Cardiovascular Perfusion at the DHZB
The Deutsches Herzzentrum Berlin offers the whole spectrum of modern cardiac, thoracic and vascular surgery for patients of all age groups. The demands on the team of cardiovascular perfusionists in terms of training, specialist knowledge and technical expertise are correspondingly high. Close cooperation with the surgeons, anesthetists and nurses is an essential prerequisite for operations being successfully conducted. This is especially true of complex procedures.
The cardiac perfusion team at the DHZB is constantly researching developing treatment concepts, participates in multicentric studies and regularly takes part in specialist conferences.
Development of Cardiovascular Perfusion
Without the heart-lung machine, which was introduced at the beginning of the 1950s, the development of modern cardiac surgery would not have been possible. Even today, despite the constant further development of minimally invasive surgical techniques, many procedures on the open heart are not possible without the heart being stopped and the patient’s circulation being maintained by a heart-lung machine.
Since the number of heart operations was increasing it was necessary to provide professional training in the use of this so-called mechanical “extracorporeal circulation”. Thus the relatively new profession of cardiovascular perfusionist and a study program emerged.
The tasks covered by cardiovascular perfusionists have, in the meantime, broadened. In addition to operating the heart-lung machine, perfusionists now work with systems for mid- to long-term circulatory support, cardiac pacemakers and defibrillators.
The Heart-Lung Machine
Many operations on the heart and the large blood vessels close to the heart, for example the aorta, can only be performed if the heart is stopped. The function of the lung is also shut down. At the beginning of the operation the blood vessels leading to and from the heart are connected to the heart-lung machine by means of cannulas and tubes.
Perfusionists monitor the function of the heart-lung machine throughout the operation. This involves checking and regulating the oxygen content of the blood, its temperature and its pH value. In-depth understanding of physiology and medical equipment is essential for this task.
The Deutsches Herzzentrum Berlin has twelve modern heart-lung machines, three of them especially for babies and small children. In 2015 over 2,400 operations were conducted using the heart-lung machine.
ECMO Systems
Extracorporeal membrane oxygenation (ECMO) functions in a similar manner to the heart-lung machine. However, ECMO systems are considerable smaller and can therefore be used outside the operation room in patients with circulatory failure.
The surfaces of the ECMO have a special coating that prevents the blood coagulating and so the machine can be used for up to four weeks. Cardiac perfusionists monitor the system.
The DHZB has one of the largest ECMO programs in Europe. It has twelve modern ECMO systems to treat patients – from the acute emergency to longer-term support. Three of these ECMO systems are for children.
A further task of the perfusionists at the DHZB consists in accompanying ECMO patients who are being transported from other areas of Germany, or even from abroad, for further care at the DHZB.
Mechanical Circulatory Support
When the heart does not recover, even with the use of an ECMO system or a longer recovery time is needed, pumps to support the heart can be implanted. These pumps supply the blood to the patient’s body and remain in place long term. The DHZB has the largest program worldwide for ventricular assist devices. Read more about them here.
The perfusionist in the operating room checks the systems and prepares them for implantation.
Heart-lung machines for babies and children
Newborns and even prematurely born babies with severe congenital heart defects often need an operation shortly after birth to save their lives. The very small volume of blood in the bodies of these small patients stands in a particularly unfavorable relationship to the volume of fluid needed to fill the heart-lung machine before the procedure. At the same time the transfusion of blood products is associated with a certain risk.
In long-standing close cooperation with the manufacturers as well as with surgeons, pediatric cardiologists and anesthetics, perfusionists at the DHZB have developed special heart-lung machines for newborns with a birth weight of less than 2000 grams. These mini heart-lung machines regularly allow operations in these tiny patients without blood transfusions. This means of operating at the DHZB has been shown to allow better recovery of the children and is without comparison worldwide.
Professional Training
The DHZB offers a training course for prospective perfusionists and studies leading to the B.Sc. in Cardiovascular Perfusion.
The training course and the study program are open to nurses, surgical assistants and individuals in comparable medical professions who wish to qualify as perfusionists. The DHZB is one of the three certified training centers in Europe whose alumni are fully recognized internationally, without taking an additional examination, by the European Board of Cardiovascular Perfusion.