. And you were there for about I think four years. Forgive me if wrong.

Bharat Datt:                  Five.

Todd Schlosser:            Five years. And then you moved over to where you are now at Children’s Hospital in New Orleans.

Bharat Datt:                  You see I want to talk about my drive.

Todd Schlosser:            You clearly are very driven.

Bharat Datt:                  My drive is to make a difference. And I think that perfusionist make a big difference. Whenever I get a chance to talk to young cardiac surgeons, they asked me, “So you know, what is your advice about profusion?” And I say, “Listen, there’s one guy who’s going to make a big difference to your outcomes. That’s the perfusionist.” Of course there’s a bunch of people in the team. But the perfusionist makes a great impact on outcomes. And you’ve got to make sure you choose the right one.

Bharat Datt:                  And I think that’s what drives me is as a perfusionist, I think I can make a big impact on Dr. Pettit’s outcomes. Or Dr. DiCaprio, whoever I’m working with, their outcomes. And I think any perfusionist does that, more so in pediatric cardiac surgery. So I actually vent west from Toronto to Alberta. and I worked at University of Alberta hospitals for a few years. I enjoyed every bit of it. Again, I made a lot of friends. Got another mentor. His name is David Dallington, a very modest person, but I learned a lot, one of the best pediatric perfusionist I have known in my life. You can’t ask for more. I learned so much. And you know, again, obviously I had… This is what they’ve told me is that you’ve outgrown this place and I think now you got to go somewhere and make a difference.

Bharat Datt:                  Yeah. And the opportunity presented myself in Orlando. And fortunately they were interested in me and I got hired, that was my first leadership position. So that’s another journey of mine is not only just learning about pediatric profusion and clinical science and doing research, but also learning how to be a leader. And I think in healthcare that’s really important.

Todd Schlosser:            Yeah, absolutely. And I would say it’s a different skillset then even being a cardiac surgeon or being a perfusionist, leading a team is a very different skillset from being a clinician or a surgeon. Right.

Bharat Datt:                  Absolutely.

Todd Schlosser:            I had the chance to see Toby Cosgrove speak. And he’s very big in the cardiac circuit, if that makes sense. And he said that his… The change from him being like a head surgeon to CEO of the Cleveland clinic was so different and he just… It was something he wasn’t expecting and it was so difficult for him to get into that and figure out how to do that because it’s a different animal leading people is a different animal than leading in surgery. And that I found that super fascinating.

Bharat Datt:                  So it’s funny you mentioned his name because you know, leadership is all about the people. You know, how you connect with people, how you motivate people, how you make them ascribe to do your vision and your institute’s vision. But funny you mentioned Toby Cosgrove because I think he was one of her adjunct faculty at the Jack Welch Management Institute, the MBA I’m participating in right now. So I have heard him speak about leadership. And it’s amazing coming…

Todd Schlosser:            And much like you just said, he said that it was all about getting the right people around him and he was learning as much from them as he was leading them. And I think that that’s, so that’s such a bottom up style of leadership, but I think is rare, but super effective.

Bharat Datt:                  I think so I think empowerment is really important. Five brains better than one. Ten are you in better? That’s how I feel and I depend on my team to tell me when things are wrong. You know, I think like anyone else, I’m human and I can make a mistake or error. So I depend on my team and that’s why I try to encourage an atmosphere where everyone has a right to speak up. But then again I back it up but you can speak up, but you got to do your research and have your data. So that’s really important.

Todd Schlosser:            Yeah, absolutely. You can’t just… Facts are better than feelings any day of the week.

Bharat Datt:                  Absolutely. It’s not an opinion. It’s backed by data. So then I have to listen to you.

Todd Schlosser:            Yeah, I bet you sort of get that from your research background because research is sort of all about that. You even have feelings, but you got to prove it.

Bharat Datt:                  I will tell you that actually I don’t get that too much from research because you can be very opinionated in research. You can be very opinionated. You have an idea and you base your experiment on that idea. And you can be very biased. It’s hard not to be biased. But I learned early on in leadership that you can be biased and have an open mind. You can feel strongly about something and then you can look at data and support that. But if somebody else has better data, you got to listen to them. Because at the end of the day, we are in a profession where that baby who enters the operating room is the focal point of our care. It’s not about me. It’s not about anyone else in that room but that baby.

