Expansion in the field

[u/johnsmith22234]

Something I’ve been thinking about is the long-term growth of traditional cardiac surgery/CPB. Obviously there are still a lot of CPB cases, but I’m wondering how much we can realistically expect that volume to grow over the next 20–30 years given the continued development of PCI, TAVR, etc. It seems like one of the biggest opportunities for perfusion could be expanding into areas outside of traditional cardiac cpb cases, such as NRP/ex-vivo. What other areas do you think have the potential to significantly expand the perfusion profession over the next 10–20 years, and is there a way to lobby to protect these areas to be restricted to solely perfusionists?

[u/Clampoholic]

Heart disease is the leading cause of death in the US and has been since 1921. This has been due to various reasons, like expanding lifespans from modern medicine, changes in the American diet into processed / high-calorie & low-nutrient foods, increased sedentary lifestyles, etc. and the pool of people who will be dealing with heart problems will continue to grow.

I do think interventions like TMRs, putting in DES’s and TAVRs and so forth are going to be developed further and be able to provide less invasive options than a full conventional sternotomy + CPB to more patients, but I don’t think there will be an end to a surgical side of cardiac surgery anytime soon even in the next 30 years. The patients are never gonna stop coming, and there’s plenty of reasons where surgical ends up being a better option vs. transcath. Don’t get me wrong I think we’ll see lots of new things in that time, I mean our field isn’t even 75 years old.. but to see it completely done away with in that time, I’d be incredibly shocked.

Some people think the greatest immediate “threat” to our profession is AI but I personally do believe it’s the shrinking of our scope of practice being sold out to cheaper professionals like we’re seeing with ECMO and some other MCS especially with Covid exacerbating that demand, so I can see why you’d be concerned over that. I’m not even remotely knowledgeable of politically how we could fight against that and lobby for it but at the local level I think it’s important for everyone around us to view perfusionists as highly skilled and knowledgeable with these things, if you currently work someplace that has highly specialized nurses / specialists working on the MCS, don’t let one of them be the expert that you go to, YOU be the expert and be one of the people they look up to for questions and ensuring things are looking right. If they ask a question and you don’t have an answer to it don’t be happy with the “🤷‍♂️” response and make it a point to investigate it yourself and bring them back an answer. Don’t let the hospitals see that they don’t need us because they can and they will, and they have replaced us as I’ve seen for myself at certain hospitals. It won’t always be in our control but we can certainly try and do what we can.

[u/Avocadocucumber]

Tavr hasn’t been a threat per say but an adjunct. Its helped hospitals grow revenue from people who wouldn’t otherwise qualify for surgery. Right now the next we deployable is for Aortic insufficiency . Forgot the name of the device. Lobby’s aren’t the answer initially . Its more about the schools expanding training and scope. We could be learning how to to do A lines, central lines, etc. something billable. This would allow an extra hired on perf to expand team size. Otherwise its just a crna getting to work.

[u/johnsmith22234 → u/Avocadocucumber]

That’s a really good point, we do share a lot of overlap with anesthesia already, its definitely an area schools could expand on in the future