Patient Blood Management and Perfusion During Heart and Lung Surgery

An Interview with Robert Dyga, Corporate Director, UPMC Perfusion Services

What is a perfusionist?

A perfusionist is a highly trained and specialized professional who operates the heart-lung machine during cardiac and other types of surgery. Perfusion is relatively new to medicine.

Dr. John Gibbon performed the first open heart procedure in 1951 while using the heart-lung machine.

The perfusionist’s main responsibility is support of the patient’s physiological and metabolic needs, creating a motionless and bloodless field so that the cardiac surgeon can effectively operate on the heart. This is accomplished through the use of equipment that includes an oxygenator, filter, reservoir, tubing, and specialized devices.

Other responsibilities of the perfusionist include:

• Blood recovery (cell saver)
• Autologous (use of the patient's own blood) biologics (platelet get)
• Maintenance of mechanical heart and lung support devices, such as intra-aortic balloon pumps and extracorporeal membrane oxygenation (ECMO)
• Management of ventricular assist devices
• Support for lung and liver transplants

The UPMC perfusion team provides expert support for all of these procedures.

How important are acute normovolemic hemodilution, autologous blood recovery, and biologic therapies in patient blood management?

Use of the patient's own blood (autologous) can decrease the need for transfusion of banked blood. This can, in turn, benefit patients by avoiding the risks associated with transfusions.

Acute normovolemic hemodilution

• While the patient is going to sleep, the patient’s blood is withdrawn, while intravenous fluid is infused.
• Approximately one to two units of blood are removed, anticoagulated, and returned to the patient at the end of the procedure.
• This technique provides autologous red blood cells for oxygen transport and plasma for blood clotting later in the procedure.

Blood recovery

• Blood recovery, also known as “cell saver” or “cell salvage,” is not new to medicine. Actually, the first blood recovery procedure was performed in 1818 by James Blundell during an obstetrical procedure.
• This procedure incorporates the use of suction tubing, and a collection reservoir, centrifuge bowl, and reinfusion bag. During the surgery, most shed blood is recovered, washed, and returned to the patient.
• This technique can salvage as much as 70 percent of shed red blood cells.

Biologic therapies

• Another autologous technique provides concentrated levels of plasma proteins and platelets, which are known for their ability to stop bleeding and assist with wound healing.
• At the start of surgery, one to two ounces of the patient’s blood is collected, processed, separated, and returned topically at the end of the procedure.