Todd Schlosser:            I can’t imagine a more higher stakes scenario than what you just laid out. And you really want to go with what is the most accurate, right? Because there’s nothing more precious than a baby’s life. And that is literally the stakes where you are.

Bharat Datt:                  Absolutely.

Todd Schlosser:            The field in which you play or work is very high stakes. And there’s something to that in leading those people. And you started doing that in Orlando, correct?

Bharat Datt:                  Yes…

Todd Schlosser:            Sorry, go ahead.

Bharat Datt:                  Yes, so in Orlando, I had this opportunity where I could improve outcomes. You know, my passion is bloodless cardiopulmonary bypass. And I, 10 years ago, if you had asked me that, could you do bloodless cardiopulmonary bypass for children I would’ve been scoffed at. But it’s no longer the case.

Todd Schlosser:            Sure, but as technology advances those procedures that seemed farfetched become very, “Oh we might be able to do that,” and then eventually you can do that.

Bharat Datt:                  And then that’s what… I would I’d like to say not just me but my team. That’s what we did in Orlando is that we went from transfusing multiple units of blood and you know, in any pediatric program we do with complex operations. It’s not a cabbage… I’m not saying that that’s not an important operation. That is. But there are more challenges in pediatric cardiac surgery because of the size of the baby, the blood volume involved. The disease processes, the multiple operations. So it’s not uncommon for us to do a re operation, fifth, sixth time. And so it’s kind of hard to optimize your blood management, but we know that whether it’s an adult or a child, if you optimize your blood management, then your outcomes are better. You spend less time in hospital, you spend less time on the ventilator, the patient has a better quality of life. And you spend less money. So it’s a no brainer.

Todd Schlosser:            Yeah, absolutely. If you’re improving outcomes while saving money, that’s a huge win for both the hospital, the parent, the child who was a patient and you just can’t beat those kinds of results.

Bharat Datt:                  You can’t…

Todd Schlosser:            Can I ask a question and forgive me, I’m not a perfusionist. So when you say things like bloodless profusion, it just makes me want to ask what that is specifically. So I’d imagine, because perfusion has sort of acting as the heart and oxygenating the blood, right.

Bharat Datt:                  And the lung.

Todd Schlosser:            So, yes. Fair enough. So blood less part of that doesn’t mean you’re not transfusing new units in.

Bharat Datt:                  Correct.

Todd Schlosser:            So you’re still acting as a circuit.

Bharat Datt:                  Correct. So the circuit has got connected to the baby’s circulatory system. But the problem is our two kilo baby has probably a blood volume of 180 CCs. So you can’t really connect a pump, which needs a 500 CCs of volume. Because then you got to hemo-dilute him. And so there’s a balance between oxygen carrying capacity and also trying to conserve blood transfusion.

Todd Schlosser:            So how did you crack that? Like is it a new machine? Was it technique? How did you crack that?

Bharat Datt:                  So it’s all of the above. So traditional heart-lung machine was on a horizontal base, like my table right here. But the problem is every time you mount a pump, you’re moving away from the heart. So if this is the base and you’re the baby and I’m mounting pumps horizontally…

Todd Schlosser:            You’re getting further away from the…

Bharat Datt:                  I’m getting further away from the heart. So that my tubing length is longer, so I need more volume. And that’s what we did away. So we went from a traditional horizontal pump to a vertical pump. So we stack the pumps of vertically. So almost every pump is as close to the heart as the arterial pump. So that’s the first major change we made.

Todd Schlosser:            That seems so intuitively simple, but it must have had a huge impact.

Bharat Datt:                  Absolutely. And then we changed the circuits because of that, we changed the circuits, we changed the size, [inaudible 00:00:13:34], for example. We have something called the vent, which decompresses the heart when we open it. And if the vent is usually the last pump on the field. So it’s the furthest away from the baby. But every time you turn the vent on, and if it’s right here furthest from the baby, you’re going to steal 200 CCs of volume from a baby who’s total blood volume is 180 CCs.

Todd Schlosser:            It’s less than that.

Bharat Datt:                  So you just don’t have that luxury. So it’s all about planning and configuring the right miniaturized circuit. And so we don’t, for example, at children’s hospital where you have gone from a…

Todd Schlosser:            Children’s Hospital in New Orleans?

Bharat Datt:                  In New Orleans, we had about 400 CCs of prime volume and we’re down to 124 for our littlest neonates.

