Indian Society of Extracorporeal Technology

Indian Perfusionists

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Clinical Perfusionist

Cardiac surgery is technically demanding surgery requiring, intricate and complex teamwork which includes Cardiac surgeon, Anaesthetist, Perfusionist, Nurses and other technical support staff.

“Perfusion” from the Latin “Perfusio” means “to pour through”. In the human body, the heart and the lungs perform the systemic and pulmonary circulation to sustain life. In the event of cessation of the functions, the perfusionist does this work from outside the patient’s body (extra-corporeal circulation) with the help of the heart-lung machine.

In India, approximately 90,000 heart operations are performed every year with results that are as good as anywhere else in the world. Most of these procedures require temporary stoppage of the heart and lungs during the operation and take-over of their function by a “heart-lung” machine operated by a clinical Perfusionist.

A Perfusionist is a skilled, adequately knowledgeable, allied health professional, qualified by academic and clinical education, to operate the extracorporeal circulation equipment commonly referred to as the heart-lung machine. The Perfusionist is an indispensable member of open heart surgical team responsible for selection, set-up and operation of equipment and techniques necessary for support or supplementation of cardiopulmonary and circulatory system of a patient.

The Clinical Perfusionist is an integral member of the health care team primarily practicing within the scope of Cardiovascular Surgery. In the right sense, patients’ heart surgery not only relieves symptoms but also prolongs their life. The success of heart surgery has evolved through the relentless application of basic science and complex technological innovations; but it is also dependent on the team. It is vital that this team works very closely together in an environment of mutual professional trust and confidence to take the patients through their heart operations, with the best and most appropriate care necessary. Few other professions offer such intimate team relationships coupled with such a high degree of direct personal responsibility.

Perfusionists with high level of skill, decision making, monitoring and operation of mechanical devices play a major part in the successful outcome of cardiac surgery.

Knowledge and expertise shall allow the Perfusionist to assist related health care practitioners with various medical/surgical procedures requiring partial or complete extracorporeal circulation and other related mechanical support.

In depth knowledge of extracorporeal physiology and mechanics, of both the adult and the child, are a critical component of perfusion practice. Supportive knowledge of infection control, hemodynamics, laboratory testing, biochemistry and the administration of appropriate types and quantities of pharmaceutical preparations is essential to render health care to the patient.

The ability to work long hours with short notice, under intensive stress and yet maintain careful concentration may be required of the Perfusionist. Detection of errors and immediate rectification must be the foremost priority. A high degree of discretion and consultation with cardiac surgeon and anesthetist is essential in deciding matters. Effective communication skills with the health care team are essential part of Perfusionist’s day to day activities.

Perfusionist has the direct responsibility to achieve and maintain a high level of current knowledge and technique through accredited and recognized academic and clinical education and practice.

The perfusionist must have the decisive ability to make frequent and potentially serious decisions in dealing with technical problems that may arise.

Perfusionists are often consulted by surgical team in the planning of operations and are encouraged to contribute to their perspective at any point in the procedure, when confronted with complex cases for patients with a variety of medical problems.

Due to their unique skills and experience in this clinical field, the Clinical Perfusionist has outgrown the mere running of extracorporeal circulations and has taken over a pivotal role in circulatory support, in the monitoring of vital parameters, in intra-operative blood processing techniques, in the interpretation of blood gas and blood chemistry values, in organ transplantation, in documentation and statistics, and in the participation in research.

Extracorporeal technologies (outside the body circulation) such as Extra-corporeal membrane oxygenation (ECMO), Ventricular assist device (VAD), auto transfusion (Cell saver) and Intra-aortic balloon pump (IABP) and HIPEC machine (Used during peritoneal, ovarian and isolated limb perfusion) are an integral part of the Perfusionist’s practice. Last but not the least, the very pumping action of the heart is preserved by the perfusionist. He prepares and gives a solution called cardioplegia which stops the heart in diastole (relaxed phase). By doing so, he not only enables the surgeon to operate on a still heart but also protects the heart muscle, i.e., the myocardium throughout the surgical procedure (ischemia).