Toomasian John M, Searles Bruce, Kurusz Mark
Stanford University Hospital and Clinics, Operating Room Services, Stanford, CA, USA.
Perfusion. 2003 Jul;18(4):257-65. doi: 10.1191/0267659103pf677oa.
Clinical cardiopulmonary perfusion has evolved significantly during its 50 years. The science, technology and educational processes related to cardiopulmonary bypass have undergone continual change and metamorphosis. Perfusionists were initially trained on the job or in the laboratory, but with the advent of myocardial revascularization and the explosion in cardiac surgery, the need for formal educational training programs became apparent. The American Society of Extracorporeal Technology began the arduous processes of credentialing and developing certification guidelines that have continued under the American Board of Cardiovascular Perfusion. Licensure has also been adopted in many states during the past 10 years where nearly 50% of all perfusionists are covered by some legislative act. One additonal challenge has been developing minimal standards in which perfusionists practice. The initial standards included the use of a checklist and have evolved to monitoring and recording the significant events and parameters of each clinical procedure. The education of perfusionists will continue to be a challenge related primarily to reduced fiscal resources, the applicant pool and the ever-changing demands for extracorporeal circulation services. According to demographic and census information, it is expected the overall number of cardiovascular interventions will increase dramatically towards the latter end of the current decade in the US. The question arises as to what role perfusionists will play, as treatment strategies continue to change. If the number of education programs and new graduates continue to decline, the total number of perfusionists will decline, especially as many senior perfusionists leave the field or retire. It may be difficult to predict the total number of cardiovascular interventions that will be required in the next several years. However, if the total number of cardiovascular interventions that require perfusion services increase as a function of the aging population and if the overall incidence of cardiovascular treatment does not change, it will be imperative that perfusion education ramp up and train more perfusionists to meet the supply and demand or a shortage of skilled personnel may develop.
临床心肺灌注技术在其50年的发展历程中取得了显著进步。与体外循环相关的科学、技术及教育过程不断变革与演进。灌注师最初是在职培训或在实验室接受培训，但随着心肌血运重建技术的出现以及心脏外科手术的迅猛发展，正规教育培训项目的需求日益凸显。美国体外技术协会开启了艰难的认证及制定认证指南的进程，这一工作在美国心血管灌注委员会的领导下得以延续。在过去10年里，许多州也采用了执业许可制度，近50%的灌注师受到相关立法的覆盖。另一个挑战是制定灌注师执业的最低标准。最初的标准包括使用检查表，如今已发展为对每个临床操作的重大事件和参数进行监测与记录。灌注师的教育仍将是一项挑战，主要原因在于财政资源减少、申请人数量以及体外循环服务不断变化的需求。根据人口统计和普查信息，预计美国在当前十年后期心血管介入治疗的总数将大幅增加。随着治疗策略持续变化，灌注师将扮演何种角色成为一个问题。如果教育项目数量和新毕业生数量持续减少，灌注师总数将会下降，尤其是许多资深灌注师离开该领域或退休之后。未来几年所需心血管介入治疗的总数可能难以预测。然而，如果因人口老龄化而需要灌注服务的心血管介入治疗总数增加，且心血管治疗的总体发病率不变，那么灌注教育必须加强并培养更多灌注师以满足供需，否则可能会出现技术人员短缺的情况。
