Intensive Care Research

In Press, Corrected Proof, Available Online: 3 September 2021

Why you should have a Perfusionist as Workforce in the Intensive Care Unit

Authors
Gabriele Melegari1, *, ORCID, Maria Chiara Franchini2, Francesca Sola2, Emanuela Testa3, Alberto Barbieri4
1Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 71, Modena 41121, Italy
2Aferetica Srl, Bologna, Italy
3Cardiosurgery Unit, Cà Foncello Hospital, Azienda ULSS 2 Treviso, Italy
4School of Anaesthesia and Intensive Care, University of Modena and Reggio Emilia, Italy
*Corresponding author. Email: melegari.gabriele@gmail.com
Corresponding Author
Gabriele Melegari
Received 7 July 2021, Accepted 26 August 2021, Available Online 3 September 2021.
DOI
https://doi.org/10.2991/icres.k.210830.002How to use a DOI?
Keywords
Perfusionist, ECMO, training
Copyright
© 2021 First Affiliated Hospital of Zhengzhou University. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

1. INTRODUCTION

In 2018 the Italian government founded the College of Perfusionists, regulating this profession. Since 1982 the perfusionist had a training education of 2 years at the Faculty of Medicine, initially as a cardiopulmonary technician in cardiac surgery. Then in 1998, this course was increased to 3 years to develop a specific team-mate dedicated both to Cardiology and Cardio-surgery Unit (CSU). This health care workforce in Italy usually works in the Cath-Lab, in Cardiology, Coronary Unit, or Cardio-surgery but, despite this type of worker could have some potential skills, especially in the modern general Intensive Care Unit (ICU) he is not still present in these settings as it should be [1]. The perfusionist should be helpful and necessary as a residential unit in the ICU, supporting the physicians in many critical care settings. The perfusionist-course includes specific training in several settings such as Echocardiography (ECHO) Lab, Cath-lab, CSU, Cardio-Vascular Unit. During the course, the students can learn, not only perfusion, ECHO and electrophysiology, but also Extracorporeal Membrane Oxygenation (ECMO) and Continuous Renal Replacement Therapy (CRRT) (Table 1). The clinical competences of the perfusionist are functional to the continuous evolution of treatments and monitoring in the ICU. In this setting, it is always more common monitoring the cardiac output and hemodynamic parameters using the ECHO assessment, with trans-thorax evaluation, instead of the Swan Ganz catheter or PICCO® Pulsion System (Getinge, Sweden), reducing the risk of many complications [2]. ECMO procedure is not so common and easy to apply in all ICUs because generally it is feasible only in selected hospitals with a CSU, where the perfusionist is on board and on call 24 h a day. In this last period, this technique had become an effective strategy to gain time to recover the respiratory function in case of acute respiratory distress syndrome, in case of severe Covid-19 pneumonia or, for H1N1 flu disease [3]. Furthermore, extracorporeal circulation such as CRRT or ECMO may benefit from hemoadsorption filter [4,5]. The increasing need for organ donation has focused on investigating the use of ECMO in case of the Donation after Circulatory Death. This procedure tries to save and restore organs from cadaver immediately after a refractory cardiac arrest. The use of ECMO in this last case is functional to restore organs circulation [6]. For this reason, the presence of a perfusionist should help to use this device in many settings and help the physician and nurse team for the cardiological assessment and in many daily activities. There are few papers or clinical trials regarding the presence of perfusionists in ICU; at the same time, there are trials regarding the benefit of ECMO performed by a perfusionist [7]. In Italy the 63.7% of perfusionists, find a job after graduation in less than 3 months, the 91.9% with a private employ, only the 6.5% in public health and finally only 1.6% works for non-profit organization [8]. According to unpublished data of the Italian College of Perfusionists, at the moment there are seven hospitals where there are 17 perfusionists working for ECMO in ICUs or performing ECHO. The majority of these hospitals do not have a CSU. In three hub hospitals in Italy with CSU, one perfusionist is present 24 h/day for ECMO procedures, and in the other hospitals, he is on call during the nights and festive days. Anyway the importance of multidisciplinary equipe in ICU is well known. Multidisciplinary teamwork in ICU has many positive effects, increasing skills and knowledge of all ICU medical-nurse teams, improving the quality of care, probably with a better allocation of resources [9]. Despite this, this concept is still not common in Italy. It might be helpful and necessary an extended fellowship in the ICU at the end of the degree course. Furthermore, recording in an electronic log-book all skills and training and maneuvers performed by perfusionist students, as it happens for a resident of the School of Anaesthesia and Intensive Care, could favorite their integration in the ICU team [10]. The perfusionist could be an added value to the medical-nurse team, in the modern ICU.

Clinical trainings Targets Degree year
Echocardiography and Holter reading clinic ECG track execution and its ­interpretation I and II Year
Haemodialysis Preparation, setup, and operation of the hemodialysis machine II Year
Echocardiography clinic Technical execution of the complete quantitative assessment exam II Year
Respiratory function clinic Tests to evaluate cardio-respiratory function II Year
Vascular ultrasound Flowmeter evaluations of the vascular system II Year
Hemodynamic and electrophysiology Preparation, management, and application of the equipment II and III Year
Cardio-surgery and ECMO Preparation, management, and application of the equipment Management and application of extracorporeal circuits III Year
Intensive care unit Management of extracorporeal devices, echocardiography, and electrocardiography III Year
Table 1

Clinical training and targets during the Graduation of Perfusionist

CONFLICTS OF INTEREST

The authors declare they have no conflicts of interest.

AUTHORS’ CONTRIBUTION

All authors equally contributed to this paper: Gabriele Melegari writing. Maria Chiara Franchini and Francesca Sola concept of idea. Emanuela Testa and Alberto Barbieri reviewed the paper.

FUNDING

No financial support was provided.

Footnotes

Peer review under responsibility of the First Affiliated Hospital of Zhengzhou University

REFERENCES

[8]Cerca professioni. Available from: https://www2.almalaurea.it/cgi-asp/professioni/ (accessed August 16, 2021).
Journal
Intensive Care Research
Publication Date
2021/09/03
ISSN (Online)
2666-9862
DOI
https://doi.org/10.2991/icres.k.210830.002How to use a DOI?
Copyright
© 2021 First Affiliated Hospital of Zhengzhou University. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Cite this article

TY  - JOUR
AU  - Gabriele Melegari
AU  - Maria Chiara Franchini
AU  - Francesca Sola
AU  - Emanuela Testa
AU  - Alberto Barbieri
PY  - 2021
DA  - 2021/09/03
TI  - Why you should have a Perfusionist as Workforce in the Intensive Care Unit
JO  - Intensive Care Research
SN  - 2666-9862
UR  - https://doi.org/10.2991/icres.k.210830.002
DO  - https://doi.org/10.2991/icres.k.210830.002
ID  - Melegari2021
ER  -