Cardiopulmonary Bypass

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August 25, 2017 by Bill Vanderheiden


Edited/modified from an original article by Gerard J. Myers, RT, CCP Emeritus titled: “The Misconception About Your Open Heart Surgery Team” July, 27, 2017 on LinkedIn

Open heart surgery is one of the most complex and life altering types of surgery that people of all ages may require at some times in their lives. The duration of some types of open heart surgery can last from minutes to hours. The vast majority of cardiac surgical cases would not be possible without the use of a procedure called cardiopulmonary bypass (CPB) that is accomplished with the use of the heart-lung machine. It is estimated that in the United States alone, the number of CPB procedures is somewhere between 300,000 and 500,000 cases annually. The unique professionals responsible for the conduct and operation of CPB in every country around the globe are called perfusionists, the silent professional who is rarely recognized as the person responsible for placing the patient on CPB after the surgeon has connected a series of cannulas to the heart lung machine.  Perfusionists maintain the patient’s life support during the period of surgical repair when the heart is completely arrested and the ventilator has been turned off.  

In the United States, perfusionists are legally designated as Certified Cardiovascular Perfusionists (CCP), with a national governing body called the American Board of Cardiovascular Perfusion.

The obvious question at this point would be … ‘What exactly does a perfusionist do during cardiac surgery’?
The perfusionist -- using the heart lung machine and an array of devices to perform and control such functions as cardiac output, blood pressure, organ perfusion, fluid/electrolyte balance, and function of the lungs -- provide life support for as long as the surgeon needs to complete his/her surgical repair. The perfusionist monitors the patient’s acid base balance, physiology, brain function and body/heart temperature, using appropriate measures, technology and drugs to control this environment. This includes protecting the patient’s heart by delivering a pharmacologically balanced solution that cools and electrically arrests that heart to protect it from damage, which then allows the surgeon to operate on a still, non-beating heart. The perfusionists are also responsible for the operation of assist devices such as Intra-Aortic Balloon Pumps and Ventricular Assist devices (IABP, VAD’s - Left and Right), which are devices the surgeon inserts to help reduce the work of the heart and increase blood flow to the coronary arteries. These devices essentially act as the patient’s right and/or left ventricle for short or extended periods of time.  They are responsible for the operation of devices called Autotransfusion machines that are used in many types of surgery to collect most of the blood lost and return this blood to the patient after washing and processing it. If you or someone you know has had heart surgery requiring cardiopulmonary bypass, ECMO, IABP, Autotransfusion or a Right/Left VAD implanted … you have been managed and cared for by a perfusionist in a manner that no other health care professional can duplicate.
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