Kirti Patel, MPS, MPH, CCP, LP, CPBMT, serves as the Vice President of Perfusion Services at SpecialtyCare. He utilizes his extensive background in research to work with SpecialtyCare’s medical department and is involved in ECMO operations and ECMO education.

What are the Benefits of a Career in Perfusion? 

The most impactful benefit is the gratification of having an opportunity to save lives on a daily basis. A career in perfusion is very rewarding because we have a direct impact on patient lives. There is also currently a huge shortage of perfusionists which makes this career very appealing as salaries have significantly increased in the last few years. The cost of education is also low compared to other allied health professions and the relatively short time to train (1-2 years). The return on investment is great. The perfusion profession is one of the smallest allied health professions, with less than 4,500 certified perfusionists in the country, making this profession more engaging personally.  

Can You Describe a Day in the Life of a Perfusionist? 

A day in the life of a perfusionist varies based on position and responsibilities. Perfusionists are involved primarily in clinical roles, but perfusionists in administrative roles are responsible for operations. A clinical day for a perfusionist involves an alarm clock that goes off at 5:00 a.m. They head to the OR to set up for their morning case(s). Once the extracorporeal circuit is primed, a perfusionist may check on supplies and complete other ancillary duties. 

Once the patient is in the OR, a perfusionist reviews the patient’s chart and completes all required documentation. Based on the case type, the timing of going on bypass will vary, but the perfusionist is always mindful of the patient in an event that emergent bypass may be necessary. Once the surgeon is ready for heparin, the pump lines are given to the sterile field.  Once heparin is given, the cannulation process begins with usually the arterial cannula being inserted first, followed by the venous cannula, and then the retrograde catheter, if applicable. Once adequate ACT is achieved and bypass checklist is completed, bypass is initiated per surgeon instructions. The perfusionist achieves target flow rate and completes all necessary tasks per surgeon preference, such as temperature management, etc. 

The next major step is cross-clamping and cardioplegia administration. Once the heart is safely arrested, the surgeon begins performing the operation. The perfusionist maintains flow and all the necessary parameters and performs laboratory analysis for activated clotting times and arterial/venous blood gases. The perfusionist will remind the surgeon of time between cardioplegia doses based on the type of solution used. Doses are given intermittently to preserve the heart. 

Once the operation is nearing completion, the patient would be re-warmed and soon after weaned off bypass. If needed, any residual pump volume would be given to the patient, hemoconcentrated, bagged for anesthesia, or chased to the cell saver for processing. The circuit integrity is always maintained in the event re-initiation is necessary. The circuit is often torn down after all sternal wires are twisted, and the surgeon had permission to do so. All documentation is completed in the interim. If there is a second case to follow, reset and repeat. 

To help answer this question as a visual, please see this video entitled “A Day in the Life of a Perfusionist,” sponsored by the team at University Health Network’s Toronto General Hospital:

What Should All Perfusionists Know Before Starting Their Careers? 

While there is no single thing that I wish all perfusionists knew before starting a career in perfusion, many things can certainly aid as an advantage. Some of these include a previous career in another allied health field such as respiratory therapy, medical technology, exercise physiology, nursing, and so forth. Even any technical position in a hospital setting is beneficial.  Previous observation of bypass and discussions with a perfusionist is valuable and often recommended by most perfusion education programs. Some earlier courses in professionalism and ethics are also helpful. Lastly, I also believe having some coursework in finance is essential as this is personally very beneficial to new perfusionists in managing their finances. 

How Does a Perfusionist Contribute to the Dynamic of the OR? 

As mentioned previously, it is clear how impactful the role of a perfusionist is on the patient’s well-being. Every action and decision that a perfusionist makes relating to the patient directly impacts their care and outcome. A perfusionist can contribute heavily to patient care when working in a concerted manner with the multidisciplinary team. The perfusionist enhances the dynamic of the OR and brings value to the operative team that is unique in skillset and responsibilities. They share the same purpose of the team in caring for the patient. 

What Advice Would You Give a Perfusionist? 

Team dynamics is vital in all areas of healthcare, but especially in the cardiac surgical space due to the nature of high acuity. My advice to perfusionists is to always keep in mind that everyone in the room shares the same purpose: taking care of the patient. Make sure that you know your role and responsibilities, focus on communication by using a closed-loop strategy, pay attention, and be aware of what is going on. Build trust and strong work relationships with the team, embrace feedback, and always maintain an optimistic attitude.

What is a Way a Perfusionist Can Set One’s Self Up for Greatness? 

Greatness to me most simply means achieving something big, going above and beyond, or hitting a milestone. In perfusion, you can achieve greatness by setting lofty goals and then working hard to achieve those goals. I have always advised my past students to stay engaged and to get involved. 

The first step is to become part of your professional societies, which I believe is a professional responsibility. These societies have many opportunities to volunteer in various initiatives. This is always a great place to start. Get involved in continuous improvement processes, become a member of various hospital committees, become the voice for perfusion in your hospital, and present your initiatives or results of an improvement process at local and national perfusion conferences.

Perfusion has advanced over the years, and many of these contributions come from individual perfusionists who take an active role in the previously mentioned initiatives. They take accountability and take time outside of their jobs to make a difference.  Greatness comes to those that always strive to do more to make a difference. I truly believe in always doing the right thing and putting the patient first. When you do so, everything else will fall in place. Gary Bruckardt, one of the founders of SpecialtyCare, always lived by this philosophy.  

What is a Perfusion Resource You Enjoy and Trust? 

While there are many reputable peer-reviewed journals in perfusion, I have always enjoyed participating and reading AmSECT’s non-peer-reviewed publication, AmSECT Today. The other two peer-reviewed perfusion journals that I also rely on for best practices are the Journal of Extracorporeal Technology (JECT), an associated publication with AmSECT, and Perfusion, which is an associated journal with the American Academy of Cardiovascular Perfusion.

What Surprised You About the Career When You Began?

The biggest surprise about this career to me was that I had no idea this was even a profession and that this is how you achieved open-heart surgery. The concept of intentionally stopping the heart was mind-blowing to me. I heard about perfusion through a coworker who worked with me in the laboratory when I was a medical technologist. At the time, I was working on my doctorate degree. One day after my night shift, I researched perfusion and was fascinated by what I read. I immediately reached out to the program director at Texas Heart Institute and scheduled an observation. 

After my visit, I was so intrigued that I decided to apply to the program. I was accepted into the program after my second attempt and was so excited to begin that journey. I spoke with my advisor in my doctorate program and decided to drop out of the program to start a career in perfusion. As strange as it may sound, dropping out of that program was the best decision I ever made, and there is nothing I would rather do than perfusion