Page 47 - ANZCP Gazette May 2023

It would be hard to find a more prolific or more published perfusionist than Al, with almost 150 publications on perfusion, cardiac surgery, blood management and studies in many other areas. Al has been the recipient of 42 perfusion awards and scholarships including the John H. Gibbon, Jr Award in 2021, an award which is given to an individual each year that has made significant contributions to the perfusion field. Al’s passion for perfusion is a great inspiration for all perfusionists regardless of level or experience. Al lives with his wife Barb on an 80 acre homestead in Northeastern Pennsylvania, USA where they are self-sustained, growing all their own organic food and providing a forest escape for their growing family.
Al has always been a great contributor to the ANZ community and it is a privilege to have him be our first interviewee for our “Under The Pump” series.
Al, Can you take us through the journey of your career in perfusion and how you became a perfusionist?
I actually ‘fell’ into perfusion by geographical proximity to a perfusion education program. When I graduated from college in 1981 I worked in research labs at Cornell University in Ithaca, New York where I had obtained an undergraduate degree. I was a research technician working on projects to improve milk output in dairy cows. I relocated to Syracuse New York and took a position as a research associate at Upstate Medical Center in a cardiac surgery lab. For the next couple of years I worked with a pediatric cardiac surgeon (Ed Bove, MD) doing in- vivo research on myocardial protection in neonatal patients.
I had never heard of perfusion but observed an individual conducting training for a small group of students on something called extracorporeal circulation. In the early 1980’s there were only a handful of perfusion education programs in America and one was located at Upstate where I was working, and the professor in the program was Jeanne Lange. Later I would find out that she was one of the first individuals in the United States to formalize perfusion education, and was a founder of the accreditation process for perfusion education programs. She encouraged me to look at perfusion as a career and I applied and was accepted into the program. This was just at the explosion in open heart surgery due to surgical revascularization was becoming popular so when I graduated in 1987 there was ample opportunities in every state. Jeanne’s passing in the early 1990s was a huge loss in perfusion.
During your career as a perfusionist, how has your work and the profession evolved?
Well, my pre-perfusion career was all research so when I entered I sought jobs that would offer me that opportunity as well. As a perfusionist I was fortunate to conduct research both in laboratories and clinically, which afforded me with the ability to meet perfusionists across the globe, including my colleagues in Australia and New Zealand. From an evolutionary perspective on would have to include the expansion of ECMO from newborns to adult patients as a giant leap. I started studying the technology of ECMO when I was at the University of Michigan Hospital and had the opportunity to work and learn from Bob Bartlett, MD, whose week-long courses I took several times.
Probably the greatest changes in our field have occurred in two areas: Education and electronic data charting. When I graduated most perfusionists had completed only a handful of cases in their primary education, so our learning really occurred on the job when we entered practice. Thank goodness that has changed with formal perfusion education programs now including simulation training, which had its origins in Australia in Sydney. Electronic data recording has expanded tremendously providing the ability to collect and analyze vast quantities of data which have been used to reduce variation in clinical practice. One other great advancement has been in the interpretation of scientific information with a focus on discerning the quality of published studies and separating and exposing poorly designed research. High quality research serves as the foundation for establishing clinical practice guidelines endorsed by professional societies, which has been wonderful but only serves as a starting point for establishing critical thinking.
What do you believe is the most rewarding aspect of being a perfusionist?
Without a doubt it is the feeling of successfully managing a patient through the extracorporeal experience with a focus on always looking for safer and better techniques for continued quality improvement. Having followed patients post-operatively for nearly four decades, I have always enjoyed conversations with patients and their families. This has been especially true for ECMO procedures.
What is your most memorable case or perfusion related experience?
While there are many the good outcomes are always expected so the less than successful cases leave more of a lasting impact. One of the more memorable
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