The conduct of perfusion has been described as ‘95% boredom and 5% panic’. Now I cannot imagine many individuals ascribing to this gross underestimation of the challenges facing perfusionists today, but there are times in all of our practices, especially those centers who have embraced off-pump coronary artery revascularization, that these challenges seem a wee bit unwanting. As a past director of a perfusion education program my main responsibility was on education. No surprise there, but during the latter part of my professorial stint, a significant part of my time was spent spreading the good news of perfusion to both suspecting and unsuspecting college seniors who had yet to select a field. Obviously their intent was to find a meaningful career with the intent of finding gainful employment upon graduation. This recruiting was done in the face of some sobering predictions that hardly brought cheer to perfusion academic institutions charged with educating new practitioners while maintaining financial solvency. Now I can’t say that my view from the ivy tower was any clearer than those who watch medical trends, but I maintained an optimistic view. How effective a recruiter would a program director be who chose to believe the less than rosy outlook for the profession?
In the past several years some statistics have appeared in reputable publications and from highly respected sources (The Society of Thoracic Surgery Database most noticeable). The growth in the off-pump surgery has tapered from the once lofty predictions of 80% of all coronary surgery to a more accurate level of approximately 27% today. However surgical revascularization continues to decline at a rate of between 2 and 5% per year. My own institution has seen declines in CABG surgery of 3.2. 4.1 and 4.5% during the last three fiscal years. The impact on the perfusion department has been somewhat muted since we all ready perform 95% of all of these surgeries off-pump, so from our perspective, the cases we are loosing have all ready been lost. However, other events have occurred due to the diligent efforts of the perfusionists, which may be worth sharing.
In the past year to year eighteen months we have developed a platelet-gel program that has grown from 0 procedures in 2002 to over 600 this year - next year we should do over 1,000. We roll out our bloodless medicine program on November 1st with the perfuision department playing an integral role in both the perioperative and intraoperative aspects of this service. Our autotransfusion practice is predicted to substantial increase from our current 1,000 procedures per year. Our point-of-care coagulation service has expanded to the point where we have purchased eight viscoelastic coagulation monitors that are used hospital wide in tandem with sophisticated algorithms for hemostatic intervention. There have been no less than five prospective Institutional Review Board studies undertaken which have included a 300 patient trauma study and a similar sized cardiology project. Oh yes, and we have also started an ECMO service with the perfusionists providing the clinical acumen as well as coordinating all the training for the hospital.
One might ask why a From The Editor piece should take on such a personal note; one not before so overtly stated. These changes have necessitated a rethinking of how perfusion should be addressed. The ‘bread and butter’ on-pump aspect of our profession remains the touchstone for how perfusionists are viewed. Or does it? Not a single educated mind would be so brazen as to state that perfusionists are the dinosaurs of the medical industry. In a few short years the heart-lung machine, and its assorted instrumentation, will transform into a less invasive process that supports more critically ill individuals for longer periods of time. Today, however, the opportunities afforded to perfusionists are greater than I have seen in the past 20 years. The question becomes will the ‘will’ be there to recognize these advantageous circumstances, and the mind to ‘mind’ the unknown.
Alfred H. Stammers, MSA, CCP
Editor