 And thank you for the introduction. My name is Justin Slesman. I'm a perfusionist at Stanford Children's Hospital in Palo Alto, California. Relevant to this presentation, I serve as the AMSEC perfusion liaison to ELSA. And within ELSA, I represent perfusionists by sitting on their technology, conference planning and steering committees. I am joined by two perfusionists for this panel discussion on the COVID-19 joint perfusion task force. Luke Puiz joined us from Belgium and Bill Riley at a Boston, Massachusetts. First off, on behalf of all the speakers for this presentation, I would like to say thank you to the Texas Heart Institute Conference Planning Committee for inviting us to present at your annual conference. Obviously, our profession is indebted to the foundational educational work that Terry Crane and all THI personnel who were or are involved in building, maintaining and now growing the perfusion program at THI for the betterment of our profession. So we thank you. The group has no disclosures. Our focus for this presentation is to share the development and evolution of the COVID-19 task force. Then Luke will share some of the work he has done emerging CCPs and ECCPs in this process, followed by Bill highlighting institutional experience and lessons learned as a COVID-19 pandemic spread in the Northeast region of the United States. Lastly, we'll reserve 15 minutes at the end of our lot of time for a question and answer session. Okay, so who and what is the joint perfusion task force and how did it come to be our forum? As COVID-19 pervaded our world in healthcare systems, I say with a heightened anxiety and concern, peaking in mid-barch, there was an increasing need to formalize a hub to help answer questions and lend support for perfusionists. Leadership from AMSEC, notably Jim Rager and Tammy Rosenthal, aligned with Bill Riley at the Academy, supported by Brad Crullot and Angarico at our foundational American board who began the process of combining their knowledge, resources and networks to construct and disseminate information using this platform. As word spread, we were a standard with a swift addition and participation from various organizations, societies, employers and industry on a global scale. This slide shows this exceptional display of collaboration and all parties involved. The website URL, which you can see above, please take some time if you haven't visited it. If you're looking for any information on COVID-19 and also please contribute any information that you think pertinent for this task force. So we needed the website which you saw and had to decide on the main content which you can see here. First, the discussion board was created to quickly share the early experiences and hardships for perfusionists, clinically supporting patients with COVID-19. And I think this was the right thing to do just to get something up quickly where we could all share our experiences with potentially just case reports to starts on lessons learned, but just something quick that we could share on this task force website. Secondly, Braylee Millen, election on health and wellness providing links to resources for all of us who might be struggling with concerns and uncertainties with COVID-19 and mental health. We reached out to Elsa who quickly responded that all CCPs will be given a one-year free individual membership, enabling access to their extensive ECLS COVID-19 resources, webinars and protocols which are ongoing and present today. Next, Shelley Brown led the legislative and governmental resources section as questions emerge on licensure and employable state boundaries, staffing regulations and FDA leniency and products to help guide CCPs to better face this pandemic. Current and publications were posted, webinars were established and perfusion industry partners continued to update on the supply distribution and projections, especially as we now head back to the operating room for elective cases. So as Zoom and social distancing became the norm, these webinars were a welcome tool of information sharing and I think I'd say some FaceTime with colleagues. We started with centers that were first seen these patients in the greater New York City area and Seattle, Washington. I think I, like the majority of us out there, personally and institutionals, that we were ready for a surge but had yet to see one COVID-19 patient in early April. Nick Mellis, who's the chief at Montefiore Medical Center in New York City, his presentation during the first webinar was eye-opening to me and I think others as well. You could feel as calm yet urgent tone over the webinar and how to prepare your staff for the stress that will come if faced with a surge of COVID-19 patients at your institution, specifically in the ICU setting. So we started with Nick, Seattle, University of Washington, Swedish Medical Center in Seattle as well and our first three which were sequentially April 2nd, 9th and 16th weekly, were more case reports, institutional experience that we could share that knowledge. In the fourth, fifth and sixth webinar, I'd say they are more systematic approaches and we reached out to kind of our colleagues across the pond with ECCPs and URA ELSO. So the fourth one was patient transport, URA ELSO data kind of digging deeper into that and