Editing Perfusionist

{{Short description|Healthcare professional who uses the cardiopulmonary bypass machine}}
{{more citations needed|date=October 2018}}
[[Image:Coronary artery bypass surgery Image 657C-PH.jpg|thumb|right|320px|A '''perfusionist''' in front of a [[heart–lung machine]] (upper right) early in a [[coronary artery bypass surgery]]]]
A '''cardiovascular perfusionist''', '''clinical perfusionist''' or '''perfusiologist''', and occasionally a '''cardiopulmonary bypass doctor'''<ref>{{cite web |url=https://www.eacts.org/faculty/yuri-ganushchak-2/ |title=Yuri Ganushchak |website=eacts.org |publisher=European Association for Cardio-Throacic Surgery |access-date=1 April 2019}}</ref><ref>{{cite book |title=Beating Heart Bypass Surgery and Minimally Invasive Conduit Harvesting |isbn=978-3-7985-1399-0 |publisher=Springer Science & Business Media |editor-last1=Gulielmos |editor-first1=Vassilios |page=179 |date=31 October 2008}}</ref> or '''clinical perfusion scientist''',<ref>{{cite web |url=https://www.healthcareers.nhs.uk/explore-roles/healthcare-science/roles-healthcare-science/physiological-sciences/clinical-perfusion-science |title=Clinical perfusion science |website=healthcareers.nhs.uk |publisher=[[Health Education England]] |access-date=1 April 2019|date=2015-03-25 }}</ref> is a [[healthcare professional]] who operates the [[cardiopulmonary bypass]] machine (heart–lung machine) during [[cardiac surgery]] and other surgeries that require cardiopulmonary bypass to manage the patient's physiological status.<ref name="thiperf2019" /> As a member of the cardiovascular surgical team, the perfusionist helps maintain [[blood flow]] to the body's tissues as well as regulate levels of [[oxygen]] and [[carbon dioxide]] in the blood, using a heart–lung machine.<ref name="thiperf2019">{{cite web |title=What is a Perfusionist? |url=https://www.texasheart.org/heart-health/heart-information-center/topics/what-is-a-perfusionist/ |website=Texas Heart Institute |publisher=Texas Heart Institute |accessdate=6 May 2019}}</ref>

== Duties ==
Perfusionists form part of the wider cardiovascular surgical team which includes [[cardiac surgeon]]s, [[anesthesiologist]]s, and [[Medical resident|resident]]s.<ref name="fleminvestigate">{{cite journal |last1=Fleming |first1=M |last2=Smith |first2=S |last3=Slaunwhite |first3=J |last4=Sullivan |first4=J |title=Investigating interpersonal competencies of cardiac surgery teams. |journal=Canadian Journal of Surgery |date=February 2006 |volume=49 |issue=1 |pages=22–30 |pmid=16524139 |pmc=3207507 }}</ref> Their role is to conduct [[extracorporeal circulation]] as well as ensure the management of physiologic functions by monitoring the necessary variables. The perfusionist provides consultation to the physician in selecting appropriate equipment and techniques to be used.<ref name="CAAHEP">{{cite web |title=Perfusion |url=https://www.caahep.org/Students/Program-Info/Perfusion.aspx |website=Commission on Accreditation of Allied Health Education Programs |accessdate=6 May 2019}}</ref>

Other responsibilities include administering blood products, administering [[anesthetic agents]] or drugs, measuring selected laboratory values (such as [[blood cell count]]), monitoring [[blood circulation|circulation]], monitoring [[blood gases]], surveil [[anticoagulation]], induction of [[hypothermia]], and hemodilution.<ref name="thiperf2019" /><ref name="CAAHEP" /> Sometimes, perfusionists are granted administrative tasks such as purchasing supplies or equipment, as well as personnel and departmental management.<ref name="CAAHEP" />

=== Involved procedures ===
Perfusionists can be involved in a number of cardiac surgical procedures, select vascular procedures and a few other surgical procedures in an ancillary role.<ref name="thiperf2019" />

[[Perfusionists]] may participate in curative or staged palliative procedures to treat the following pediatric pathologies:

