Perfusionist (Clinical Perfusion Scientist)

Clinical perfusion scientists (perfusionists) operate extracorporeal circulation equipment during open-heart surgery and other cardiac and thoracic procedures. The heart-lung bypass machine (cardiopulmonary bypass circuit) takes over the function of the heart and lungs during surgery, oxygenating the blood, removing carbon dioxide, regulating temperature, and maintaining perfusion pressure to all organs while the surgeon operates on a stopped or arrested heart. Perfusionists set up, prime, and operate this circuit; manage anticoagulation using heparin; monitor the patient's arterial blood gases, electrolytes, and acid-base balance; and apply cardioplegia (cardiac arrest solution) to protect the myocardium during cross-clamping.

Beyond standard bypass, perfusionists manage more complex extracorporeal techniques: deep hypothermic circulatory arrest for aortic arch surgery, minimally invasive perfusion for TAVI and keyhole procedures, and extracorporeal membrane oxygenation (ECMO) for critically ill patients in intensive care. ECMO — providing long-term cardiac and respiratory support for patients awaiting recovery or transplant — is an expanding responsibility that requires specialist training and on-call commitments.

The Society of Clinical Perfusion Scientists of Great Britain and Ireland (SCPS) is the professional body. Registration with the SCPS and completion of the postgraduate Diploma or MSc in Clinical Perfusion Science (delivered at the University of Manchester and other centres) are the professional qualifications. Most perfusionists are NHS employees working within cardiothoracic surgical units, banded at AfC Band 7–8a.

Cardiac surgery volumes in the UK remain substantial and are supported by NICE guidance for conditions including coronary artery disease, valve disease, and aortic aneurysm. Every cardiac surgical case requires a qualified perfusionist — there is no substitute. The SCPS register and the technical complexity of bypass management mean that perfusionists cannot be quickly replaced or their skills replicated by non-specialists. The expanding use of ECMO in critical care creates significant additional demand outside the operating theatre. The specialist workforce is small — nationally there are fewer than 600 registered perfusionists in the UK — which creates genuine recruitment pressure and supports strong remuneration.

Morning: prepare the bypass circuit for a scheduled coronary artery bypass graft (CABG) — prime the oxygenator and tubing with crystalloid, set up the cardioplegia system, confirm equipment checks with the cardiac anaesthetist, and discuss the surgical plan. Theatre: support the team through a four-vessel CABG — commence bypass on instruction, manage flows, temperature, and haematocrit throughout, deliver cardioplegia at intervals, and come off bypass after 95 minutes of successful surgery. Afternoon: decant and return the circuit for sterilisation and prepare documentation; attend a brief MDT case review for an ECMO patient currently on support in ITU, review circuit parameters and assist the bedside team.