Todd Schlosser:            Wow. So you’re able to do a bloodless for fusion with someone who only has…

Bharat Datt:                  We have not done a bloodless profusion yet. It’s a journey. It’s a culture you need to build. But what we have done is instead of needing a unit of blood to transfuse to fill the pump, we just need a partial unit. So we went from 250 CCs of washed red cells to about 80 CCs.

Todd Schlosser:            So you’ve cut it in more than half.

Bharat Datt:                  More than half.

Todd Schlosser:            And I’d imagine that as you continue to do that, you’ll be able to wean it off completely.

Bharat Datt:                  Yes, I think so.

Todd Schlosser:            That’s amazing.

Bharat Datt:                  That was a journey in Orlando. Started off small, baby steps, and we ended up doing, I’d say around three Jehovah’s Witness patients, you know? Jehovah’s Witnesses do not allow transfusion. And I think that it’s important to respect people in this country and their beliefs, but it’s more important to take their beliefs and make it optimize for the rest of the population. Because we know if he can optimize and reduce transfusion, we can improve outcomes.

Todd Schlosser:            Yeah, absolutely. Because you’re not using foreign blood, you’re using that patient’s own blood.

Bharat Datt:                  Correct.

Todd Schlosser:            And there’s no… And I didn’t realize this, but when I first started interviewing perfusionist and cardiac surgeons, I did not know that your body reacts to a transfusion, sort of like it would…

Bharat Datt:                  A transplant.

Todd Schlosser:            It’s like a transplant. I had no idea about that. So you’re mitigating all that risk because you’re not using anyone else’s blood. It’s all that patient’s blood. Now for you, that patient is much smaller and has a lot less blood.

Bharat Datt:                  Yes. And that’s what I try to teach my team and when I have students is that if you tailor your practice to the two kilo baby, then a 22 kilo baby will be very easy to deal with. And a 220 pounder even more easier. You know, you know what I mean? So that’s what you got to do. You got to look at your most challenging patient and tailor your practice according to that patient. And then you’re going to have your fundamentals really strong.

Todd Schlosser:            Absolutely. So is that… I guess my question that I’m still left with about how you ended up here. What was it that drove you from Orlando to New Orleans.

Bharat Datt:                  I think that I had made that difference in Orlando and I was there for four to five years. And you know, I’m a restless soul. I’m always looking for challenges. That’s the other word which comes to me challenge, and I think the challenge was dealt with in Orlando. I think we’ve made a lot of progress in the five years, I know for a fact that the physicians that I worked with are really happy.

Bharat Datt:                  So I was looking for my next big challenge and Children’s Hospital New Orleans presented that to me. I’m grateful for that opportunity. I see a lot of potential in this place and for the fact that this is the only freestanding children’s hospital in the state.

Todd Schlosser:            I didn’t realize it was the whole state. I knew it wasn’t the city.

Bharat Datt:                  The whole state.

Todd Schlosser:            I didn’t realize it was the whole state. Wow.

Bharat Datt:                  The whole state. And is a lot of potential not only just to grow the program but to optimize their outcomes. And that’s the thing, that’s the stuff I’m looking for.

Todd Schlosser:            So can I ask a little bit about how you grow a program now that you’re… And I guess you were in Orlando too, but I wasn’t speaking to you then. But now that you’re here trying to grow, this program is all about growing the results part of it and then the results tend to speak for themselves and that grows the program or is it a more minute than that?

Bharat Datt:                  In any organization there are two goals you have. There’s an operational goal. Which is day day every year. And the operational goal obviously is to balance your budget, but also to improve quality. And to me that makes sense. If you balance your budget… If you improve your quality, you’re going to make money and not just balance your budget. And that’s your operational strategy. And then you have a strategic plan. And the strategic plan is to grow to be one of the biggest high quality center in the region. So that’s what we are aiming to do right now. And you can have a strategic plan of being the number one if you don’t improve your quality, which is your operational plan. So that’s what we’re dealing with right now.

Todd Schlosser:            So here at Children’s Hospital of New Orleans, they formed a LCMC, which is sort of a hospital group, correct?

Bharat Datt:                  Yes.

Todd Schlosser:            And not the other way around, which normally like you see an HCA buys a hospital. So the actual hospital created on an organization. What drove the need for that?

