What Does A Perfusionist Do?
A perfusionist is a healthcare professional who has been extensively trained to operate a heart-lung machine known as the extracorporeal circulation and autotransfusion equipment. This highly-sophisticated machine is used in surgical procedures when the surgeon needs to work on a still heart. The perfusionist operates the heart-lung machine which basically acts as the patient’s artificial heart while the operation is going on. The cardiopulmonary bypass machine, as it is also called, functions by redirecting the blood away from the heart and lungs, putting in oxygen to the blood and then allowing it to go back to the rest of the body—all while allowing the surgeon to operate on a “dead” heart.
As a member of the surgical team, the perfusionist essentially allows the surgeon to concentrate on the surgery and not on the physiological and metabolic needs of the patient which they take care of. Some of their tasks involve administering blood products, monitoring blood gases and ensuring that sufficient anticoagulation is attained. Under the supervision of anesthesiologists and the cardiovascular surgeon, perfusionists may also administer anesthetic agents and medications through the heart-lung circuit. When directed to do so, they are also responsible for inducing hypothermia, undertaking hemodilution and other tasks. All throughout the procedure, perfusionists need to see to it that the machine is functioning correctly in order to keep the patient alive.
Aside from monitoring the heart-lung machine, the perfusionist is responsible for informing the surgical team about the condition of the patient. In case there are changes in the patient’s condition that would compromise his safety, the surgeon will instruct the perfusionist to take the necessary action to stabilize the patient.
Before the surgical operation starts, perfusionists are responsible for seeing to it that the heart-lung machine is ready to be used. They may also be asked to attend a pre-surgery briefing with the rest of the medical team to discuss the operation that will be undertaken on the patient. After the surgical operation is over, they will still need to monitor the machine in the event that the patient will still be hooked to it.
Perfusionists are also responsible for putting patients on ventricular assist devices. These are electromechanical circulatory devices that can replace the function of the heart partially or completely. These devices are often used by patients awaiting heart transplant or as a bridge to recovery. Perfusionists may also play a supportive role in patients who are undergoing lung or liver transplants. They may also play a role in procuring cardiothoracic donor organs that are needed for transplant operations. They may also be assigned to take care of patients in the Intensive Care Unit who are placed on extracorporeal membrane oxygenation machines because of impairments of their heart and lungs. Perfusionists are also trained to operate and manage intra-aortic balloon pumps.
As an integral member of the cardiac surgery team, perfusionists may assist not only in adult cardiopulmonary bypass procedures. They may also play a role in pediatric surgical operations to treat conditions like atrial and ventricular septal defects, tetralogy/pentalogy of Fallot, hypoplastic left or right heart, transposition of the great vessels, coarctation of the aorta, interrupted aortic arch and aortic valve disorders, among others. They may also play a role in cardiac and lung transplants of young children. It’s important to understand that while the perfusionist is responsible for operating the heart-lung machine in any of these procedures, the surgeon in charge takes final medical responsibility for the entire surgical operation.
When not in the operating room or intensive care unit, perfusionists may be tasked with keeping track of the department’s inventory, buying equipment and supplies and managing personnel.
Perfusionists need to draw on their training in order to become efficient and effective members of the cardiovascular surgery team. Aside from the need to remember how to operate the machine correctly, they must be able to work well under intense pressure. They must also have the presence of mind to do the things that need to be done when emergencies happen in the operating room. They must also have the physical stamina to still be able to function accurately in surgical operations that could last for more than three hours.