Although not an election year, anyone watching, reading or listening to the media in America would sense that the presidential race is foremost on the minds of the voting electorate. It is tempting to overstate that the present frenzy as representing an interest far greater than that has occurred in the past, or at least our memory of it. However, the underlying tenet in any democratic society has always been the knowledge that change is possible. Regardless of one’s political leanings, it is this potential that instills interest and motivates even the most sullen of individuals. In medicine, however, even the mention of change tends to chill even those that deem themselves flexible and amenable to new ideas. Some believe that the current state of cardiac surgery, with a declining case load and failure to fill fellowship programs, was a result of the slow response to the erosion of surgical revascularization cases over the past decade. It is not difficult to see that the field of perfusion may also be destined to such a fate.

In the late 80’s and early 90’s, perfusionists found themselves thrust into the political arena with a single bill that appeared in the California legislature. If passed,  it would have given another allied health specialty the ability to conduct cardiopulmonary bypass.  Although the push was focused towards the conduct of extracorporeal membrane oxygenation (ECMO), quick-thinking and brilliant, perfusionists saw this as an affront to the scope-of-practice for the profession and the era of government relations was born and continues to this day. The question of how this was able to occur can be easily answered by looking at what was happening in the field at that time. Business was booming, much as a result of the expansion of CABG surgery. Perfusionists were forced to focus on the heart-lung machine and the conduct of CPB and less on other traditional perfusion services such as IABP, ventricular assist, ECMO and autotransfusion.  At the time, it was logical, since these ancillary procedures lacked, arguably, the sophistication of CPB. In some hospitals a new specialty of that of perfusion assistant was born but many facilities decided to assign these duties to other allied health professionals or to nurses who were more abundant at in-patient settings. As long as the caseload that perfusionists had chosen to follow maintained itself at a sustainable level, then the future would have been promising. As we now know, this did not turn out to be the case. The effect of the ability of surgeons to perform CABG surgery ‘off-pump’ has resulted in a vilification of the heart-lung machine, which further sensationalized perfusion and drove individuals from entering the field. Clearly change is necessary and no longer could the field take a wait-and-see philosophy and hope for a market correction. As usual, AmSECT has taken a proactive role and has addressed this in its long-term strategic plan, with the incorporation of a field within perfusion using the techniques and methods that are taught in perfusion education and emphasized in continuing education events. Perfusionists are the only group of professionals that has received formal education in techniques of autotransfusion, intraoperative plasmapheresis, and ultrafiltration. Obviously, patient safety remains the stalwart characteristic of what we as perfusionists do, and it would be futile to argue that there are better prepared individuals to take a leadership role in the area of perioperative blood management. The October issue of AmSECT Today will describe in detail AmSECT’s commitment to this area.

PERIOPERATIVE BLOOD MANAGEMENT
INITIATIVE: Develop a blood management initiative whereby Scope of Practice changes in perfusion responsibilities are fostered.

GOALS:  Create a new Standing Committee to formalize the development and promotion of all aspects of perioperative blood management.

STEPS:
   a. Using the committee, identify what areas need to be explored for future growth.
   b. Using the revised Scope of Practice, address the topics from this document.
   c. Utilize the established New Advances in Blood Management meeting (NABM) as a venue for this committee.
   d. Establish a location on the AmSECT website for the development of this initiative.
   e. Survey autotransfusionists to see how the Society may support them and attract new members to the Society.