Perfusion: supplying of an organ or tissue with nutrients and oxygen by injecting blood or a suitable fluid into an artery.
The word is derived from the French verb “perfuser” meaning to “pour over or through.” During certain procedures, perfusion keeps a patient’s blood flowing by taking it out of the body.
A heart-lung machine, as well as the associated components of an oxygenator, filters, reservoirs and tubing, does the work of the patient’s own lungs or heart.
A perfusionist is responsible for the complex circulatory and respiratory functions of a patient during some cardiac and other procedures requiring bypass of the heart and lungs. The return and preservation of the patient’s own blood is a top priority.
“Basically, the perfusionist uses equipment to pump blood with rich oxygen and nutrients throughout the patient’s body during surgery,” said Mike Wood, one of 13 perfusionists at CAMC. “Whether the patient is older or newborn, whether receiving coronary artery bypass grafting, cardiac valve replacement or surgical correction of a cardiac birth defect, the perfusionist operates the heart-lung machine which replaces the function of the heart and lungs during the procedure.”
This provides a bloodless, motionless organ for the surgeon.
The perfusionist ventilates the patient’s blood to control the level of oxygen and carbon dioxide. In addition, perfusionists constantly monitor many vital signs and physiologic measures to ensure that the
circulatory and respiratory needs of the patient are being met.
The perfusionist training is generally two years in length and requires the completion of a national certification administered by the American Board of Cardiovascular Perfusion. Upon completion of this certification, one earns the title of Certified Cardiovascular Perfusionist and must maintain continuing medical education, competency and recertification every three years. Clinical certification is accomplished by clinical activity each year.
The complexity of the process is highly challenging and requires the use of many safety devices and excellent communications between all members of the surgical team.
Perfusionists further assist cardiac surgeons in standby settings while operations that can be performed off pump are conducted, being there to emergently supply the heart-lung machine and support if
“On a typical day, we arrive early in the morning and prepare a heart-lung machine to support a planned surgery which generally requires one to two hours use of the machine,” Wood said.
However, the entire procedure may last six to eight hours.
“CAMC is in a fairly unique situation,” Wood said. “We employ perfusion assistants who do many of the clinical services such as laboratory analysis, emergent blood salvage and intra aortic balloon pump management in the cardiac cath lab, which frees up perfusionists to do the more complex procedures.”