Who are Cardiac Perfusionists?

Open heart surgery is one of the most complex and life altering types of surgery that people of all ages may unfortunately require at some time in their lives. It is routinely performed in patients as small as a newborn infant and as large as a full grown adult, and in those of any age group. The duration of some types of open heart surgery can be measured in minutes, while others can be measured in many hours. But regardless of the time it takes the surgeon to repair the heart, all cardiac surgical procedures are multidisciplinary labor intensive events that have no room for error. All of the professionals involved in cardiac surgery have undergone extensive training in their respective fields of expertise. These people are usually well educated, driven individuals who strive to make a difference in health care and prolong the lives of those patients who are placed under their specialized care.

The vast majority of cardiac surgical cases would not be possible without the use of a procedure called cardiopulmonary bypass (CPB), a very complex procedure that is done with the use of the heart-lung machine. Worldwide, it is estimated that there are approximately 1.5 million people placed on cardiopulmonary bypass (CPB) every year. In the United States alone, the number of these CPB procedures is somewhere between 300,000 and 500,000 cases annually. Generally, males make up approximately 70% of these CPB procedures, and females make up the remaining 30%. The unique professionals responsible for the conduct and operation of cardiopulmonary bypass in every country around the globe are called Cardiac Perfusionists.

The Cardiac Perfusionist is responsible for placing the patient on cardiopulmonary bypass after the surgeon has inserted a cannula into the patients large artery and large vein. This Perfusionist then takes over and maintains the patient's life support during the period of surgical repair when the patient’s heart is completely arrested (stopped) and their breathing machine has been turned off to allow the lungs to deflate. 

All Cardiac Perfusionists are either board certified by their individual national governing bodies or licensed to practice in their individual respective states. Prior to entering a 1-2 year college or university based School for Perfusion program, most of these individuals had been previously practicing as a Registered Respiratory Therapist (RRT) or a Registered Nurse (RN), professions that usually require the completion of a 4 year Bachelor’s degree. Over the past 10-15 years, all perfusion student candidates must now possess a 4 year Bachelor’s degree in some Science or Health Related field before entering a School for Cardiac Perfusion. Many Perfusionists further their education and medical knowledge by obtaining their masters or doctorate degrees in Perfusion.

Around the globe, perfusionists are recognized and respected by their peers in cardiac surgery but their title designations may differ from country to country. For example, in Canada, perfusionists are legally designated as Clinical Perfusionists with a national governing body called the Canadian Society of Clinical Perfusion. In the United States, perfusionists are legally designated as Cardiovascular Perfusionists, with a national governing body called the American Board of Cardiovascular Perfusion. In England and Ireland, the perfusionists are legally designated as Clinical Perfusion Scientists, with an international governing body called the Society of Clinical Perfusion Scientists of Great Britain and Ireland. While in most of Europe, the perfusionists are legally designated as Cardiovascular Perfusionists, with an international governing body called the European Board of Cardiovascular Perfusion. In most other countries around the globe they are usually referred to as Cardiovascular Perfusionists.

The obvious question at this point would be … ‘What exactly does a perfusionist do during cardiac surgery’?

Using the heart lung machine to perform and control such functions as cardiac output, blood pressure, organ perfusion and body/heart temperatures; the perfusionist manages a complex array of other devices to perform the functions of the lungs, control the patient’s fluid balance and provide life support for as long as the surgeon needs to complete his/her surgical repair. The perfusionist adjusts and monitors the patient’s acid base balance, physiology, brain function and body/heart temperature, using appropriate measures, technology and drugs to control this complicated environment. This includes protecting the patient’s heart by delivering a pharmacologically balanced solution that cools and temporally paralyzes that heart to protect it from damage, which then allows the surgeon to operate on a still, non-beating heart. This period of CPB requires a perfusionist to monitor, manage, maintain and document all aspects of the patient’s life functions, and minimize blood loss in preparation for when the perfusionist removes the patient from this extracorporeal form of life support.

In the operating theater and post op intensive care units, perfusionists are also responsible for the operation of the Intra-Aortic Balloon Pump, which is a catheter the surgeon or cardiologist inserts into the patients aorta to help reduce the work of a weak heart and increase blood flow to the heart's coronary arteries. They are also responsible for the operation of devices called Autotransfusion machines that are used in many other types of surgery other than cardiac, to collect most of the blood lost during surgery and then return this blood to the patient after washing and processing it. Both in the operating room and in the subsequent clinical setting, perfusionists are also responsible for operation/monitoring of devices called right and left ventricular assist devices (RVAD and LVAD). These devices essentially act as the patient’s right and/or left ventricle for short or extended periods of time until either the heart recovers or the patient is transplanted by a donor heart. Outside the operating theater, perfusionists are also responsible for the set up and care of maintaining the cardiac output and lung function of critically ill patients (eg. COVID-19) in the intensive care unit through a process called Extracorporeal Membrane Oxygenation (ECMO). This ECMO procedure can go on for hours, days, weeks or even months, and is most frequently done in the pediatric population, but is growing in use with the adult population as well. Due to the extended time and care ECMO requires, many perfusion programs have elected to train other professionals (eg. nurses, respiratory therapists, etc.) to take over this task and become ECMO Specialists.

Cardiac Perfusionists also have a role in some cancer treatments. Hyperthermic Isolated Limb Perfusion for some melanoma's require a perfusionist to perfuse and circulate powerful chemotherapy drugs through a patients leg, after the surgeon has isolated that leg from the rest of the patients circulation. Similar types of chemotherapeutic perfusion, called Hyperthermic IntraPeritoneal Extracorporeal Circulation, is used to circulate fluids in the abdominal cavity of patients undergoing surgery for certain intestinal cancers.

Unfortunately, it has been my experience over the past 40 years; that in spite of maintaining a critical and irreplaceable role in cardiac surgery, most perfusionists have always preferred to maintain a low profile in the public eye. The unfortunate truth about this low profile is that it is sometimes unintentionally perpetuated by their own medical colleagues. If you or someone you know has had heart surgery requiring Cardiopulmonary Bypass, ECMO, an Intra-aortic Balloon Pump, Autotransfusion or an RVAD/LVAD device implanted … you have been managed and cared for by a Cardiac Perfusionist in a manner that no other health care professional can duplicate.