{{div col}}
* [[atrial septal defect]]s,
* [[ventricular septal defect]]s,
* [[tetralogy of Fallot|tetralogy/pentalogy of Fallot]],
* [[truncus arteriosus]],
* [[transposition of the great vessels]],
* [[cardiac transplant]]s,
* [[lung transplant]]s,
* [[coarctation of the aorta]],
* [[interrupted aortic arch]],
* [[hypoplastic left heart syndrome|hypoplastic left]]/[[Hypoplastic right heart syndrome|right heart]],
* [[subaortic membrane]],
* [[mitral valve repair]]/[[Mitral valve replacement|replacement]],
* [[aortic valve]] disorders,
* anomalous/single [[coronary artery]],
* [[vascular ring]],
* [[extracorporeal membrane oxygenation]] (ECMO)
{{col div end}}

Adult surgical procedures may include:

{{div col}}
* [[coronary artery bypass]],
* [[aortic valve replacement]]s,
* [[mitral valve repair]]/[[mitral valve replacement]]
* [[tricuspid valve]] repair
* [[valve-sparing aortic root replacement|aortic root replacement]]s
* [[atrial myxoma]]s
* [[aortic dissection|dissections]]/[[Aortic aneurysm|aneurysms]]/[[Traumatic aortic rupture|trauma of the aorta]] (ascending, arch & descending)
* [[renal cell carcinoma]]/[[obstructive vena cava]]
* [[veno-venous bypass]] (e.g. during [[liver transplant]]s)
* [[cardiac transplant|cardiac]]/[[lung transplant]]s
* implants of [[ventricular assist device]] and [[ECMO]].
{{col div end}}

Select ancillary procedures in which perfusion techniques and/or perfusionists may be involved include [[isolated limb perfusion]], [[intraperitoneal hyperthermic chemoperfusion]] and [[Tracheobronchial injury#Treatment|tracheal resection/repair]].

==Training and certification==
{{more citations needed|section|date=November 2016}}

===United States===
{{See also|American Academy of Cardiovascular Perfusion}}
In the [[United States]], a four-year [[bachelor's degree]] is a prerequisite for admission into an accredited perfusion program, typically with a concentration in [[biology]], [[chemistry]], [[anatomy]] and [[physiology]], varying depending on specific perfusion program.<ref>{{cite web |title=Perfusionist |url=https://explorehealthcareers.org/career/allied-health-professions/perfusionist/ |website=Explorehealthcareers.org |publisher=Liaison International |accessdate=12 February 2019}}</ref> As of 2022, there are 18 accredited perfusion training programs, of which ten are [[master's degree]]s, seven are [[Professional certification|certificate programs]], and one is a bachelor's degree.<ref>{{cite web |title=Commission on Accreditation |url=https://www.caahep.org/Students/Find-a-Program.aspx |website=CAAHEP |publisher=CAAHEP |accessdate=12 February 2019}}</ref> Training typically consists of two years of academic and clinical education.<ref>{{cite web | title = Career Perfusionist: [2] Training & Education | publisher = Perfusion.com | date = 28 March 2012 | url = https://www.perfusion.com/career-perfusionist-training-certification/ | accessdate = 22 April 2020}}</ref> A perfusion student will typically begin his or her training in a [[Didactic method|didactic fashion]] in which the student will closely follow instructions from a certified clinical perfusionist in the confines of a cardiac surgery procedure. Academic coursework may be concurrent or precede this clinical instruction. Early in their clinical training, the perfusion student may have little involvement outside of an observational role. However, as time progresses, more tasks may be incrementally delegated to them. Upon graduating from a perfusion program, the graduate must begin the certification process. In the interim, the perfusion graduate is typically referred to as board-eligible, which is sufficient for employment in cardiac surgery with the understanding that achieving certified status is required for long-term employment. Most employers have stipulations on the duration of board-eligible status.

