PERFUSIONISTS
Sustaining life during surgery

When a child undergoes open heart surgery, the blood flow and heartbeat are stopped and the lungs are motionless, but the child is kept alive through the meticulous care of the perfusionists tending the heart-lung machine.

Texas Children’s Heart Center pediatric perfusionists are skilled allied-health professionals trained and educated specifically as members of the congenital heart surgery team. 

Perfusionists are responsible for the selection, setup and operation of the heart-lung machine and any other circulation equipment during medical procedures where it is necessary to support or temporarily replace a patient’s respiratory or circulatory functions.

The patient’s heart is stopped during surgery so it is easier for the surgeon to operate. Using the heart-lung machine, the perfusionist diverts the patient’s blood away from the heart and lungs into the machine. The heart-lung machine oxygenates that blood and returns it to the patient’s body.

Perfusionists Deborah Surprise and Mary Claire McGarry check the perfusion equipment before a surgery.

Physiological care
The perfusionist’s job is to keep the child’s body in physiological balance, as though it were working on its own under normal circumstances. Doing so requires the use of heating and cooling equipment. 

At the beginning of surgery, the perfusionist cools the blood to lower the patient’s body temperature. Cooling the blood slows the patient’s metabolism so that he or she requires less oxygen. Toward the end of surgery, the perfusionist warms the blood to a normal temperature.

Customized care
"We have a fine-tuned team because we’ve done this so many times with each other, and everyone knows his or her role well," said perfusionist Deborah Surprise. "We have the best people. Our anesthesiology team is highly trained, our surgical team is excellent, and our perfusion team comes from an experienced background. What sets us apart from other pediatric heart programs is our experience. No one is a rookie at this." 

The perfusion team does not operate with a one-size-fits-all approach. 

"In adult programs or children’s programs that are served by adult perfusionists on a part-time basis, what you often find is that they are trying to fit children into adult protocols," said Dr. Charles D. Fraser Jr., chief of congenital heart surgery at Texas Children’s Heart Center. 

"That translates into poor perfusion, very sick children after surgery and sub-optimal outcomes," Dr. Fraser said. "Our perfusionists customize the perfusion to each child's unique needs. "This customized care allows for a predictable level of perfusion support and children have optimal physiology to help them withstand even the most complex cardiac repair.