oa The role of the perfusionist outside the OR

In 2010, following the H1N1 swine flu pandemic,¹ five severe respiratory centers were commissioned in England. These were established to provide veno-venous ECMO (extracorporeal membrane oxygenation) for patients with refractory respiratory failure. Moreover, it was a condition set out by the commissioning body that each center would carry out a minimum of 20 cases per year to remain certified. The reality of the situation has proved somewhat different. At Guy's and St Thomas’ NHS foundation Trust (GSTT), the annual number of cases has steadily increased. In 2015, the Trust carried out almost 100 veno-venous ECMO cases.² These recent developments in available therapies for patients with refractory respiratory failure or cardiac failure meant that intensive care staff have been exposed to equipment with which they have been hitherto unfamiliar. Clinical perfusion scientists, previously “shackled” to the heart lung machine, have found themselves thrust into clinical, supportive, and educational roles, teaching both nurses and medical staff the ins and outs of the ECMO equipment and being an integral part of the multidisciplinary team retrieving patients from tertiary centers.

This increase in workload has necessitated an increase in staffing requirements across all specialties and an ever evolving training program. All ECMO specialist nurses are required to undergo a comprehensive training program.³ This serves to familiarize them with the equipment used, give them a good understanding of the nuances of the ECMO circuit, and train them to an accepted level of competency in ECMO emergencies. All water laboratory training is carried out by perfusion ECMO trainers. The competencies practiced have evolved to include emergency procedures that staff have encountered over the years since the service began. Since 2009, at Guy's and St Thomas’ NHS Foundation Trust, we have developed a robust and comprehensive training program to ensure that we have a large cohort of well-trained, confident, and competent intensive care staff who are able to handle any ECMO emergencies in a safe and timely manner.

ECMO specialist training involves water drills approximately 3 days a week prior to “signing off” and then mandatory updates every 3 months.³ ECMO consultants and medical fellows also undergo the same training and have yearly updates.

This presentation explains how the role of the clinical perfusionist at GSTT has evolved outside the operating theater environment in training, supportive, and clinical roles.

It also explains the role of the perfusionist in the retrieval process as well as outlining the training program and the three-day bi-annual high-fidelity simulation course developed by the multidisciplinary team in the Trust.