also looking at some of the technology that might help serve these patients, even if that was some of the older technology such as cytosorb that was available but might have a place for COVID-19. Then we asked MDs to support us in our endeavors here for these webinars and had a lot of MDs talk for patient treatment and also going into reopening of ORS and CPP. Our last webinar, which is held on May 28th, I think was a welcome addition from manufacturers and profusion service organizations. Those organizations mostly being specialty care and comprehensive care services which provided us a deeper dig or deeper look into where was the dip in case volume and are we seeing it come back now and geographically where are these locations? And we absolutely support, we appreciate the support of the manufacturers industry and highlighting that they are ready for, if there's a potential surge to meet that demand for ECLS equipment. So these numbers reflect the initial views from the two tools used to watch the webinars, zoom and profusion.com's YouTube live stream channel. So we wanna thank profusion.com, Brian Lynch and his colleagues at profusion.com for assisting and gaining this information out and making this available on a webinar format. As you can see, like we said before, I think we met the demand initially in April with 785 initial views. Now these views are just who is there present for the first offering and they are still available on the joint profusion website and profusion.com's YouTube live stream. So I suggest if you haven't viewed to go check them out if you're looking for information on COVID-19. But I think this reflects that we did meet that demand in the beginning. We hopefully answered some questions for our colleagues in the profusion community. And what's good to see also is that we still have a strong presence and strong viewership here with 327 for the last webinar. But I hope this reflects a trend back to the operating room and some normalcy as we move forward. So in closing statement, what I find most valuable about this task force is that now the framework has been established. Whether we have a resurgence of COVID-19 later this year or we are faced with another global emergency down the road, this collaborative platform can serve as an educational hub and voice for our global profusion community. And I regret not mentioning Kate Maude as Smith and Bucklin, who is the absolute glue of this entire operation pulling us together on a weekly basis. With this, Sid, I'll now pass the presentation over to Luke Puiz. Thank you. Thank you, Justin. Thank you for this very nice introduction. I will go briefly, I would like to thank Texas Heart Institute to allow us to talk here as members of the COVID-19 task force. And I will briefly go on to describe how profusion organizations from Europe got involved in this global joint profusion task force. And here you can see an overview of all the members of that task force. And there are three European organizations, namely the European Board of Cardiovascular Profusion, the Society of Cardiovascular Profusion Scientists, that is basically the UK organization for profusionists, and then the Tiny Profusion Leather, which is basically myself. So I cannot speak on behalf of the UK society, as I don't know who is representing those and how they got involved. But the Tiny Profusion Leather got involved by someone saying that I should be, someone saying to someone else that I should be on the profusion task force. And then through the Tiny Profusion Leather, I was involved. There you go. And then I suggested also to have the European Board of Cardiovascular Profusion in the joint profusion task force, so we could exchange information. I would just like to remark that I regret that there are no profusion organizations from Asia or Africa represented in the task force. And we are busy with talking to them how we can include them for the future. So the Tiny Profusion Leather is a weekly newsletter, which gives you 10 articles, one or twice a week, once or twice a week on scientific literature regarding profusion. We did a few extra additions on COVID related literature. And if you're interested, you can always subscribe here. And this Tiny Profusion Leather is also on the website of MSECT and on a few other websites. And this is how we got involved into the COVID-19 task force by providing literature. And then the European Board of Cardiovascular Profusion is in fact the global, not the global, but the association of most perfusion societies in Europe. They try to unite the European perfusionists regarding standards in training and education and professional status of perfusionists in Europe. There are about 29 countries united within the EBCP, as we call it, we have 27 European countries and then there's Saudi Arabia and also South Africa who use our platform to use our standards for education and training. So you can find all their information on their website, ebcp.eu. And they are basically represented by the Secretary General of EBCP and the liaison between EuroElso and the EBCP, just like Justin, there's a liaison between the EBCP and the EuroElso organization. And so then there's a third representative as a backup. And the way we are involved in the joint perfusion task force is