46 Occupational Outlook Quarterly ● Winter 2002-03

in a highly volatile situation.

Perfusionists have to be brave and

believe in themselves and their training.

They have to work well with other

people, because they don’t work alone.

They work with a surgeon and an

anesthesiologist as part of a team.”

According to Holt, the average

cardiac surgery takes a little more than

3 hours. Often, a perfusionist has

additional roles before and after

surgery. Holt may help prepare for a

surgery using cardiovascular monitoring techniques. “The heart is a complex

pump,” he says, “and to get the proper

information, we need the proper

monitoring devices in place.”

In addition, Holt may use devices that

assist the functioning of a failing heart to

keep a patient alive until surgery can be

done. He also may use such devices for

days or weeks after surgery to support

circulation until the heart regains its

strength. Some perfusionists acquire

expertise in pacing technology, as well.

They help restart a patient’s heart after

cardiac surgery or stabilize an irregular

heartbeat using electrical pacemakers or

defibrillating devices.

Like most perfusionists, Holt does not

have a set work schedule. He spends

some time on call and may have to rush

to the hospital for an emergency. “If

you’re a clock watcher,” he says, “you

could not do the job. It’s a 24-hour-aday, 7-day-a-week responsibility.”

Most perfusionists spend all of their

work hours in a hospital—as did Holt,

when he started out 24 years ago.

Although he still does perfusion, Holt

now changes locales more often than the

average perfusionist. He currently works

for a medical transport company and

serves as a professor of perfusion science.

Holt’s job with the medical transport

company sends him around the country

and around the world. He may work in

the back of an ambulance, in a helicopter, in a jet, or from anyplace in which he

has access to a computer that is connected to a modem.

Holt supports critically ill cardiac

patients in transit to distant medical

facilities where specialized heart

surgeries are done. “I’ve done cardiac

assist transports from as far away as

Malaysia to the Mayo Clinic in Rochester, Minnesota,” he says. “In that case, it

was for a heart transplant.” Oftentimes,

Holt does not actually travel with the

patient. “I’m able to dial in to cardiac

monitoring devices from a remote

location,” he says, “and communicate

with medical personnel by fax or cell

phone to help manage a patient’s

circulatory function and assist in

troubleshooting.”

As an instructor at the Ohio State

University and at the University of

Nebraska Medical College, Holt trains

perfusionists through extensive hands-on

practice and lectures. He shows students

how to assemble, prime, and operate a

heart-lung machine and related devices.

The students must learn by practicing on

Matthew Mariani is desktop publisher for the live animals, because, Holt says, “Some

OOQ, (202) 691-5728.

46 Occupational Outlook Quarterly ● Winter 2002-03

David Holt explains to students the

functioning of a blood oxygenator, the

“lung” portion of a heart-lung machine.

ou breathe. Your blood absorbs

oxygen from your lungs. Your heart

pumps the blood, transporting oxygen to

all the cells of your body. If this natural

rhythm stops, you will die.

Or maybe not. Under certain circumstances, a highly trained medical

professional called a perfusionist can

sustain the life of a person whose heart

has been stopped. David Holt is such a

professional. He uses biomedically

engineered devices that support the vital

life functions normally performed by the

heart and lungs. Most commonly,

perfusionists operate a heart-lung

machine to keep a patient alive during

open heart surgery. But their skills have

other applications, too.

Holt flashes back to his early days

as a perfusionist in describing the

typical duties of the occupation. When

assisting in a scheduled open heart

surgery, Holt comes in to the hospital

at 6 a.m., collects all the components

of the heart-lung machine, assembles

them aseptically, and makes sure the

equipment works perfectly. Then, he

waits for his cue.

A surgeon connects the patient to the

heart-lung machine by inserting tubular

instruments, called cannulas, into the

proper blood vessels to bypass the heart

and lungs. When the surgeon gives the

order, Holt administers a drug that

stops the patient’s heart. “Then the

surgeons do their magic,” says Holt,

“while the perfusionist manages the

patient’s lungs and bloodflow using the

heart-lung machine.”

