The History of Perfusion Education

The evolution of perfusion education has been a fascinating journey, reflecting the growing complexity and importance of the field in modern healthcare. In this blog, we delve into “The Maturation of Perfusion Education,” an insightful editorial by John M. Toomasian. The article traces the history of perfusion training, from its informal beginnings to the sophisticated, simulation-based curricula of today, and explores how these advancements are shaping the next generation of perfusionists. Whether you’re a seasoned professional or just curious about the field, this piece provides a compelling overview of how education is driving innovation and excellence in perfusion services. Read on to discover more about the past, present, and future of perfusion education.

The Maturation of Perfusion Education

By: John M. Toomasian

In the 70-plus years of clinically applied cardiopulmonary bypass, the training of that specialist operator, or perfusionist, has been through several stages. Perfusion was not a field that was easily identified as a possible career path when students were studying in secondary school or college. Established curricula found in physician and nursing training did not exist in extracorporeal technology education when the field was born. Many of the early operators of the heart-lung machine were often selected by cardiac surgeons to support their existing institutional program. These individuals acquired the skillset by sitting next to the technician who assembled and ran the pump. The goal was to learn the mechanics of the machine and follow the surgical commands during operations. Many of the goals were simple: maintain a set blood flow rate, blood pressure, and administer sufficient anticoagulant empirically so the large volume circuit did not develop clots. Often blood gases were optional. Those individuals could have been a nurse, lab technologist, or even someone without a science background, but eager to learn a new skill.

Many of these “on-job-trained” or OJT technicians embraced their new role and eventually formed the American Society of Extracorporeal Technology (AmSECT). AmSECT provided a place to exchange ideas and embrace the quickly expanding field. A few years later, AmSECT approached the American Medical Association seeking recognition of extracorporeal technology as a new field in health care, but what to call it? After many iterations of using the term “technologist”, the term “perfusionist” was adopted as a more creditable description than a technologist due to limitations in skills, education, and ability than a technician, which had been used earlier.¹ Since that time the term perfusionist has been the identity of practitioners in this field and has been adopted and integrated into all educational curriculum and credentialing.

Formal perfusion training programs, as one might associate with a medical school or nursing program, were slow to evolve. This was in part because of the small numbers that would be required to provide care relative to significantly larger numbers of physicians and nurses, not to mention the financial commitment to formalize a training process. Didactic education was limited, for most training was done in the operating room and teaching was absorbed within the department, and was secondary to the clinical schedule of the day. The process of formulating a formal curriculum was also difficult, because many of the physiologic parameters widely understood today were not understood or even measured in contrast to today. Certificates of completion or institutional letters acknowledging on-site training allowed the field to expand to other institutions and were the first steps in acknowledging the skillset that a perfusionist could provide.

When more formal training evolved requiring more didactic instruction and experimental practice in a laboratory or wet lab, the curriculum expanded to include more formal coursework. The first formal perfusion education program was established at the Ohio State University in 1967 from federal grant money. From that seed, other colleges and universities saw the opportunity to collaborate with their health care systems by integrating formal course work in anatomy, physiology, pathology, and pharmacology together with the extracorporeal sciences. Those programs granted baccalaureate degrees to those completing the curriculum. That added more legitimacy to the field, as the knowledge base expanded beyond the operating room to other devices and techniques including cell salvage/processing, mechanical support, and ECMO.

One tool that has improved perfusion education in recent years has been the advent of perfusion simulation. Simulation is a mechanical way to practice perfusion in a controlled setting without the relative risk of errors leading to possible catastrophe that would cause harm to a patient. Simulation allows for repetition and reinforcement of bypass principles in a controlled environment. Early low fidelity simulation consisted of buckets of water in which students would practice the nuances of flow, pressure, and troubleshooting. As students become more familiar with the conduct of bypass, the simulation setting can be adjusted to more complicated scenarios allowing for better exposure to the reality of the clinical setting and the complexities of the actual operating room. That transition has been remarkable and is integrated into the majority of education curricula. Many students have hundreds of hours of training and practice. New high-fidelity simulators that can create actual clinical scenarios. The first commercial simulator was the Orpheus (Terumo, Ann Arbor, MI, USA) which was basic, but provided trainees an opportunity to become relatively more comfortable in an artificial clinical setting. More recently the Califia system (Biomedical Simulation, San Diego, CA, USA) has become the predominant perfusion simulator that can be customized to provide basic and more complex customized clinical scenarios, as perfusion approaches to more challenging procedures become more routine. Simulation has also grown into ECMO applications in which this tool can reproduce situations that are not commonly observed but do exist. Many ECMO simulators are coming forward and continue to evolve. Two specific systems, the EigenFlow (Curtis Life research, Indianapolis, IN, USA) and the manikin-based E-Sim Pro 2 (The Simulator Company, London, UK) provide sophisticated high-fidelity training that can be customized by the institution to mimic clinical settings to present scenarios for recognition and intervention. There are also cloud-based applications for ECMO including the Califia platform and ECMOjo.² There is no question that simulation has become an essential component in the training and education of perfusion-related technologies and those who interact with them. Simulation has also become part of recertification process in some instances where clinical scenarios are created to provide situational practice in lieu of some clinical case conduct. Simulation will continue to be a part of perfusionists’ future as more and more expansion and elaboration of protocol-based perfusion and outcome data becomes evident.