Role of a perfusionist in patient blood management

Abstract

Perfusionists are essential members of the cardiac surgery team. They provide cardiopulmonary support for patients undergoing various cardiac surgeries with the use of the cardiopulmonary bypass (CPB) machine. This takes over the functions of a patient's native heart and lungs. Blood from the patient is drained (typically from the right atrium) into the CPB circuit where it gets oxygenated and then pumped back to the patient's aorta. It is important that the extracorporeal circulation of the CPB meets the oxygen demands of the patient. Central in this oxygen demand–supply relationship between the patient and CPB is blood and its components. Cardiac surgery involves many situations that may necessitate transfusion of blood products. CPB and its circuit components, albeit vital, are one of the major contributors to transfusion. It represents the single largest acute source of exogenous non‐hemic volume infused into a patient at the commencement of CPB. Anticoagulation is also fundamental due to the foreign surfaces of CPB. Systemic cooling of the patient on CPB is another contributor of transfusion. At the National University Hospital, Singapore, measures, both in terms of practices and devices, have been put in place to minimize transfusion. Switching to albumin prime and maintaining mild hypothermia may help reduce prime‐ and hypothermia‐induced coagulopathy. Additionally, devices such as the haemofilter and cell saver can aid in concentrating and recycling patient's own shed blood. Despite each having its own limitations, together, they help to minimize patients receiving homologous blood in the course of their surgery.