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Perfusionists perform one of the most delicate and crucial services for patients during open-heart surgery, coronary bypass, or any other procedure that involves the heart or the lungs. The perfusionist operates equipment that literally takes over the functioning of the patient's heart and lungs during surgery. Such equipment may also be used in emergency cases of respiratory failure.
When surgeons pierce the patient's breastbone and the envelope surrounding the heart, which is known as the pericardial sac, they must transfer the functions of the patient's heart and lungs to the heart-lung machine before any surgery can begin on the heart itself. This process is known as establishing extracorporeal bypass, or outside heart and lung functions. The heart-lung machine is activated by inserting two tubes into the heart, one circulates blood from the heart to the machine and the other circulates blood from the machine back into the heart. It is necessary during this procedure not only to maintain circulation and pumping action but also to maintain the appropriate oxygen, carbon dioxide, and other blood gas levels. In addition, perfusionists must effectively control the body temperature of patients who are undergoing extracorporeal bypass circulation because the flow of blood through the body greatly influences body temperature. To slow metabolism and reduce the stress on the heart and other bodily systems, perfusionists often reduce the body temperature of patients during open-heart surgery to 70 degrees Fahrenheit or below. Perfusionists use various probes within the body to monitor body temperature, blood gases, kidney functioning, electrolytes, and blood pressure.
Although the ultimate responsibility for open-heart surgery and for decisions concerning blood circulation, temperature, and other matters rests with the surgeon in charge of the operation, surgeons tend to rely heavily upon the judgment of perfusionists, who are regarded as specialists in their own right. Although the perfusionist may never have a discussion with the patient, perfusionists almost always have preoperative conferences with surgeons to discuss the patient's condition and other characteristics, the nature of the operation, and the equipment to be used.
Because of the nature of their work, perfusionists work in hospitals in cardiac operating rooms. They are members of a cardiac surgery team, and it is not uncommon for perfusionists to work through several successive operations in a row as well as to work on emergency cases. Because open-heart surgery cannot be performed without these specialists, perfusionists are usually on call a great deal of the time.
In addition to cardiac surgical procedures, perfusionists also practice in the areas of wound healing, ventricular assistance, and extracorporeal circulation.