We recently celebrated the 50th anniversary of the first successful use of cardiopulmonary bypass. It appears to many practicing clinical perfusionists that the profession is at a major crossroad. Because of major technological advances, treatment for cardiovascular disease has dramatically changed the surgical patient population. Advances in medical management and interventional cardiovascular procedures have delayed surgery in many adults. This affects perfusionists in terms of new psychological and technical challenges, and it has serious potential consequences and implications for the future of the perfusion profession.
However, after reviewing the case numbers for the period 1990-2000, it appears that the rate of population growth > 65 years of age, CABG surgery volume, valve surgery volume, and discharges for CHF are all increasing in the range of 2.6-5.3%/year. The net increase in clinical perfusionists has leveled off at 1.3% per annum since 1996. Population growth and the looming “baby boomer” population at the cusp of the cardiac surgical intervention period maintained a slow but steady increase in cardiac surgical procedures during this period.
Some perfusionists have questioned the wisdom of continuing to train new perfusionists considering the changing patterns of cardiovascular treatment. There was an 11% increase in the number of hospitals performing open-heart surgery in 2001. Many centers, especially academic medical centers, experienced a decrease in caseload due to the increase in the total number of centers. Also, the number of off-pump procedures have not increased at the rate originally expected.
The continuation of perfusion education programs at their current rate of output seems justified. The perfusion profession is already very small with only 3300 certified perfusionists in the U.S., and the annual net increase due to education programs is just over 1%. The best way to insure the future of the profession is to continue to education excellent clinical practioners, expand the scope of practice, and to support recognition of this scope of practice through state licensing and national certification.
- Elderly population increase (>65) 2.6%/yr
- CABG numbers increased 2.9%/yr
- Valve surgery volume increased 5.3%/yr
- CHF hospital discharge 4.3%/yr
- Net increase in perfusionists (since 1996) 1.3%/yr
Sistino JJ Epidemiology of cardiovascular disease in the last decade: treatment options and implications for perfusion in the next century. Perfusion 2003:18;73-77.
Sistino JJ Expanding the role of perfusionists in the era of new treatment options for cardiovascular disease Perfusion 2003:18; 253-256.
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