As I approach the end of my elected time for serving the Society I reflect, and reminisce, about the 24 years that I have been an AmSECT member. The field of perfusion has evolved immensely during those years despite the less than dramatic changes that have occurred in the technological aspects of our profession. This in no way is meant to offend the numerous cardiopulmonary device companies and their engineering staffs who toiled long and hard to bring new products to the perfusion community. Nor to the countless perfusionists who served as advisors and participated in focus sessions trying to predict what the future needs of our profession would be. The devices we use today have assuredly made the conduct of cardiopulmonary bypass safer and more reproducible, improving the care we administer so that our patients’ outcomes are improved. It’s just a point of fact that the improvements made to the devices we use daily have been more subtle then overt. However, the field of perfusion has undergone a dramatic transformation and will continue to do so both as a result of our efforts, and those of a changing patient base.

When I first began my perfusion education in 1985 at SUNY Health Science Center in Syracuse NY, we were using Sarns 5000 heart-lung machines (roller pumps) and Biomedicus (pre-Medtronic buy out) Bio-Heads as arterial drivers. There were bubble oxygenators side-by-side on the shelf next to the Bentley CM-50, Shiley 2000 and COBE CML membrane oxygenators. As any perfusion student can attest, what we remember most of our educational years are the times when our instructors grounded us in the realization of how critical and demanding the profession we had chosen to pursue: done so in an effort to mandate that we adhere to the highest standards of patient care. My blessings were many and I was fortunate to have Jeanne Lange, Scott Alexander, Jeri Siles and Howard West as instructors. As I approached the end of my education (I think I had amassed all of 40 cases as a primary perfusion student, or whatever the minimum the ABCP mandates were to sit for the exam), I asked Jeri if I could use a bubble oxygenator one time to gain experience. She looked at me as if I had just committed a capital offense and stated “would you use one if it were your mother on the table?” Needless to say I have never used such a device on a human being and her comments reverberate in my mind today. Jeanne passed away, leaving a great void in perfusion education that few could ever truly appreciate. Luckily for us we had, and still have, consummate professionals like Bill Horgan, Bruce Bartel, Leroy Ferris, who were there at the beginning of the formal education process for perfusionists (Bill and Bruce are still leading AmSECT’s efforts in CAAHEP and AC-PE) who guided us and provided the foundation for our profession through the formal establishment of perfusion education. Few would argue that this serves as the foundation from which all things perfusion are based.

In the late 80’s, perfusion was faced with its first major challenge that would serve as a call for action and galvanize the profession. Respiratory therapists in California had infused language into a bill going forth in front of the legislature that permitted them to perform cardiopulmonary bypass. Savvy California perfusionists like Debbie Gherlone (Raymond) and Sandy Hooker took leadership role in alerting the country to this rather simple statement that would have had catastrophic consequences for our profession. AmSECT stood up as the only perfusion organization to address this challenge and took the unpalatable step of raising dues from $75 to $225, which was to be used to hire lobbyists and fund initiatives across the United States. Some individuals balked at this increase but most, thank goodness, did not. Today there are 15 states that have enacted legislation to recognize the perfusion profession, and two others close to doing so. Individuals like Bob Longenecker, Gary Beckman, Keith Samolyk, Richard Burns, Mark Lucas, Bob Reinshuttle and many others have kept the critical importance of this legislative identity as a mandate for the future of our profession.

The next major challenge is ongoing, and will take the concerted effort of the entire profession to address: the decline in perfusion education programs. In 1995 the number of programs peaked (35) in a response to the late 1980’s and early 1990’s where the need for qualified perfusionists outpaced the supply of available clinicians. Anyone seeking a job during that time was aware of the ample opportunities that existed and the skyrocketing salaries (mine had doubled from 1987 to 1988). Perfusion companies brought in foreign trained perfusionists to meet the growing demand. Then the bottom fell out, or at least was lowered, and the ‘glut’ of available perfusionists was felt (real or perceived). Education programs closed, and are continuing to close, at unprecedented rate, which portends a quaking future that will need to be addressed in the short order. No profession can survive if the foundation by which it is established is weakened.

Over the years I have met and befriended a large number of individuals who have shaped what I do and affected who, in perfusion, I am. I met Jim Dearing in the spring of 1986 shortly before he died. As a ‘newbie’, ‘wet behind the ears’ neophyte I talked to Jim about cardioplegia, which I thought I knew something about, having won a Fellowship Award and Research Grant on this subject. Did I go to school quickly when, in the middle of my conversation with Jim, he looked at me and said, “There’s a lot more to cardioplegia then what you are stating”. Boy, was he ever correct. A year later I met Charlie Reed in Anaheim CA, but this time had the good sense to keep my mouth shut. I remember sitting in a hotel lobby sharing a glass of wine with Mark Kurusz and Aaron Hill when they simultaneously told me that the number one mishap in our field occurred when perfusionists forgot to clamp their arterial line when coming off bypass. What sound words of wisdom (from extremely knowledgeable people whom I admire) that I continue to practice today, despite the presence of electronic clamps configured to both bubble and level sensors placed strategically on all of my circuits. In addition to those already mentioned, AmSECT leaders like Ed Berger, Ben Mitchell, Ace Adams, Maddy Massengale, Calvin Scott, Ron Richards, Paul Cappola, Craig Vocelka, Susan Englert, Gary Reeder, Jerry Richmond, Nancy Achorn, Phyllis Palmer Stark, Jeff Riley, Robin Sutton, Ian Shearer, Bill DeBois, Richard Chan, Harry Hoerr, Susie Haubert, Carla Maul, Bruce Searles, Ed Darling, Ron Matheis, Richard Motley, John Toomasian, Mary Hartler Winkler, Pat Courtney, Bill Harris, Rebekah Trittipoe, Gary Grist and so many others have set the bar so high for all of us that we must find solace in any attempt to at least follow in their paths. And more recently people like Joe Deptula, Cody Trowbridge, Nadia Azuero, Kirti Patel, Greg Smigla, Scott Kmiecik, Brian Mejak, Bryan Lich, Greg Hahnel, Jeff Acsell, Kenny Shann, Donny Likosky and so many others who are generous in their efforts and actions so that the rest of us could prosper. To all of these individuals, and countless others, I offer my thanks and admiration.