that we provide networking opportunities. We find speakers for webinars and we even organized one, the fifth one, I think it was. We exchange our experiences as we have a lot of ECMO experience, namely in Italy and France and Belgium, which I can speak of. We participated in the meetings and the webinars and we provided answers and questions to the discussion forum. Or when, for example, during the webinars there were still questions after the webinar, we provided, we tried to get answers by providing the questions on the different discussion forums of the different organizations. And we also provided literature to answer the questions on the forum. So as Justin said, the future role of the joint perfusion task force would be that we continue networking and I've met a lot of people by joining the task force. I've met a lot of people learn a lot new things and we will continue the exchange of the experience and knowledge that we gained. And we are in this way ready, as Justin said, ready for new events in case there's a second wave of COVID or if there is another H1N1 pandemic, we can now exchange way more rapidly all our knowledge. This said, if we can go beyond COVID then we could try to get a global curriculum for profusion education and training and try to set a standard for certification which would allow easier exchange of certification, jobs and recertification across the globe. And we could also agree on more uniform research needs and methods and even re on a curriculum. So now I give, thank you for your attention and now I give the podium to Bill Riley. Thank you very much. Okay, thank you. Sorry about that, folks. I wanna thank the Texas Art Program Committee for trusting us with a live feed and a heartfelt congratulations to all of the profusion school graduates this spring. These times are crazy and we get it. We can't wait to see you guys in the workforce. All right, sorry folks. So I'm joining you today and I came to the Joint Profusion COVID-19 Task Force as the current president of the American Academy of Cardiovascular Profusion. I'm also the director of profusion services at Mass General Hospital in Boston. So here's American Academy was one of the original members of the JPCTF as we began to call it and we were very excited to be joined by other members from all over the world. It was a wonderful collaboration to be part of. So what I'm gonna talk to you today is a little bit about what it's like, what it was like for us as a major metropolitan medical center in the COVID-19 pandemic so far. We became quite a referral center for a lot of other hospitals and I'll talk about that in a bit. And then at the end, we'll be able to answer your questions. So my first doses of COVID-19 reality actually started early in March. I looked back in my emails and saw that on March 3rd, I sent out some fairly explicit emails to some representatives from industry asking about PMP oxygenators other than what we typically use. And I think that was my first hint that something might be afoot. After that, we moved along pretty quickly. We had our first MGH official COVID meeting with cardiac surgery folks March 12th. But for me, it was March 17th of this year. We had an issue in one of our rooms with a breaker that kept tripping off and we called buildings and grounds and a guy showed up with a bunny suit on over his dark blue work uniform. And he had a tie on that had beer signs and shamrocks all over it. And I looked at it and I thought to myself, that is the most unprofessional thing I've ever seen in my life. And then I remembered, wow, it's St. Patrick's Day. For a guy named Riley to forget St. Patrick's Day in Boston, that means something's going on. So that was the first like, wow, these are strange times we're living in. March 25th, I'm gonna step forward a little bit. We went live with COVID passes here. We have to go on our phone. There's an app every morning and a test to having no symptoms before we're let in the building as an employee here. And then with the COVID pass, you're let in the building, you get a squirt of hand sanitizer, a new mask, then you're free to go on your way. And again, a sign of the times, my jury duty for the state of Massachusetts wasn't just postponed, it was canceled. I mean, there are some silver linings if you look hard enough, I think in all of this. So staffing in the face of our reduced caseload because of COVID was tricky. We use Amion as our scheduling program here for monthly scheduling. And then I usually take that and I'll send out the schedule for the following day. MGH and Partners Healthcare, actually now called Mass General Brigham Healthcare, was very generous in allowing folks to work from home whenever possible to keep everyone healthy. So thanks to that, I was able to bring in about half staff for six weeks or so. And then I increased that with our ramp up phase. So the weeks I'm showing here are Amion, the tall skinny one. This is the week of May 11th to 15th. So we were pretty close to three quarters feet at this point. But you'll see the tall skinny photo there is Amion. That's what we usually use. And then every Wednesday night and Thursday morning, I'd work on an alternate schedule to bring in as few people as possible, but still be able to cover our very, very diverse