Indian Society of Extracorporeal Technology

Indian Perfusionists

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Perfusionist At Job

“Five more minutes and they would not have made it” can often be said following Perfusionist interventions.

Perfusionists frequently make all the difference in the patient who is five minutes away from losing his life. The classic example is a young boy who contracted acute viral Myocarditis. He had been shifted urgently to our hospital, given 150 DC shocks and was still unable to maintain blood pressure, and was put on Extra-corporeal membrane oxygenation (ECMO). The patient had to be cannulated immediately upon arrival. After he was stabilized on ECMO for three days his heart rhythm became regular and he was weaned from ECMO. Today, he is leading a perfectly normal life which would be impossible without the Perfusionist. However, he would not be alive today if it were not for perfusion science. These miracles are what motivate perfusionists, to do what they do.

Even in our day to day routine, Off-pump CABG (OPCAB), where Perfusionist usually will be on stand- by like the border security force. If any untoward incident happens and patient is not able to maintain Haemodynamics, then Perfusionist is the only one who can intervene to save the patient.

During cardiopulmonary bypass (CPB), the perfusionist may administer blood products, anesthetic agents, or drugs through the extracorporeal circuit on prescription and/or appropriate protocol. The perfusionist is responsible for monitoring the blood gases at various low body temperatures which is not an easy task. Since CPB is done under anti-coagulation conditions, he also monitors adequate anticoagulation of the patient, induction of hypothermia, haemodilution, and other duties, when prescribed. His duty includes administrative abilities in purchasing materials, supplies and equipment that are required. Final medical responsibility for extracorporeal perfusion rests with the surgeon in charge.

All open heart operations performed require the expertise of the Perfusionist. These operations can vary from heart valve repair or replacement (MVR, AVR), coronary artery bypass graft surgery (CABG), to heart and heart-lung transplantation. The age of the patient can vary as well from adults to the new born who may have been born with malformations of the heart requiring corrective cardiac surgery.

Daily activity of a Perfusionist

A typical day starts at 7:30 with checking the operating list, going through patients case notes and details and ensuring that there are no surprises waiting for us with this particular surgery, Calculating the patient’s Body surface area thereby determining the blood flow rates and deciding on appropriate disposables required, assembling the Oxygenator along with blood cardioplegia delivery (BCD) system and priming the heart-lung machine and haemoconcentrator. The surgeon will insert canulae (tubes) into the big veins around the heart and the aorta. These are connected to the tubing of the heart-lung bypass machine. Then we bypass the heart, drain all the blood out of the body, away from the heart, put it through an artificial lung (oxygenator) and pump(heart) it back into the aorta. We take over the function of the heart and the lungs. Perfusionists infuse cardioplegia that stops the heart so that the cardiac surgeon can operate on a still and blood less Heart. Once the surgery is over the heart starts beating normally and slowly the patient is weaned off from Cardiopulmonary bypass.

Necessary Skills and Qualities

Perfusionists help keep critically ill and medically unstable patients alive. Good perfusionists know how to keep a level head during tense situations in order to focus on what must be done to keep a patient alive. Perfusionists keep themselves healthy and fit in order to have superior stamina and mental focus, staying alert during operations that could last as long as 6-8 hours or more. The best perfusionists have a naturally scientific orientation with the ability to pay very close attention to the smallest details. Excellent communication abilities in a close knit team environment are needed for perfusionists. It is a demanding but ultimately very rewarding career in the field of medicine.

Rewarding moments

The personal satisfaction of knowing that you are doing something which contributes to society in a useful and positive way, in spite of the occasional bad outcomes and stress and long hours that you may work. Being able to work independently contributes to high levels of job satisfaction among Cardiovascular Perfusionists.

Time spent in operating theatre

Depends on the type of surgery. For closure of a small hole in the heart it can be 3 hours. If it is for complex reconstructive surgery on a small, newborn baby then it can be anything up to 7 or 8 hours. The average length of a cardiac operation is about 4 - 5 hours.

Unique stresses that a Perfusionist faces

Cardiac perfusionists may have to be on-call as a physician would, and they typically don’t keep steady work schedules, which can affect quality of life, that makes for unpredictable hours, including weekends, evenings and holidays. On top of handling scheduled surgeries, perfusionists work on emergency cases in a hospital operating room, intensive care unit or ER. It does interrupt your social life.

The perfusionist has to be an enthusiastic problem solver on a constant mission for maximum efficiency. Perfusion as opposed to the other medical professional has its uniqueness and pronounced amount of critical thinking.

Awareness of medical/legal responsibilities and accountability of perfusion practice is an integral aspect of daily activity.

Opportunities beyond Perfusion

Some perfusionists choose to pursue additional education or training that enables them to assume supervisory roles in medical administration while others go on to careers as perfusion educators. Some perfusionists also choose to work for medical product manufacturing companies, developing the perfusion equipment that saves lives or working in the marketing and sales divisions. Perfusionists who manage departments oversee budgets, equipment purchases, hiring and staff scheduling.

There is nothing more humbling for us than the trust placed in us by the patients we care for, regardless of the fact that it is often done anonymously.

Thus, although Perfusionist plays a vital role in the cardiac surgical team, his very presence is not revealed to the outside world.