Why you should have a Perfusionist as Workforce in the Intensive Care Unit
- https://doi.org/10.2991/icres.k.210830.002How to use a DOI?
- Perfusionist, ECMO, training
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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 . 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 . 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 . 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 . 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 . 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 . 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 . 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 . 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|
Clinical training and targets during the Graduation of Perfusionist
CONFLICTS OF INTEREST
The authors declare they have no conflicts of interest.
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.
No financial support was provided.
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 -