caseload. We kept the call folks as scheduled. And I tried not to assign anyone on my new schedule that wasn't already assigned for the day in Amion. So there wasn't really much to do on your day off around here, but I tried to respect everyone's time off and it worked out pretty okay. I'll be working on a clinical out practice guideline for how to do this at some point. So if anyone's interested, please reach out. You know, one of the realities of this is I needed to have buffers for positive employees or people that just didn't feel well, even if it wasn't COVID. So this is a lot of responsibility and a lot of creativity went into this and an awful lot of support from my team. Everyone really stepped up every time they were asked to. And now we're pretty much at 75% capacity. We actually have six cases going on right now. That's why I'm in scrubs, not on my fancy dress shirt, but you know, we're managing and we're just happy to be getting back into business. So we have a, like I said, we're ramping up. MGH proved to be a COVID hub for the region. We're about a thousand bed hospital. At one point we had about 350 COVID positive patients in-house, nothing like New York City. And I'll echo the sentiments about Nick Mellis' talk, the first webinar we had, I think everyone was blown away and everyone was braced for that here, but luckily it didn't really happen that way for us. We had, I think a total of 12 ICU floors. I had a hard time actually confirming that, but right now we're in the phase of starting to get back to business. So ICUs for COVID are now being converted back. The nurses that were deployed there going back to their original floors, the ventilators from the OR and storage are being brought back to their original spots after thorough cleaning from the Biomed departments here. And I think everyone is gonna walk away from this a little bit smarter and I'm not gonna say better off, but I think we all learned a lot of lessons here because I think just being responsible, it's very likely that something like this could come back to some extent in the fall. So I'm sure there's gonna be a lot of conversations like that over the summer. And hopefully we still have a forum to share whatever we're talking about when the dust settles, we have a little bit of time to think about that. So again, I wanna thank you on behalf of the Joint Perfusion Task Force, Luke and Justin, we worked together on this and it was a pleasure working with you guys. So we have time, I think 10 to 15 minutes left, it looks like for Q and A. So I'm going to relinquish my control and thanks very much. Lied. What does work from home look like for a perfusionist? Since we're pretty much clinical people, what were your staff doing on their work from home? So we have a very busy service but being Mass General, we're involved all over the hospital. So we're involved in research on many levels, we're involved in different protocols. So we use this opportunity to go through and buff up many of our dozens of protocols and clinical practice guidelines. We developed a few new protocols and clinical practice guidelines that we found we didn't have and everyone was also on call technically. So there were a few times where we had to call people in. So it definitely wasn't, doing a third time re-op every day, but we kept busy. For Luke and Justin, alternate working that your staff did or did you ever feel that you were short staffed having to work with staffing in the crisis? I can take it on the, I work at a children's hospital and so our biggest concern, we're your neighbors with the adults, cardiac center at Stanford. And our biggest concern is that we're gonna have overflow from the adult ICU into the pediatric ICU. So a lot of us, the cases were on hold for a concern that we wouldn't have capacity to treat those patients or potential COVID patients that would come in. Our staffing model, we didn't change because we didn't see a huge fluctuation of COVID-19 patients, luckily. But we did talk about a process to implement potentially, all of us would be on for two weeks or off two weeks. I think Cincinnati Children's adopted that philosophy. So we did have, let's say protocols in place, but fortunately it did not affect our staffing model on a day-to-day basis. Yes, and I can be very briefly, I am in between jobs. So during the first three months of the COVID-19 from March to end of May, I was in the United States, but I was not working. So it didn't affect me. And we do have a question about students and teaching these skills. Obviously we've not lived through a pandemic in our lifetimes, but what do you think are the takeaways that we need to maybe incorporate in perfusion education? I think for me, the take-home message is that you need to maintain your scientific knowledge about your equipment. I think a lot of us, not to say we're caught off guard, but the questions of how does COVID interact with a membrane of different styles of membranes? Are we properly exhausting our oxygenators? Are we wearing our certain PPE that would be relevant for COVID-19? So I think the student in me, which is always there hopefully, is that you have to go back and read and make sure your knowledge basis is adequate on the equipment that we use. I think, as I said in Elso, I always