Holt monitors the machine as it draws

blood from the patient, adds oxygen,

removes carbon dioxide, and then pumps

the blood back into circulation. He

adjusts the equipment as needed to

ensure proper blood pressure and flow

during the surgery.

“It sounds simple,” Holt says of his

work, “but it takes somebody who can

see small changes in events, evaluate

them in rapid sequence, and think clearly

Y
Occupational Outlook Quarterly ● Winter 2002-03 47

things cannot be simulated artificially

and have to be experienced.”

Holt also teaches evolving applications of perfusion technology, such as

autotransfusion. His students will likely

be called upon to assist patients having

massive internal bleeding resulting from

traumatic injury or as a complication of

surgery. Using special tools,

perfusionists can recover blood that is

hemorrhaging into a patient’s chest or

abdominal cavities, recondition that

blood, and then return it into circulation.

Instructing students in research

methods is another part of Holt’s

teaching role. Some perfusionists

collaborate with other medical professionals to research and develop better

perfusion techniques and tools, so

research skills are important.

In the United States, only 21 schools

have programs to educate students for a

career in perfusion. All these schools

combined graduate about 140 students

per year. The programs vary in their

entry requirements and in length. They

also confer different types of educational

credentials upon completion.

For some programs, applicants need

only 60 to 80 semester hours of college

credits, including prerequisite science

courses. For others, a bachelor’s degree

with similar course prerequisites is

needed. Still others look for a combination of education and experience in a

health-related occupation. Most perfusion programs require 20 to 24 months

of study; some require less.

Program graduates may earn a

bachelor’s degree, a master’s degree, or

a certificate in perfusion science. The

choice of a program depends partly on

where people are in their education when

they decide on a career in perfusion.

Sometimes, medical assistants,

nurses, paramedics, or other healthcare

workers choose to become perfusionists.

They may already have a bachelor’s

degree, so they may opt for a master’s or

a certificate program in perfusion. Others

may decide on this career in high school

or early in college, so they may specialize sooner, pursuing a bachelor’s degree

in the field. For example, Holt began his

undergraduate education at Ohio State

University, planning on a future in

medical school, but he soon discovered

Ohio State’s bachelor’s degree program

in circulation technology. “That just

caught my eye,” he says. “I found it to

be a nice mix of electronics and cardiac

care, and I said, ‘Wow, that’s what I want

to do.’” After becoming a perfusionist,

Holt decided that he wanted to teach

others, so he later earned a master’s

degree in education.

Today, students who complete

perfusion programs typically take a

written exam administered by the

American Board of Cardiovascular

Perfusion to receive professional

certification. The board requires

by

Matthew

Mariani

continuing education credits and

handling at least 40 perfusion cases

each year to renew certification. Some

States license perfusionists, but licensure

may depend primarily on having board

certification.

According to the American Society of

Extra-Corporeal Technology, there are

about 3,700 perfusionists currently

employed in the United States. Holt

estimates that starting salaries for

perfusionists are about $58,000 to

$61,000 per year and that earnings for

those with 10 years of experience range

from $85,000 to $100,000 per year. The

Bureau of Labor Statistics does not

collect data on perfusionists’ employment numbers or earnings.

If you’re like most people, you take

for granted every heartbeat and every

breath of air. But someday, your luck

could run low—and that’s when you

might need a perfusionist like Holt to

help save the rest of your days on earth.

“It’s gratifying,” Holt says, “to find ways

to save patients’ lives: to sustain them

artificially, to enable them to have

corrective surgery, to see them wake up

and walk out of the hospital.”

Occupational Outlook Quarterly ● Winter 2002-03 47

Perfusionists use complex electronic and

mechanical devices to support a patient’s

circulation.

The training of perfusionists involves

extensive hands-on practice.

Photos courtesy of David Holt