Bharat Datt:                  Well the children’s hospital is the founding member of LCMC. And to me that says a lot because at says that our mission is primarily to treat the children of the state, but also to step up where care is lacking in the adult side of things. And what it does to me as a leader, what I learned from that is it’s very different from, for example, Orlando, where you know, the founding member is not a children’s hospital. So I, I think it’s easier for us to get things done. We have our eyes on the ball. I don’t report to somebody else. I report to the founding members. They understand what I’m trying to do. They understand that I’m trying to optimize care of the children in the state of Louisiana. So I think it makes our job a lot easier. Fundamentally.

Todd Schlosser:            Less red tape as it were.

Bharat Datt:                  Less bureaucracy.

Todd Schlosser:            Yeah, bureaucracy. That’s a good way of putting it. So how long ago did that happen? Or does that predate you? Because you started this position in January, correct?

Bharat Datt:                  It does predate me. So I’m, don’t quote me what I think it’s 2014.

Todd Schlosser:            So for a number of years they’ve been operating. Now do they have any other hospital systems under LCMC?

Bharat Datt:                  Correct. For they have University Medical Center. They have West Jefferson. And Touro.

Todd Schlosser:            And all of these are I’d imagine adult focused hospitals.

Bharat Datt:                  Touro is more maternity based and OB/GYN, maternity. And the other two are adults based.

Todd Schlosser:            So do you have a hand in helping shape and create the culture of that profusion community as well? That perfusion team?

Bharat Datt:                  I do not. I focus on children’s.

Todd Schlosser:            So your focus is just children. So let me ask this, you obviously have a leadership role here at Children’s, is that… And it may not be new to you, but in creating that team… Because you mentioned earlier that the surgeon needs to rely on a perfusionist and a profusion as they trust. So when you’re bringing someone on and training them up, how do you help foster a relationship between a surgeon and a newish, at least new to here perfusionist?

Bharat Datt:                  Yeah. Well, what I do is buddy them with somebody. Sometimes it’s me, sometimes it’s one of my team members. But I buddy them with somebody and I think that it’s important for them to get the basic skills of how we work in the OR. Because it’s it’s different from a institution where we’re doing bloodless operations is not important. But for us it is. So we want to teach the fundamental skills to the perfusionist.

Bharat Datt:                  But it’s also important I think, like I talked to you earlier about people and connections. I think it’s important to socialize outside of work. And I believe in that and I believe in that fosters teamwork and collaboration as really important. When somebody understands who you are in real life, what your family does. And that’s what I try to encourage that we meet up, have a meal, have a couple of drinks, have a chat and I’m always up for it.

Bharat Datt:                  If I have a problem with one of the physicians, I will take that initiative. I’ll say, “Hey doctor, what you doing. Let’s go grab a beer. As long as you’re not on call, I’m not on call. That’s school.”

Todd Schlosser:            Right. As long as it’s appropriate.

Bharat Datt:                  Yeah, let’s go grab a beer and let’s talk because you know you need to talk, we need to figure this thing out and the best way to do it is one-on-one. Not through email. Not through Twitter, not through a text. It’s hard to do that.

Todd Schlosser:            No, absolutely. I do think in any kind of corporate setting and hospitals are corporations. I think in any sort of setting like that it is easier to send an email because you’re not having that face to face interaction, which may, especially if you’re dealing with a difficult situation, be uncomfortable. So I think that that’s a very wise precedent to set. To that end when you are… I mean you mentioned quite a few times how mentors helped you along the way. You are in a position where you are a mentor whether you want it or not. Leadership is sort of seen that way. And I’m sure that that’s a mantle you accept and are excited for the challenge. But it is a challenge. So how do you foster that mentorship in perfusion specifically?

Bharat Datt:                  Yeah. I mean leadership is not about your success. It’s about how many people you get to succeed in. You know, so, my success depends upon my team’s success. Yes. So when it comes to mentors, that’s what I learned. I always had mentors who taught me everything. They were transparent about knowledge, about skills and I hope I’m doing that. Like I don’t hide anything if I know anything. I want to teach, I want people to learn and if they are better for my team’s better for, I am better for it. So that’s the kind of culture I am trying to foster here at Children’s Hospital is that we all are in ed for the quality of care, for that baby. If you have some knowledge you got to share. If you see a potential to improve quality, you got to take ownership.

Bharat Datt:                  You got to step up and take ownership. Say, “Hey, maybe there’s a better way to do it. Let’s just talk about it.” And go from there. Build on that foundation. That’s what I believe in. I don’t know if I answered your question.

