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The role of perfusionists and engineers has evolved over the decades since mechanical circulatory systems were used in the clinical setting. Experience has ranged from managing total artificial heart (TAH) and ventricular assist device (VAD) patients who could not leave the hospital to today’s mix of durable and temporary systems in both the acute and ambulatory (through their continuum of care). Durable devices are primarily implanted at centers with certification from the Joint Commission (JC) or Det Norske Veritas (DNV) as disease-specific VAD centers. Certification requires device patient data to be entered into the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Temporary MCS covers a variety of devices that can be implanted in the operating room, intensive care unit, catheterization lab, and emergency room. Extracorporeal membrane oxygenation (ECMO) is one classification of these devices, which can be venous to venous (VV) or venous to arterial (VA). Most experienced ECMO centers belong to the Extracorporeal Life Support Organization (ELSO) and enter patient data in a registry. Maintaining a JC and/or ELSO certification requires dedicated individuals on teams that the perfusionist and engineer can be part of. Another temporary MCS has evolved from the catheterization lab with the ABIOMED Impella, Tandem, and CentriMag systems. All these temporary MCSs have been used in different settings at heart transplant centers since the UNOS allocation changed in 2018. The variety of temporary MCS before transplant can now include, more often, a balloon pump, a temporary device, or VA ECMO. There are numerous opportunities for incorporating the perfusionist/engineer on these teams, as more systems are used for longer durations. Other areas that need these skilled individuals are the transport on MCS (both from other hospitals and within hospital areas), and organ recovery. The skill set gained in this environment with teams with perfusionist/engineers is useful in the future evolving challenges with MCS.

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The Role of Perfusionists/Engineers in Mechanical Circulatory Support

  • 工具书词条

  • 发表日期：

    2025年

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  • Richard G. Smith,
  • Edward Betterton

摘要

The role of perfusionists and engineers has evolved over the decades since mechanical circulatory systems were used in the clinical setting. Experience has ranged from managing total artificial heart (TAH) and ventricular assist device (VAD) patients who could not leave the hospital to today’s mix of durable and temporary systems in both the acute and ambulatory (through their continuum of care). Durable devices are primarily implanted at centers with certification from the Joint Commission (JC) or Det Norske Veritas (DNV) as disease-specific VAD centers. Certification requires device patient data to be entered into the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Temporary MCS covers a variety of devices that can be implanted in the operating room, intensive care unit, catheterization lab, and emergency room. Extracorporeal membrane oxygenation (ECMO) is one classification of these devices, which can be venous to venous (VV) or venous to arterial (VA). Most experienced ECMO centers belong to the Extracorporeal Life Support Organization (ELSO) and enter patient data in a registry. Maintaining a JC and/or ELSO certification requires dedicated individuals on teams that the perfusionist and engineer can be part of. Another temporary MCS has evolved from the catheterization lab with the ABIOMED Impella, Tandem, and CentriMag systems. All these temporary MCSs have been used in different settings at heart transplant centers since the UNOS allocation changed in 2018. The variety of temporary MCS before transplant can now include, more often, a balloon pump, a temporary device, or VA ECMO. There are numerous opportunities for incorporating the perfusionist/engineer on these teams, as more systems are used for longer durations. Other areas that need these skilled individuals are the transport on MCS (both from other hospitals and within hospital areas), and organ recovery. The skill set gained in this environment with teams with perfusionist/engineers is useful in the future evolving challenges with MCS.