You 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
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
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 patientís heart. "Then the surgeons do their
magic," says Holt, "while the perfusionist manages
the patientís lungs and bloodflow using the heart-lung
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
"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
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 donít
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
patientís heart after cardiac surgery or stabilize an
irregular heartbeat using electrical pacemakers or
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 youíre a clock
watcher," he says, "you could not do the job. Itís
a 24-hour-a-day, 7-day-a-week responsibility."
Most perfusionists spend all of their work hours in a
hospitalóas 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
Holtís 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. "Iíve 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. "Iím 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 patientís
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 live animals, because,
Holt says, "Some 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 patientís
chest or abdominal cavities, recondition that blood, and
then return it into circulation.
Instructing students in research methods is another part
of Holtís teaching role. Some perfusionists collaborate
with other medical professionals to research and develop
better perfusion techniques and tools, so research skills
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
For some programs, applicants need only 60 to 80 semester
hours of college credits, including prerequisite science
courses. For others, a bachelorís 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 bachelorís degree, a
masterís 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
Sometimes, medical assistants, nurses, paramedics, or
other healthcare workers choose to become perfusionists.
They may already have a bachelorís degree, so they may opt
for a masterís 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 bachelorís
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
Stateís bachelorís 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, ĎWow, thatís what I want to do.í"
After becoming a perfusionist, Holt decided that he wanted
to teach others, so he later earned a masterís degree in
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 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
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 perfusionistsí
employment numbers or earnings.
If youíre like most people, you take for granted every
heartbeat and every breath of air. But someday, your luck
could run lowóand thatís when you might need a
perfusionist like Holt to help save the rest of your days on
earth. "Itís gratifying," Holt says, "to
find ways to save patientsí lives: to sustain them
artificially, to enable them to have corrective surgery, to
see them wake up and walk out of the hospital."
Photos courtesy of David Holt