Todd Schlosser:            You did, absolutely. I love it.

Bharat Datt:                  [inaudible 00:24:18].

Todd Schlosser:            so obviously we’ve talked a little bit about you being here at Children’s, but I’d love to ask what sort of things you’re doing here at Children’s that you’re passionate about?

Bharat Datt:                  Well, first off, the optimization of outcomes through trying to reach for that bloodless transfusion threshold obviously is what I’m very passionate about. But also to build a culture of learning. Because I think it’s really important from a leadership perspective, if you’re passionate and you got to be curious and that curiosity is about improving.

Bharat Datt:                  About improving quality standards, outcomes. And so I do envision that academia is going to play a part. As soon as we all get settled in the first year or so, we are fortunate that Children’s Hospital liaises with a Tulane University Medical School and also with the LSU School of Medicine. So we actually have an animal lab which is available to us. So that’s a great start for us. From a profusion perspective I’ like us to be a clinical site for one of the profusion schools. At present we have no profusion schools in this state.

Todd Schlosser:            And there’s almost a profusion skill shortage across the nation.

Bharat Datt:                  Correct. So I’m hoping that we can cooperate with one of the established schools of profusion and via clinical site for them. And I think it’s a two way street, it gives them a pediatric clinical side, which are a few and far between. But also it allows us to learn, because you know, when young students come to our program and they ask questions. Why do you do this? Why can’t we do it the other way? I think it makes my team better because when people ask questions then we question ourselves and we learn along with the students.

Bharat Datt:                  So I’m a great believer in that. I’m very believer in young people getting that energy and that curiosity to my team. So I’m hoping that I will be able to do that in the near future. That’s my plan.

Todd Schlosser:            So when I want to learn something new, I usually go online and search for it, right? Because the stuff that I’m doing people have done before. When you’re sort of in the field of profusion or anything that’s sort of on the cutting edge of research in profusion or whatever, how do you go about doing it if someone’s never done it before? You have to sort of build that roadmap, right? So how do you go about doing that and what are the steps to achieve any sort of success with that?

Bharat Datt:                  Well I think the first thing I would tell young people, I think, I’m not trying to call myself old here, but young people is that believe in yourself. You know, when you have spent some time in the clinical field. You’ve seen some things. You know what things are right. Now all you got to do is prove it. So yes, you got to search out data to back yourself up. Right? But if you do find yourself in a position where you believe in something, you have a hypothesis. But there is no data, what do you do?

Todd Schlosser:            You’ve got to get that data.

Bharat Datt:                  You got to get that data. You’ve got to do that research. And you got to present it and publish it. And more often than not, you will be ridiculed because you’ll… And you know, people are going to say, “What are you talking about?” But when you show them the data, yeah. They got to listen to you. And it also is a positive reinforcement for yourself because you do believe in it, but now you backed it up with your data, with your research. So now you are strong fundamentally. And trying to execute that initiative.

Todd Schlosser:            Excellent. To that end about research, what research are you guys doing here at Children’s?

Bharat Datt:                  For profusion specifically? You know, like we talked a little bit about how did you work towards a bloodless cardiopulmonary bypass scenario? And we started off with the structure, the base of the pump and the circuitry. One of the things which we do differently in cardiopulmonary bypass versus adults is we do what’s called modified ultrafiltration. So earlier on we were using a centrifigul pump, which is a different technology.

Bharat Datt:                  It needs a minimum number of revolutions per minute for it to push blood forward. And that’s a disadvantage as far as modified ultrafiltration is concerned. Or I feel is a disadvantage. Many of my colleagues might not, but I think it’s a disadvantage. And so when we moved over to the, to the RO pump, what happens in modified ultrafiltration is you come off heart lung bypass and then you reverse the flow. So instead of going veno-arterial, you’re going arterial-venous with a small amount of flow and you’re putting that blood through a hemo concentrator. So it thickens the blood makes the hemoglobin go higher.

Bharat Datt:                  At the same time that’s an opportunity for you to return all the blood leftover in the pump to the baby. So what we did is when we changed our technique of modified ultrafiltration, we went from a step up of three to four , hematocrit of three to four. So you would have come off with a hematocrit of 30 and your posts modified ultrafiltration hematocrit will be 33 or 35. We went from a step up of three to five to a step up with a 10. So now you could come off bypass with a hematocrit of 30 and post modified ultrafiltration there will be 40. So one of our med students is actually doing some research on that along with one of our faculty who is also an associate professor at LSU, Dr. Gottlieb-Sen. He is actually doing research on how changing our technique improved the endpoint of our modified ultrafiltration, which is the step up in hematocrit.

