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Perfusion Education

History of Perfusion Education in India

In various parts of the world, Perfusion has evolved in a different manner with different practices and India is no exception. Cardiovascular perfusion was then performed by a variety of persons with varying qualifications and experience.

In initial period of the history of cardiac surgery in India the assistant surgeon or anesthesiologist used to handle the CPB system. Later they trained some paramedic like an theatre assistant or any other paramedic were deployed as a Perfusionist. There were no formal training centers in the country. They got training under a surgeon, and certified by their Association.

The efforts to provide scientific education and training in perfusion technology were initially made by the Christian Medical College, Vellore in the early 1980s by starting a diploma course in perfusion technology. Later on in 1986, the same was extended to King Edwards Memorial Hospital at Mumbai. In 1990, the Indian Association of Thoracic and Cardiovascular Surgeons and Medtronic, Inc. started a one-year course which included an initial six months of training in basic medical sciences theory and six months practical training in perfusion at any reputed institute.

Perfusion education in India has come a long way from the initial phase when there were no formal training programs, only on-the-job training. Now there are a multitude of courses like Bachelor's degree, Master's degree, Post Graduate Diploma etc.

The mission for Perfusion education is to train competent, focused and highly-skilled perfusionists. Using evidence-based medicine, the program will produce graduates to perform the duties and responsibilities of a cardiovascular perfusionist in a variety of clinical settings.

The academic integrity is one of the most important values and behaviors that should be practiced by students during their academic and clinical education. Integrity and honesty are especially valued in the healthcare profession because they are greatly dependent upon a health practitioner's honest and capable management. The students who was dishonest in their educational and clinical pursuits is at great risk for making costly mistakes and such errors can mean that someone's health care is mismanaged.

Presently there are hundreds of Perfusion training centers with varying qualifications and varying courses in India. Some institutes train students at Intermediate level (12th Std) which is not at all recommended for Perfusion training. Majorities are imparting Bachelor degree (B.Sc.) in perfusion, few are conducting Post graduate diploma and few are conducting Masters in Perfusion (M.Sc.).

Indian society of extracorporeal technology (ISECT) is committed to the upliftment of clinical perfusion profession by offering academic guidelines to upcoming institutions which are running clinical perfusion training programme. ISECT is holding continuous deliberations with ministry of Health, Government of India for standardization of clinical perfusion profession in India.

ISECT arrived at Guidelines for starting the clinical perfusion course after deliberations with the bodies of Indian association of cardiothoracic and vascular surgeons and Indian association for cardiothoracic anesthesiology.

Guidelines for Perfusion Training program

Admission criteria

For B.Sc. Perfusion

Course duration: Three and half years

Qualification for Admission: should be 12th standard science in biological subjects

For M.Sc. Clinical Perfusion

Course duration: Two years

Qualification for Admission: B.Sc. Perfusion or Post graduate diploma in perfusion technology.

For Post Graduate Diploma in Perfusion

Course duration: Two years

Qualification for Admission: B.Sc. Degree in Biological science

  • The admissions are to be restricted to in the ratio of one operation theatre/ one perfusionist/ one student only.

  • The faculties should be of a Senior Perfusionist Tutor, Cardiac Anesthesiologist and Cardiac Surgeon. Following teaching faculties should be available to teach students of Perfusion Technology Course. e.g. Anatomy, Physiology, Pharmacology, Pathology, Bacteriology or Microbiology, Perfusion Technology

  • The board of examiners should be consisting of 2 Senior Perfusionists, who are already involved in teaching and training of Clinical Perfusion i.e. one internal and one external apart from a cardiac surgeon and cardiac anesthesiologist.

  • For availability of all clinical material, library is must.

Perfusion training should include

Detailed knowledge of all medical aspects of patients undergoing Cardiopulmonary bypass and to manage these aspects effectively. This includes managing the cardiopulmonary bypass, and medications given via the heart-lung machine during this period.

Understanding principles of operation and design of perfusion equipment like Heart lung machine, Hemotherm and other equipment operated by a Perfusionist.

Training in assembling CPB circuit, Cardioplegia, Arterial filter, Hemoconcentrator and priming them in proper manner to deair meticulously. They must also understand the principles of operation and design of other circulatory support equipment and be able to assemble and operate it as needed.

Essential areas of physiological and pathophysiological management include optimisation of cardiovascular parameters, gas exchange, acid base management, glucose and electrolyte balance, coagulation and blood conservation requirements and the administration of blood and blood products.

Assembling and operating of equipment like cell savers, haemofilters, intra-aortic counter-pulsation devices, extracorporeal membrane oxygenation devices and ventricular assist devices is required.

Log book must be kept during training, to include details of procedures attended and activities of the year.

Minimum of 50 cases should be performed under supervision of senior perfusionist.

Training must include simulation of critical scenarios like main pump head failure, gas in the patient circuit, oxygenator change out. They must demonstrate that they are competent to manage these situations.

Clinical Perfusion Training

Clinical education is a major component of perfusion program. Working closely under the supervision of Senior Perfusionists you will have the opportunity to integrate knowledge and skills into practice during the clinical phase of your program. Clinical training will give you hands-on experience in real work environments.

Institutes providing perfusion training program without Cardiac surgery specialty in their hospitals are lacking Clinical practice for their students. A Perfusion training program without clinical exposure should be avoided.

In India Perfusion Training centers without clinical exposure are surviving because there are no government guidelines to regulate perfusion training programs. It is duty of the students to join only those Hospitals/institutes who have Cardiac surgery speciality and which can impart in house clinical training.

Study of the techniques of perfusion, perfusion equipment and clinical applications. Specific emphasis on clinical pathophysiology of cardiopulmonary bypass to be reviewed. Infection control, blood borne pathogens, and risk management are also covered.

Training students in the use of ethics and professionalism. Improving the ability of students to be sound in health professional ethics, competent in critical thinking and to communicate clearly about ethical values, integrity, and judgment.

Advanced clinical exposure in ECMO, hemostasis management, blood conservation techniques, ventricular assist, all aspects of cardiopulmonary support, emergency bypass.

Instructing perfusion technology courses, requires faculty who have minimum of 15 years clinical perfusion experience and is certified member of ISECT.

Why Perfusion course is in demand?

Perfusionists are highly paid paramedics in health care, so there is a financial motivation to enter this profession. That is why we see may allied health professionals switch to this profession. It is well known that with experience in this field chief perfusionists command large salaries. But if a fresher is looking at above case and joining this profession then you are choosing a wrong profession.

Why so many Perfusion training centers and Perfusion students in India?

  • ISECT in their own capacity has been pushing for Perfusion council formation such that there can be a regulation in running these Perfusion training programs.

  • ISECT is united together to do the needful for our upcoming perfusionists.

  • Information given above is for right direction to aspiring Perfusionists in the interest of the future of India.

ISECT in their own capacity has been pushing for Perfusion council formation such that there can be a regulation in running these Perfusion training programs.

ISECT is united together to do the needful for our upcoming perfusionists.

Information given above is for right direction to aspiring Perfusionists in the interest of the future of India.

Perfusion Education in India Survey Map

This is a survey of perfusion education in India conducted by Mr. P. Mathavan, Senior Perfusionist, Department of CTVS, JIPMER Hospital, Pondicherry in 2015.