try to carve out a niche for us perfusionists is the fact that we are the experts in technology. And this is a great instance of where we should be the experts in technology, knowing devices and knowing how COVID-19 could potentially interact with the equipment that we use. I'd like to speak to this, Justin, if you're all set. I'll speak to our perfusion students who I think it was March 16th. I had to cut them loose and that stunk. We didn't like to do that at all. I think I'll take a page from what we're learning with my two boys who are in middle school and high school. I think perfusion schools need to be ready to do a little bit of distance learning in the event that something like this happens again. I think we're all getting really good at Zoom, some better than others, apparently, sorry, again. But I think perfusion programs are gonna have to build in some component of distance learning capability, even if they have it tucked in their back pocket, ready to go. I don't know if simulation somehow can come into play, but I think this is, again, a first-off thing, but something we need to be prepared for again. What this pandemic has told me is that that there are many things that we don't know and probably there's a lot of room for a little bit of research there. Like Justin said, those viruses are they in the blood and do they go through the oxygenator? There was a recent publication about it, but they were not like, they were conclusive that you should be aware of it, be careful, but without much evidence. So maybe there's a role for that. And also like we saw that people were creative in creating solutions for looking at their ECMO from a distance, learning about coagulation and how the virus affected the coagulation cascade. And it's really an opportunity to learn here. So, and I think students, I think most schools just suspend that education or try to find ways of distance learning. And I think that we'll see more of that in the future, the distant learning. But of course, perfusionists still need to be in the UR to learn. That's a challenge for sure. And we do have a question from the chat regarding COVID and use of ECMO at times for it. What has been the prognosis just in y'all's experience? How well is it going? How well do they do? Bill, do you wanna take that one? Yeah, sure. You know, we at first had a triple of ECMO patients about what we expected. And then we thought we plateaued and fairly recently we had a big spike to the point that we were kind of at emergency mode. And a lot of these patients are presenting with long, like long-term proposed ECMO runs. With the perfusion team here is involved with ECMO but we're not really the administrators of that service. So I'm really not 100% confident to speak numbers, but we've put, I think over 20 COVID patients on now so far, but I just don't have the numbers to speak to how well they did. I know there were a few high profile weans off that, you know, we're in the news and stuff like that, which is great. But that's obviously just the tip of the iceberg. And is it predominantly VV? Yeah, we went with VV, fem-fem VV, just because at first it was to protect the folks up at the head. If we were gonna be putting a dual lumina and we didn't want people working so close to the nasal pharynx and stuff like that. So we did fem-fem VV, I think we're still doing that for almost all of our COVID patients. We did have a couple of VA COVIDs with the acute myocarditis, but that all needs to be worked out to figure out exactly what happened there. If I, I can not speak from personal clinical experience, but there is a survey of ECMO for COVID going around in Europe. And I think they have now more than 1,200 ECMO patients in that survey. And I think in beginning, people were really taken, taken aback by the severity of some of these patients of these patients with COVID. But I think now, if I'm not sure, but I think around 50% is the survival rate or the mortality rate, like I think it's a 50-50. I don't know, Bill, if you can speak from that experience or I mean overall, not every center has those figures. I'm curious. I think if you combine and you look at the URL also data and our also.org data across the board right now, discharge home is 54%. And at first I think that, you know, we didn't know how to apply and they were figuring out how to apply ECMO and versus VA, VAV, VV. Now obviously majority, VV of course. And so those numbers have improved as we've defined, kind of, you know, who is the ideal candidate or when to use ECLS support for these COVID-19 patients. But for more information, you know, reference the COVID Task Force webpage, hit the link to ELSO or URLSO and there's great data and information on the entire volume of ECLS use globally. And Justin, you bring up a good topic. What it's ELSO doing for the COVID ECMOs in terms of data capture and also I saw that there was people could participate maybe without paying the usual ELSO participation fees. Can you tell us a little bit about how people could either use ELSO for data to look at or participate with their ECMO patients? Sure, and so participation, it would be a little more challenging, but viewership is available with that initial membership. It's under the, if you are a center of ELSO and you're included