To become certified as a certified clinical perfusionist, a perfusionist must undergo a two-part exam administered by the [[American Board of Cardiovascular Perfusion]]. The first part is the Perfusion Basic Science Exam and the second part the Clinical Applications in Perfusion Exam. The exam process is open to a perfusion student that has graduated or about to graduate from an accredited perfusion education program. In addition, a perfusion student must have participated in a minimum of 75 perfusions during the course of their training before sitting for the Perfusion Basic Science Exam and performed 40 independent perfusions after graduation before sitting for the Clinical Applications in Perfusion Exam.<ref name="ccp">{{cite web|url=http://www.abcp.org/certification_.htm|title=Certification|publisher=American Board of Cardiovascular Perfusion|accessdate=1 April 2019}}</ref> Upon passing the Clinical Applications in Perfusion Exam, the perfusionist is designated a certified clinical perfusionist.

Following certification, perfusionists must be recertified every year by attaining minimum clinical and educational requirements.<ref>{{Cite web|url=http://www.abcp.org/recert_clin.htm|title=Recertification- Professional Activity|access-date=1 April 2019}}</ref> Proof of fulfillment of these recertification requirements must be submitted to the American Board of Cardiovascular Perfusion and are mandatory to maintain certified status to use the designation.

[[File:Perfusionist opearting heart lung machine.jpg|thumb|250px|Perfusionist operating a modern heart–lung machine]]

As of February 2010, there were 3,766 certified perfusionists in the United States and approximately 300 certified perfusionists in Canada.<ref>{{cite web
 |url         = http://www.abcp.org/cert_listing.htm
 |title       = Clinical Perfusionists Currently Certified by the American Board of Cardiovascular Perfusion through December 31, 2010
 |publisher   = American Board of Cardiovascular Perfusion
 |accessdate  = 2010-02-15
 |url-status     = dead
 |archiveurl  = https://web.archive.org/web/20100213011801/http://www.abcp.org/cert_listing.htm
 |archivedate = February 13, 2010
}}</ref>

===Canada===
In [[Canada]], there are three training programs: [[Burnaby]] in [[Western Canada]], [[Toronto]] and [[Montreal]] in [[Eastern Canada]]. [[British Columbia Institute of Technology]] in Burnaby offers an advanced specialty certificate in cardiovascular perfusion to graduates of its two-year program. Applicants must be certified respiratory therapists, critical care nurses, or cardiac professionals with two years or more of current experience in cardiac critical care. Applicants to the [[The Michener Institute|Michener Institute]] program in Toronto must have a [[bachelor's degree]] at minimum, with or without respiratory therapy, nursing or other clinical certification. The master's program is two years. The perfusion program of the [[Université de Montréal]] is a three-year bachelor's degree of 90 credits in biomedical science of which 27 credits are specific to clinical perfusion and in addition a diplôme d’études supérieurs spécialisées (DESS) of 30 credits in clinical perfusion of one-year at the master level.

===United Kingdom and Ireland===
{{confusing|reason=is the training course prior to or whilst a trainee perfusionist?Which parts are paid?|date=February 2017}}
In the [[United Kingdom]] and [[Ireland]], a bachelor's degree in a science subject (usually life or clinical sciences) is a prerequisite to enrolment on the two-year perfusion training course. Trainees must complete a two-year MSc program at the [[University of Bristol]] while employed as a trainee perfusionist by a sponsoring hospital trust. This post is paid as an annex U AfC band 7. They complete academic assessments (essays and exams), while in the workplace moving from a purely observational role to one in which they are capable of managing the patient while they are on cardiopulmonary system with minimal supervision. Once a trainee has been the primary perfusionist in 150 clinical procedures, they must undertake a practical exam. For this exam, the candidate is observed by two external examiners whilst building and priming a cardiopulmonary circuit, then using it during a surgical operation. After the practical exam, trainees must complete a 40-minute ''viva voce'' exam, which tests their academic knowledge. After this is successfully completed, they are awarded an MSc in Clinical Perfusion Science and the status of accredited clinical perfusion scientist. They must maintain this by performing a minimum of 40 clinical procedures per year.

