In operating rooms around the world, dedicated cardiac surgeons perform skillful feats that save lives, but they cannot do it alone. There is a whole team of people in the operating room, each with a critical role to play in seeing patients through an operation. One of the most important roles on this team is the Perfusionist—the person who knows how to operate the machines that keep a patient alive during serious procedures such as open-heart surgery.
When an operation needs to be performed which involves stoppage of a patient’s heart or lungs, Perfusionist maintains oxygenated blood circulation flowing to vital organs such as the brain, kidneys, liver and intestines with the help of the heart-lung machine. Perfusionist who operates the heart-lung machine blends his mind with the machine without deviating from the very normal physiology of the patient.
The perfusionist sets up the heart lung machine prior to the case, primes it with IV fluids, necessary buffering drugs and de-bubbles the circuit. The heart lung machine is connected by tubing to the patient's heart during most heart surgeries, and it circulates oxygenated blood to the tissues and removes carbon dioxide from them.After a surgeon connects the patient to the equipment, perfusionist cool down the patient to the desired temperature and occludes the blood supply to the heart following the administration of “cardioplegia” to stop the heart so that the surgeon can operate on it safely. Thus, the patient’s blood circulation continues uninterruptedly till the surgeon finishes operation on the heart. During the surgery perfusionist monitors the blood gas status, blood glucose levels, electrolytes and blood pressures throughout the extra-corporeal circulation period and take appropriate corrective measures.
“Healing Hearts: A Memoir of a Female Heart Surgeon” is a book written by a Heart surgeon. she says at some point that next to her, Perfusionists that is THE most important person in the OR, because if they don't do their job right, the patient will die.
Perfusionists interact with surgeons to select and operate the appropriate equipment needed for surgical procedures. They also monitor blood coagulation factors and operate machines that conserve blood and blood products. Besides operating the machine, the perfusionist also has the crucial role of keeping the surgical team and anesthesiologists informed about the patient’s circulatory status. If the patient’s circulation becomes compromised during the procedure, the perfusionist takes corrective measures and administers any needed medicines or blood products through the heart-lung machine.
A Perfusionist is someone who brings his/her full attention to the task at hand, who is mindful, who respects their position of responsibility and who engages with the care team in the most constructive way possible.
A Perfusionist is not easily distracted; vigilance is the most important characteristic that we must possess. ALWAYS ALERT (“SEMPER VIGILIS”-Latin) is the motto of ISECT.
The Clinical Perfusionist role is centered on the management and supervision of the heart lung machine during heart surgery. However, with the development of extracorporeal circulatory techniques and the increased expertise of Clinical Perfusionists, their role has been extended beyond the operating room to manage extracorporeal membrane oxygenation (ECMO) machines for patients in the Intensive Care Unit (ICU). Placement of ECMO also becomeslifesaving option in even non-cardiac cases like acute respiratory distress syndrome (ARDS). They also help place and manage ventricular assist devices (RVAD, LVAD, BIVAD) in patients. In some health care systems, perfusionists even play a role in obtaining donor organs for heart and lung transplants. Without the pivotal knowledge and skills of perfusionists, many vital medical procedures in modern medicine simply would not be feasible.
Autotransfusion (Cell Saver) is utilised during procedures when significant amounts of blood loss are expected. Autotransfusion allows otherwise discarded blood to be collected, processed, and reinfused to the patient. This procedure salvages amost valuable biological resource, reduces the need for bank bloodand reducing potential for transmission of blood-borne diseases or allergic reactions. The Perfusionist independently operates this device ensuring a safety of the patient’s own blood.
The Clinical Perfusionist will manage and operate mechanical cardiac assist devices including Intra-aortic balloon pump (IABP). The intra-aortic balloon pump is a device inserted into the descending aorta to assist the failing myocardium. The Perfusionist independently monitors and is available for insertion procedures and trouble-shooting this device.
Ventricular assist devices (VAD) provide cardiac output support. These pumps augment the function of the left or right ventricle or both ventricles, supporting the patient as a bridge to transplant, recovery or destination therapy. The Perfusionist deals with implantation, equipment changes and troubleshooting.
Perfusionists have been involved in the post-operative management and care of patients with these devices, along with patient and family education.
Extra Corporeal Membrane Oxygenation (ECMO) is an expanding area of the Perfusionist role. Over years, the use of extracorporeal circulation has increased steadily in the treatment of cardiac and respiratory failure in critically ill patients of all ages. The concept of extracorporeal life support is simple, but the procedure itself is complex. ECMO is rather therapeutic and not identical to standard operating theatre cardiopulmonary bypass.
People remember reading that some H1N1 patients were placed on ECMO after suffering such severe lung damage that they could not be adequately ventilated. They even extubated a few of these patients and they were conscious while on bypass for days.
Isolated Limb Perfusion and hyperthermic peritoneal chemotherapy (HIPEC) is a method of treating cancer patients, by delivering high dose chemotherapeutic agents, at high temperature, to the site of tumor growth bythe Clinical Perfusionist via an extracorporeal circulation. The Perfusionist potentiate the effectiveness of the therapy by careful control of many different aspects of the circulation.
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