Perfusionists and their heart-stopping work

Perfusionists are a rare breed in the health-care world. There aren’t many of them, and their patients rarely remember them as part of their health-care team. Yet their work is heart-stopping, in both the literal and figurative sense. 

A major part of a perfusionist’s job is cardiopulmonary bypass (CPB), which involves operation of the heart-lung machine. During grafting or other repairs to the heart, it is stopped, and isolated from the rest of the circulatory system. The heart-lung machine keeps the patient alive while surgeons do their work, and perfusionists are the ones operating that machine. 

“Normally we do about 750 heart surgeries a year in Saskatchewan,” said Lori Garchinski, Saskatchewan Health Authority’s Executive Director of Provincial Programs – Tertiary Care. “All patients undergoing cardiac surgery have their heart stopped to facilitate surgery, and this requires a perfusionist.”

Saskatchewan currently has a total of eight full-time and two part-time perfusionists in Regina and Saskatoon. In July, these numbers will change to 10 full-time (five in Regina, five in Saskatoon) and two casual.

The work of perfusionists is extremely specialized, and they largely work in critical care units. They do cell saving or autotransfusion, which is basically harvesting the blood of a bleeding patient, washing it and giving it back to them. This mitigates the number of transfusions needed using blood from the blood bank.   

ECMO or Extra Corporeal Membrane Oxygenation is also in the hands of perfusionists. ECMO machines are used to support either the heart and lungs or just the lungs when they are not working well enough to oxygenate the blood, even with drugs and a ventilator. Since the COVID-19 pandemic began, eight patients in Saskatoon and Regina with COVID have needed help from ECMO to support their body’s ability to manage the infection. 

Monitoring a patient on ECMO is a round-the-clock, bedside affair for perfusionists. 

“In Regina, we became quite busy with COVID-19 ECMO patients during the second wave of the pandemic when we put five patients on ECMO,” said Mark Mazur, a perfusionist in Regina. “Once these patients are on ECMO, a perfusionist must be available in hospital 24/7 for the duration of the patient’s time on ECMO. During March and April, we ran bedside ECMO 50 out of 60 days at Regina General Hospital.”

Typically, a patient placed on ECMO is on for 10 days to two weeks, until their lungs are strong enough. Then they are incrementally returned to their own support. However, patients with COVID-19 who have received ECMO to date have needed it for anywhere from two to 50 days.

“Due to COVID-19, patients who arrive in critical condition in the emergency room are now more difficult to treat because the whole team must don personal protective equipment (PPE) and more perfusioninsts are needed, as one perfusionist must be in the room in PPE while another perfusionist is available outside the room to run the specialized analyses on blood samples, which fine tunes the patient’s treatment and affects their outcome,” said Jo-Anne Marcoux, Senior Perfusionist in Saskatoon at Royal University Hospital. 

Perfusionists are also the ones who do arterial blood gasses in the operating room, helping with the analysis of a patient’s blood and decisions about transfusions. And they help install IABP or Intraaortic Balloon Pumps, which puts a balloon in the aorta of patients whose hearts cannot support their own cardiac output. These pumps inflate and deflate inside the aorta in accordance with a patient’s own cardiac cycle in order to increase blood flow and decrease the work the heart has to pump against. These happen between 60 and 80 times per year. 

Perfusionists only deal with patients among the most sick, the most unstable and the most challenging in the hospital. And the patients they treat are often too sick to remember them. But that’s okay with perfusionists. They know their work has impact. They know it saves lives. The huge responsibility is what attracted most of them to this profession in the first place.