=== Australia and New Zealand ===
In some states of [[Australia]] and [[New Zealand]], a perfusionist must have at least a science degree (usually in health sciences) as an entry requirement before training. Further didactic training is in a practical format at a hospital whilst doing a three-year course via correspondence and e-learning, with the Australian and New Zealand College of Perfusionists (ANZCP). The final examination for a clinical perfusionist is administered by the ANZCP over two days. This involves three hours of written assessment, two hours of multiple choice questions, and four half-hour ''[[Oral exam|viva voce]]''. Perfusion training is determined by the hospital at which the perfusionist is employed and may involve a hospital accredited training program which is determined by the health department to be the equivalent of ANZCP certification program.

In Australia perfusion can also be provided by a medically trained [[physician]] who has undertaken additional subspecialty training.<ref>{{Cite web|url=https://mdhs-study.unimelb.edu.au/short-courses/mms-short-courses/medical-perfusion/overview|title=Overview - Overview — MDHS Study|website=mdhs-study.unimelb.edu.au|access-date=2019-08-12}}</ref>

===India===
In [[India]], there are different programs for educating perfusionists. A three-year bachelor's degree program (most common) with one-year internship, a two-year post-graduate diploma  are available. Bachelor's and master's degree in some reputed institutions (i.e. PGI Chandigarh, AIIMS New Delhi, jipmer, [[Gandhi Medical College, Bhopal]], naryana groups Bangalore, Sawai Mansingh Medical College Jaipur, Sher-e-Kashmir Institute of Medical Sciences, Srinagar). Recently, the Board of Cardiovascular Perfusion of India introduced certification.{{Clarify|reason=Extremely incoherent|date=March 2019}}

===Other countries===
In [[China]], [[Egypt]], and some South American countries, a clinical perfusionist is a medical doctor who has completed subspecialty training.{{citation needed|date=October 2014}}
In [[Argentina]], a perfusionist is a medical doctor, usually a [[Cardiology|cardiologist]], who has undertaken additional sub-specialty training. They are often referred to as ''hemodinamistas'' (hemodynamics specialists).

In [[Europe]], perfusionist education standards are set by the European organisation of perfusion, EBCP (The European Board of Cardiovascular Perfusion) and has been implemented in many European countries. The length of the eduacation and training varies between 1 and 4 years, depending on requirements for entering the program.<ref>{{Cite journal |pmid=31576396 |date=2020 |last1=Wahba |first1=A. |last2=Milojevic |first2=M. |last3=Boer |first3=C. |author4=De Somer FMJJ |last5=Gudbjartsson |first5=T. |last6=Van Den Goor |first6=J. |last7=Jones |first7=T. J. |last8=Lomivorotov |first8=V. |last9=Merkle |first9=F. |last10=Ranucci |first10=M. |last11=Kunst |first11=G. |last12=Puis |first12=L. |author13=EACTS/EACTA/EBCP Committee Reviewers |title=2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery |journal=European Journal of Cardio-Thoracic Surgery |volume=57 |issue=2 |pages=210–251 |doi=10.1093/ejcts/ezz267 }}</ref>
In the northern countries of Europe, [[Scandinavia]] including [[Sweden]], [[Denmark]] and [[Norway]], perfusionists are educated at [[Aarhus University]] at the Scandinavian School of Cardiopulmonary Technology.<ref>{{cite web | url=https://www.en.auh.dk/departments/department-of-cardiothoracic-and-vascular-surgery/education/the-scandinavian-school-of-cardiovascular-technology/ | title=The Scandinavian School of Cardiovascular Technology - Aarhus Universitetshospital }}</ref> Most perfusionist candidates are educated intensive care nurses/anaesthetic nurses and the education includes a Master Thesis in Cardiopulmonary Technology.<ref>{{cite web | url=https://www.en.auh.dk/departments/department-of-cardiothoracic-and-vascular-surgery/education/the-scandinavian-school-of-cardiovascular-technology/scientific-thesis/ | title=Scientific Thesis - Aarhus Universitetshospital }}</ref>

== References ==
{{Reflist}}

==External links==
* [https://www.iperfusion.org International Perfusion Association]
* [https://www.perfusion.com Perfusion.com]
* [https://perfusioneducation.com/blog/ Perfusion Education Portal]
* [http://abcp.org American Board of Cardiovascular Perfusion]

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[[Category:Health care occupations]]
[[Category:Cardiac surgery]]