The Clinical Perfusion ScientistThe aim of this document is to introduce to you the role of Clinical Perfusion Scientists (Perfusionists), their training and their career prospects. Few of you who are considering a career in the professions that are allied to medicine will have even heard of the role of the Clinical Perfusion Scientist let alone considered a career as one.
Since 1812 when Caesar Le Gallois suggested replacing the heart with a system that could provide a continuous supply of blood to support the vital organs of the body, the search has continued to perfect such a system. This "fantastic" idea became a reality in 1953 in Massachusetts USA, when Dr. John Gibbon performed the first successful open heart operation. This was enabled by using a heart-lung machine to provide CARDIOPULMONARY BYPASS (CPB).
Clinical Perfusion Scientists are the highly skilled professionals who manage the heart-lung machine and therefore the patient's physiological parameters during these CPB procedures. When employing CPB the patient does not require his/her own heart and lungs to be working, as the heart-lung machine includes an artificial means of pumping blood around the body in place of the patient's own heart, and an artificial gas exchange device or oxygenator to oxygenate the blood and remove excess carbon-dioxide in place of the patient's lungs. This allows the surgeon to perform the operation on the patient's heart in a controlled way, confident that the rest of the patient's organs and tissues are being adequately managed by the Clinical Perfusion Scientist. There are at least 33,000 open heart operations performed in Great Britain and Ireland each year, and each of these procedures requires the expertise of the Clinical Perfusion Scientist. These operations can vary from heart valve repair or replacement, coronary artery bypass graft surgery, to heart and heart-lung transplantation. The age of the patient can vary as well from adults to the new-born who may have been born with malformations of the heart and surrounding vasculature and therefore require corrective cardiac surgery.
The Clinical Perfusion Scientist’s main role is within the cardiac operating theatre, where he/she is an integral part of the cardiac surgical team. Along with the Clinical Perfusion Scientist this team comprises of the SURGEON, the ANAESTHETIST, the THEATRE NURSE, and assorted technical support staff including Operating Department Practitioners and Cardiology Technicians/Technologists. It is vital that this team works very closely together in an environment of mutual professional trust and confidence to take the patients through their heart operations, with the best and most appropriate care necessary. Few other professions offer such intimate team relationships coupled to such a high degree of direct personal responsibility.
Due to their unique skills and experience in this clinical field, the Clinical Perfusion Scientist has outgrown the mere running of extracorporeal circulations and has taken over a pivotal role in circulatory support, in the monitoring of vital parameters, in intra-operative blood processing techniques, in the interpretation of blood gas and blood chemistry values, in organ transplantation, in documentation and statistics, and in the participation in research. As well as this, the Clinical Perfusion Scientist will manage and operate mechanical cardiac assist devices including intra-aortic counter-pulsation.
You can see that the main body of the Clinical Perfusion Scientist’s work is centred on the management and supervision of the heart lung machine during heart surgery. However with the development of extracorporeal circulatory techniques and the increased expertise of Clinical Perfusion Scientists, their role has been extended to employment in a number of different sub-specialities, some of which you may have already read about, and some of which we have described below.
Extra Corporeal Membrane Oxygenation (ECMO) is an expanding area of the Clinical Perfusion Scientist’s role. Over the last ten years, the use of extracorporeal circulation has increased steadily in the treatment of cardiac and respiratory failure in critically ill patients of all ages. The concept of extracorporeal life support is simple, but the procedure itself is complex. ECMO is related, but is not identical to standard operating theatre cardiopulmonary bypass. Extracorporeal membrane oxygenation implies the diversion from a major systemic blood vessel through a gas exchange device (membrane oxygenator) and back to a major blood vessel.
Isolated Limb Perfusion is a method of treating malignant skin cancers that have a high mortality rate. When a localised tumour occurs in an extremity, the affected limb can be isolated with a surgical tourniquet and an artificial blood circulation provided for the limb by the Clinical Perfusion Scientist via an extracorporeal circulation. By keeping the limb isolated, it is possible to administer tumour-destroying drugs at very high dose levels, which would prove lethal if injected into the patient without the limb being isolated. The Clinical Perfusion Scientist must also raise the temperature of the limb so as to potentiate the effectiveness of the therapy by careful control of many different aspects of the circulation within the affected limb. There is a narrow margin between effective destruction of the tumour and failure to control it, and the Clinical Perfusion Scientist’s task is to stay within these margins and ensure the best outcome for the patient.
Liver Transplantation is now becoming more common and it is the largest single organ transplant that can be done today. The procedure length varies from anything between 5 and 15 hours, and the amount of blood lost can, on occasion, be heavy and dramatic. The transplants themselves can occur at any time of any day or night. Therefore liver transplantation is a highly unpredictable operation and it is the role of the Clinical Perfusion Scientist to be able to adapt to this dynamic situation and provide the skilled resource that is required, when required.
EDUCATION AND TRAININGObviously all of the qualities and resources required of a Clinical Perfusion Scientist have to be supported by a sound scientific training. In the early days, the job was largely learned in the work situation by people coming to it from a wide range of other disciplines. They learned as they went along, as did all the other members of the team. Those days are long gone and the training of the Clinical Perfusion Scientist is now far more structured, involving practical training in a cardiac surgery clinical perfusion unit as well as formal academic training at the North East Surrey College of Technology (NESCOT).
The NESCOT course will enable students to gain either a PgCert, a PgDip, and with later study, an MSc in Perfusion Science. The course addresses both academic and professional needs by integrating academic knowledge and understanding with the practical requirements of the working professional perfusion scientist. Students will attend college for nine one-week blocks each academic year, spaced out at approximately monthly intervals. Students will be awarded the PgDip provided that they also pass the Society’s professional accreditation examination. The certificate of accreditation will show that you have the knowledge and practical ability to be a competent practising Clinical Perfusion Scientist able to work independently, and participate in an "on-call" rota dealing with emergency and out of hours operations. This is supported by the Royal College of Anaesthetists and the Senate of the Royal Colleges of Surgeons of Great Britain and Ireland who have ratified the following statement;
(The two Associations) – "Wish the National Health Service Management Executive to know that they unanimously expect that any mechanical perfusion used in the management of a patient undergoing a surgical procedure in the United Kingdom or Ireland should only be undertaken by a clinical perfusion scientist who has been accredited by the Society of Clinical Perfusion Scientists of Great Britain and Ireland, or by a trainee under the direct supervision of an accredited Clinical Perfusion Scientist."
Attainment of the Accreditation certificate will allow your name to be added to the Register of practising Clinical Perfusion Scientists held by the College of Clinical Perfusion Scientists of Great Britain and Ireland. Indeed the NHS Executive advice is that “the employment of Clinical Perfusion Scientists is limited to those practitioners who are accredited by the Society of Clinical Perfusion Scientists of Great Britain and Ireland and the College of Clinical Perfusion Scientists or who are registered with them [College of Clinical Perfusion Scientists] as trainees”.
Students commencing the NESCOT course will normally be working in a clinical environment as a trainee clinical perfusion scientist. The following entry requirements would usually apply:
CAREER STRUCTURE AND PROSPECTS
Initially you would be employed as a Trainee Clinical Perfusion Scientist and will gain advancement by qualifying and by gaining experience or taking on extra roles and competencies. Clinical Perfusion Scientists are paid largely on Clinical Perfusion scales which compare with Clinical Scientist scales. Your point of entry on to the appropriate pay-scale will depend on your qualifications and experience.