Todd Schlosser:            Sure. And that step up, does that directly correlate to better outcomes?

Bharat Datt:                  Absolutely. So if you have a hematocrit of 40 post modified ultrafiltration and the anesthesiologist has to give some other kind of volume, like FF plasma, or platelets, he’s got that room. And so even if he transfuses that product, which is a non blood product. It’s a blood product but you know what I mean, like a non red cell product. He hasn’t got that room so that you don’t have to transfuse another unit of blood after you transfer the plasma. Whereas as if you had started off with 30 and ended with 33 and you gave some clear fluid, whether it’s plasma or platelets, now you’re ending up with a crit of 27, 28 which increases the likelihood of another blood transfusion. So definitely that’s why we feel that it actually improves outcomes and I think that is also a part of his study.

Todd Schlosser:            That’s, okay, so a lot of that stuff for me is very foreign because you know, I don’t work in the realm of perfusion, but anything that you can tie to directly to more positive outcomes I think as a worthwhile area of study. Whether it’s a hypothesis you believe in or not, if you could back it up with data sort of like you were talking about earlier. You know, and you could prove to your, I guess, peers in the industry that they can start adopting it and just improving outcomes across the board. And that’s sort of what you wanted to do early on is to make a real change for the better, obviously, in this realm of profusion. So it’s awesome that that’s happening in a site that you actually sort of manage at this point.

Bharat Datt:                  Yes. Perfusion is all about attention to detail. And it’s just one of the many things we have done. You know we partner with Medtronic and got started using the Hepcon, heparin management system. We actually tailors our heparin dose because we had to anticoagulate every patient. So we have started that. We used [Carmita] coated tubing, which is on the inside of our tubing, mimics the intima of the blood vessel. So we are looking at every little detail, whatever we can do to optimize cardiopulmonary bypass for that baby. And in an ASD with a 25 minute bypass time, I don’t think it makes that much of a difference. But now you’re doing a second time, third time redo Glenn shunt or first time Norwood, four hours on pump or three hours on pump. It will make a huge difference. That’s the difference between and optimized outcome and a not so optimized outcome.

Todd Schlosser:            Obviously you want the optimized outcome. Being that you are now in that mentor position for lack of a better term. And also that we sort of have a perfusion crisis as far as staffing is concerned. There’s a lot of need for perfusionist. So if you had the opportunity and you may very well have the opportunity to, but if you had the opportunity to talk to someone who was considering going to perfusion school and seeking this out as a career, what would you tell that person? What advice would you give that person?

Bharat Datt:                  Well, I would say that obviously I would not suggest any job to anybody unless they have a passion for it. But if there is a job where you can make a difference… You know how many people can get up in the morning and say, “You know what, I get up in the morning and I join a team, which ends up saving a life.” You know, it’s not very money. I mean the cardiac surgeon and the cardiac anesthesiologist, but you can’t get greatest satisfaction then that. Perfusion is also a very independent profession. So it’s not like being, I believe registered nurses and the respiratory therapists has to do a great job, but there’s a lot more independence in perfusion. You make independent clinical decisions and you learn as you go along. And you have an opportunity to be part of AmSECT the American Society of Extracorporeal Technology.

Bharat Datt:                  Part of the American Academy of Cardiovascular Perfusion. You know, be in an organism organization with peers and learning together, publishing in our journals, whether it’s a Journal of Extracorporeal Technology or Perfusion in the UK. You can present at national and international meetings. And there are so many advantages and I don’t even want to talk about monetary value because I think perfusion pays very well. But you have to understand that there’s a balance between work and life and you have to be ready for taking call and working at nights and got to be prepared for it. But if you are a person who’s passionate about doing that, about making a difference, about learning, you’re curious. You want to be part of saving somebody’s life. That’s the profession to go.

Todd Schlosser:            Excellent. Well thank you so much for taking the time to be on Scrubbing In with us. We really appreciate it.

Bharat Datt:                  Not at all. Thank you.

Todd Schlosser:            Absolutely. Thank you so much.

Todd Schlosser:            Thanks for listening to Scrubbing In. Please take a second to give us a rating on your podcast app and subscribe so you won’t miss out on what we have coming up. See you next time.