Perfusionist

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Perfusionist

A perfusionist, also known as a clinical perfusionist, is a trained health professional who operates the heart-lung machine during cardiac surgery and other surgeries that require cardiopulmonary bypass.

The perfusionist is a highly trained member of the cardiothoracic surgical team which consists of cardiac surgeons, anesthesiologists, physician assistants, surgical technicians and nurses. The perfusionist's main responsibility is to support the physiological and metabolic needs of the cardiac surgical patient so that the cardiac surgeon may operate on a still, unbeating heart. This is accomplished through the utilization of the heart-lung machine, as well its associated components of an oxygenator, filters, reservoirs and tubing. The perfusionist is solely responsible for the circulatory and respiratory functions of the heart-lung machine. In addition, there is a spectrum of physiologic parameters that are constantly monitored by the perfusionist that ensures that the circulatory and respiratory needs of the patient are being met and allows the cardiac surgeon to focus on the actual surgical procedure and less on the immediate needs of the patient. Other responsibilities include autologous blood collection and processing, implementation and management of the intra-aortic balloon pump, adult and infant extracorporeal membrane oxygenation (ECMO) as well as monitoring of anticoagulation, electrolyte, acid-base balance and blood-gas composition. In many tertiary hospitals, perfusionists are also key personnel in placing and managing patients on ventricular assist devices as bridge to recovery or heart transplantation and supporting patients receiving lung or liver transplants. In certain hospitals, perfusionists can be involved in procurement of cardiothoracic donor organs for transplantation.

Training and certification of perfusionists

In the United States, a bachelor's degree, or sophomore level prerequisites with concentrations in biology, chemistry, anatomy and physiology are required to begin training in a perfusion program. As of 2006, there were 21 perfusion training programs in the United States. Training typically consists of two years of academic and clinical education. Although structure of and training philosophies of perfusion programs differ, typically a perfusion student will begin their training in a didactic fashion in which the student will closely follow instructions from certified clinical perfusionist in the confines of a cardiac surgical operating room. Academic coursework may be concurrent or precede this didactic clinical instruction, and is equally vital for their training. Early in their clinical training, the perfusion student may have little involvement in the cardiac surgical procedure outside of an observational role. However, as time progresses more tasks may be incrementally delegated to the perfusion student. These added responsibilities in the clinical environment are delegated to the perfusion student with the ultimate goal of producing a capable and competent perfusion student. Once a perfusion student graduates from a perfusion program, he or she is not a certified clinical perfusionist and must begin the certification process. In the interim, the perfusion graduate is typically referred to as board eligible, which is sufficient for employment in cardiac surgery with the understanding that advancing their status to a certified clinical perfusionist is required for long-term employment. Most hospitals or perfusion employers have stipulations on the duration of board eligible status for an employed perfusionist.

A two part exam is required to become a certified clinical perfusionist and use the designation C.C.P. In the United States, this exam is administered and evaluated by the American Board of Cardiovascular Perfusion. Similar governing bodies exist in other countries with comparable examination processes. The first portion of the two part process is the Perfusion Basic Science Exam, and the latter or second portion is the Clinical Applications in Perfusion Exam. In order to qualify for this examination process, a perfusion student must have either graduated from or be enrolled in an accredited perfusion training program, as well as having participated in a minimum of 75 clinical procedures during the course of their training A perfusion student may qualify for the Perfusion Basic Science Exam before they actually matriculate from their respective training program. Once employment is provided, and the perfusionist has participated independently in a minimum of 50 clinical procedures, he or she can qualify for the Clinical Applications in Perfusion Exam Once the Clinical Applications in Perfusion Exam has been successfully passed, a perfusionist can use the designation C.C.P. In addition, there are recertification requirements for perfusionists in which proof of a minimum number of clinical procedures and attendance to scientific or educational meetings must be provided to a certifying body(i.e. American Board of Cardiovascular Perfusion). These recertification requirements and subsequent verification process occurs every three years and is mandatory to maintain certified status and use the designation certified clinical perfusionist. As August 2006, there were 3,328 certified perfusionists in the United States according to 2006 Annual Report of the American Board of Cardiovascular Perfusion.

In Canada, there are two training programs which are located in Toronto, Ontario and Montreal, Quebec. Applicants to the Michener Institute program in Toronto must have a bachelor's degree. The training program is 16 months to two years. The perfusion program of the Université de Montréal is a four year bachelor's degree in medical science of with 30 credits are specific to clinical perfusion.

Clinical procedures

Perfusionists can be involved in a number of cardiac surgical procedures, select vascular procedures and a few other surgical procedures in an ancillary role. In the realm of cardiac surgery, perfusionists perform cardiopulmonary bypass in adult and pediatric surgical procedures, which constitute the majority of procedures that perfusionists perform. Pediatric surgical operations may included, but may not be limited to the following: Atrial Septal Defects, Ventricular Septal Defects, Tetralogy/Pentalogy of Fallot, Truncus Arteriosus, Transposition of the Great Vessels, Cardiac Transplants, Lung Transplants, Coarctation of the Aorta, Interrupted Aortic Arch, Hypoplastic Left/Right Heart, Sub-Aortic Membranes, Mitral Valve Disorders, Aortic Valve Disorders, Anomalous/Single Coronary Artery, Vascular Ring, Extracorporeal Membrane Oxygenation(ECMO) and staged palliative procedures of the aforementioned. Adult surgical operations may include: Coronary Artery Bypass, Aortic Valve Replacements, Mitral Valve Repair/Replacement, Tricuspid Valve Repair, Aortic Root Replacements, Atrial Myxomas, Dissections/Aneurysms/Trauma of the Aorta(Ascending, Arch & Descending), Renal Cell Carcinoma/Obstructive Vena Cava, Veno-Venous Bypass(i.e., Liver Transplants), Cardiac & Lung Transplants, Implants of Ventricular Assist Device and ECMO. Select ancillary procedures in which perfusion techniques and/or perfusionists may be involved in can be Isolated Limb Perfusion, Hyperthermic Chemotherapeutic Intraperitoneal Lavage and Tracheal Resection/Repair.