Reviewed by: Blake Denison, CCP, FPP, LP
Written by: Ashley Lawrence
On March 3, 2021, the Texas Center for Pediatric and Congenital Heart Disease, a clinical partnership between UT Health Austin and Dell Children’s Medical Center, announced its educational partnership with the Texas Heart Institute in which student perfusionists will now have the opportunity to perform clinical training at Dell Children’s Medical Center.
“While student perfusionists at the Texas Heart Institute currently have the opportunity to visit nearby hospitals in the Texas Medical Center, our training program, here at Dell Children’s Medical Center, is the very first to offer these students an immersive training program that occurs in the pediatric clinical setting,” says Bake Denison, CCP, FPP, LP, who serves as the Director of Clinical Perfusion for the Texas Center for Pediatric and Congenital Heart Disease.
The Texas Heart Institute School of Perfusion Technology offers a post-baccalaureate certificate in perfusion technology. During this 18-month certification program, students who attend the School of Perfusion Technology receive academic and clinical training concurrently and are trained to operate the cardiopulmonary bypass machine, commonly known as the heart-lung machine, as well as other equipment associated with open heart surgery.
“A perfusionist is a clinician that maintains the cardiopulmonary bypass machine, which is an artificial blood pump which delivers oxygenated blood to the patient’s tissues while the surgeon operates on the patient’s heart. The bypass machine is very large, about the size of a dinner table, and this amazing piece of equipment allows the perfusionists to take over the function of the heart and lungs. An additional role of the perfusionist is to administer a drug called cardioplegia which is used to safely and temporarily stop the patient’s heart. With the patient’s heart stopped and the bypass machine moving the blood around the body, the surgeon can now operate on a quiet and bloodless field to repair extremely complex congenital heart anomalies. Our methods and equipment could essentially allow the heart and lungs to be completely removed from the body and you would still be alive, which is pretty cool,” says Denison.
Student perfusionists at the Texas Heart Institute are required to operate the cardiopulmonary bypass machine during a minimum of 75 cases to fulfill graduation requirements and obtain eligibility to become a certified clinical perfusionist, which is granted after passing the American Board of Cardiovascular Perfusion’s national certification examination. Historically, the Texas Heart Institute has been known as a powerhouse perfusion program with their graduates employed in just about every major city across the country.
“Unfortunately, there are many students graduating from perfusion programs that are never really exposed to the pediatric setting, and there are so many different nuanced things between adult cardiac surgery and pediatric cardiac surgery. As expected, major differences exist between a 100 kg adult who has chronic kidney disease versus a patient that is just four hours old. The type of equipment we use is also radically different. We have access to the latest technology and have created a bypass machine that is truly state of the art. Our specialized system looks like mission control when you sit behind it. We have designed our setup to essentially position us three or four steps ahead of the surgeon so that we can provide the best possible care. This is something that is going to be really great for these students to experience,” says Denison.
Perfusionists are vital members of cardiothoracic surgical teams. To be able to operate this complex equipment, the perfusionist must not only have a thorough understanding of both the respiratory and circulatory system, but also be very attentive to the patient’s blood parameters in order to identify the most appropriate mechanical, pharmacological, and thermal manipulation needed to maintain the patient’s physiological state.
“Perfusionists also maintain several forms of circulatory support outside of the operating room, such as extracorporeal membrane oxygenation (or ECMO), ventricular assist devices, and other long-term support options—all of which are equally as important as what takes place in the operating room,” says Denison.
The Texas Center for Pediatric and Congenital Heart Disease takes a multidisciplinary approach to patient care. This means patients benefit from the expertise of multiple specialists across a variety of disciplines. Fellowship-trained and board-certified physicians with extensive experience in treating heart diseases and defects in children of all ages work alongside a team of pediatric cardiac experts, which include cardiologists, cardiothoracic surgeons, interventional cardiologists, critical care specialists, hospitalists, anesthesiologists, perfusionists, nurses, advanced practice providers, social workers, psychologists, child life specialists, dietitians, physical and occupational therapists, pharmacists, and more to provide unparalleled care for patients and their families.
“Our goal for this educational program is to really immerse these students into our clinical setting so that they can better understand how drastically different the level of care can be. While it’s really easy to focus on all the stuff that goes on in the operating room, our holistic approach to care, not only in the pediatric aspect, but also organizationally, is something they should strive for wherever they end up upon graduation. At Dell Children’s, everyone who is involved in the care of the patient is a member of the patient’s care team, and everyone on the care team works together to ensure the patient receives the best possible clinical outcome. Therefore, all members of the care team participate in the case conference, morning rounds, and decision processes,” says Denison.
The Texas Center for Pediatric and Congenital Heart Disease, housed at Dell Children’s Medical Center, diagnoses, treats, and manages the care of children and adults with heart diseases and defects. Led by Charles Fraser, Jr., MD, who serves as the Chief of Pediatric and Congenital Surgery, the Texas Center for Pediatric and Congenital Heart Disease is the only pediatric program in Central Texas offering comprehensive heart care for newborns, infants, children, and adolescents.
“We are pleased to offer this exciting educational program in collaboration with the Texas Heart Institute. Our pediatric perfusionists at Dell Children’s and UT Health Austin are world leaders in mechanical circulatory support for children. We believe our program offers an unparalleled experience to learn from the best,” says Dr. Fraser.
This education program offered in partnership with the Texas Heart Institute is the first ever clinical affiliation between the Texas Heart Institute and a healthcare system since the school was founded by former cardiovascular surgeon Denton Arthur Cooley, MD, in 1962. As of early March 2021, 16 student perfusionists have already enrolled in the first year of this education program.
“This opportunity is pivotal for the program as we quickly approach the upcoming perfusion training season. In collaboration with Blake Denison, we are proud to be a part of expanding the Texas Heart Institute mission of educating the next generation of perfusionists to the broader region while championing Dr. Cooley’s devotion to educational excellence that he consistently advocated dating back to THI’s founding nearly 60 years ago,” says Deborah Lowery Adams, CCP, who serves as the Director and Clinical Coordinator of the School of Perfusion Technology at Texas Heart Institute.
To learn more about the Texas Center for Pediatric and Congenital Heart Disease, visit here.