there, the data includes those centers. So it's important to know that, yes, we're not gonna be able to capture all of the cases that are COVID-19, but it is a great database of over 500 centers that are submitting their information into this database to give us kind of information on is ECLS proper use and when is it proper use for these patients. So the membership to CCPs, which we're thankful, thanks ELSO for doing that, is waived. So you can go in there, look through the data, join the webinars, potentially contribute at some capacity for a year while this COVID-19 pandemic continues. Thanks for sharing that. I don't think people realize that they can participate without spending money or doing a membership or something like that for this time. We do have another question from the chat for all of you. For your patients, COVID-positive needing surgery, are you changing your anti-coagulation protocols? Is there anything different for the regular heart surgery patients that are COVID? We have not at MGH. I think it's very important to try and not put people on bypass with COVID-19. Of course, there's always these urgencies, but I think you should have tried to avoid it at all costs. And if you have to put them on bypass, I think you really have to be careful, but I have no knowledge of protocols of putting more heparin in or I cannot speak for that. And I think your question is for ECMO, right? Not cardiopulmonary bypass, would that be correct for ECMO? No, actually for cardiopulmonary bypass. Okay, okay. So I think time will tell on that one as we get back to the operating room. Obviously, I think as we learn more through ECLS is the frontline of extracorporeal circulation for these patients. Obviously a lot of places that were maybe, no anti-coagulation for BV ECMO has switched because of this hyper-coagulable state. So hopefully we'll learn that and translate that information to the operating room, but I think we're still a little too early to know because hopefully all these patients that are coming to the operating room are screened for COVID-19 and they're not going to elective heart surgery until negative or antibodies. Yeah, I think also people who are really having a hard time on with anti-coagulation are the real severe patients and hopefully they will not need surgery at that point. So I think it's fair to say we haven't, you all haven't seen one, you haven't done a COVID patient on bypass so far. We've had patients that were COVID risk because they either came to us unable to be tested or with too acute to test. And I think now you need to have two negative tests 48 hours apart in order to be deemed negative. So we have a lot of COVID risk patients, but actually to my knowledge, I don't know that we've had a confirmed COVID patient on cardiopulmonary bypass. There are some... P-U-I's. Sorry. There are some case reports of people getting put on bypass which were unknown to be COVID-19. I think the mortality was really high postoperatively because of the coagulation problems. There was a EBCP webinar yesterday or two days ago where the Alzheimer's gave a talk on that. And there are a few case reports in the literature if you really need to know. And I can say we had one unknown. So it came positive two days later and it was a regular cab. And obviously we didn't know so we didn't do anything different but just one experience. Yeah, as time goes on, it'll be interesting to see if the COVID positive but asymptomatic folks behaved differently on pump from the COVID positive and symptomatic. But I think we're a ways away from how the numbers would need to determine that. I think that's kind of the theme. We've all, as Dr. Coulter pointed out, we've only been at this for 12 weeks or so in the United States, which is why I thought the international component of the task force was so helpful just to know what people ahead of us had experienced and done just to know. I think I agree, the very first webinar was humbling out of New York just to know what they were experiencing, what was happening. I think that's a lot of it. People just kind of fear the unknown and the sharing and just talking about it, I thought was helpful. And I'd ask all of you, what have been your takeaways from the task force and participating, and what have you gotten out of it that you think people should know? I think all three speakers said is that we're set up for the future. It was a lot of hard work in the beginning to organize personnel, get the website going, define content. Now that that's done, I think I'm probably most proud about is that this kind of transcends all organization societies for perfusions on a global level that we can go back and reference this and then build upon it as we face such things as COVID-19 or COVID-20, who knows yet. But I think that's what I take from this is that like you said, the networking, the ability to communicate whether your social distance at home or at the hospital, I think is paramount to its application. Thanks. Yeah, nothing to add to that. Yeah, okay. I think we're at time. So for a live panel, I thought it went pretty good. Thank you so much for doing this and taking it off. Appreciate it. It's from overseas. Yeah. You're welcome. Thank you, T.A. for having us. Yeah, thank you. Thanks. Thank you. Thanks.