Annex A > Chapter 14 - Care in the Operating Theatre and the `Learning Curve' > Care in the operating theatre > The role of the perfusionists
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The role of the perfusionists
36 Mr Edward Caddy was the Chief Clinical Perfusionist at the BRI until his retirement in June 1994. He told the Inquiry that he began working at the BRI as a Theatre Technician in 1964/65:
`I started by making various pieces of equipment including oxygenators for theatre as none of the equipment used in open heart surgery was made in the UK, everything was imported from the United States and Europe. My engineering training came in useful for this.' [47]
37 Mr Caddy explained the role of the perfusionist:
`A perfusionist sets up and is responsible for the heart/lung machine in its complete assembly of sterile parts, together with its management during open heart surgery.
`Pre-operatively, the perfusionist will need to know the weight of the patient, this is especially critical in babies. The weight will determine the flow rates of the heart/lung machine thereby the size of the oxygenator to be selected for that operation. The perfusionist will also need to know the blood chemistry of the patient, so that the machine can be primed correctly ... It is then the perfusionist's job to maintain circulation to the rest of the body and to keep the patient's body at a temperature decided by the surgeon.' [48]
`Once the surgeon has completed his repair work, he will de-air the heart, which is a very important procedure. I remember that James Wisheart was very good at this. I would say he was meticulous.
`The surgeon will then ask the perfusionist to rewarm the body to normal temperature, when the heart may restart on its own. Otherwise, the DC defibrillator [49] will be used to start the heart.' [50]
`Throughout the period 1984-1995, my team would generally consist of 3 or 4 senior perfusionists and 1 student. In theatre, I would be working with the assistance of one of the perfusionists from my team; there would also be 2 anaesthetists (consultant and senior registrar) and 2 surgeons (consultant and senior registrar) present, together with a scrub nurse and nurse runner(s).' [51]
39 Of the perfusionists, Mr Wisheart said:
`Perfusionists have as their chief role the operation of cardio pulmonary bypass (the heart lung machine). This is the equipment without which open heart surgery cannot be performed. It maintains life for the time necessary to do whatever surgical procedure is being done within the heart ... It maintains life by doing the work of the lungs ... adding oxygen to the blood and also by doing the work of the heart ... by pumping the blood around the body. The delivery of oxygenated blood to all the organs of the body is essential to maintain life. Thus [it] will be seen that the role of the perfusionist is of vital importance.' [52]
40 Mr Wisheart also explained the role of the perfusionists as members of the team:
`The perfusionists relate chiefly to the anaesthetists and the surgeons who both need to be aware of how the procedure of cardio pulmonary bypass is progressing. The perfusionist in turn needs to be aware of how the surgery is progressing so that he can take the appropriate steps in operating his equipment. He also needs to know if the anaesthetist is going to perform any manoeuvres, which might affect with [sic] the performance of cardio pulmonary bypass by influencing the vascular control of the circulation. The perfusionist will need frequent information from the laboratory. Finally the perfusionist will interact with the scrub nurse to a limited degree, in terms of the provision of disposables for cardio pulmonary bypass and possibly some of the implantable material which the surgeon will wish to use.' [53]
41 Of Mr Wisheart, Mr Caddy said:
`I had known Mr Wisheart since he came to Bristol in 1976. We had a very good professional working relationship. I saw Mr Wisheart frequently in theatre ... I always felt that he was courteous and reasonable. For example, if I persuaded him that operating lists should be rearranged to accommodate absence of perfusion staff during a holiday period so as to avoid over-burdening the remaining staff, then he would ... rearrange the lists.' [54]
42 Mr Eamonn Nicholson, who started work at the BRI as a clinical perfusionist in 1988, told the Inquiry:
`The Perfusion Department remained very separate from the other theatre staff. The perfusionists had their own coffee-room, separate from other theatre staff ...' [55]
`I joined Mr D Caddy and Mr L Lawrence, his deputy, in 1988. There were 4 other perfusionists in the team then, apart from myself. Mr Lawrence and 1 other are still with the Department ... Since 1988, the number in the team has grown due to the increased workload. Two theatres require 3 perfusionists on duty.' [56]
44 As to the way in which the various specialties worked together, Mr Nicholson said:
`... I have no knowledge, on the extent of collaboration between the nurses and clinicians. The nursing staff appeared to work well with the cardiac surgeons, but in my view they had limited power in the overall running of the operating list. There was sometimes conflict over the length of the time some operations took and the consequence it had, of keeping staff working late. If the first operation took much longer than expected, a decision had to be made whether to cancel the second, which caused conflict between nursing staff and the cardiac surgeons.
`The working relationship between the perfusionists, surgeons and anaesthetists was similar to what I had been used to at Guy's. There is and has to be a cohesion between all three with good communication. My impression was that there was, and still is, good inter professional communication. The nursing staff (scrub team) does not really have a great deal of input with the duties of the perfusionists and anaesthetists, but is more concerned with assisting the surgeon. Having said this there was, and still is, good communication between the scrub nurse and perfusionist concerning the types of cannulae, connections, and other perfusion related equipment, which might be needed.' [57]
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Footnotes
[47] WIT 0143 0001 Mr Caddy
[48] WIT 0143 0003 Mr Caddy
[49] A device used to apply an electrical shock via paddles to the chest wall
[50] WIT 0143 0004 Mr Caddy
[51] WIT 0143 0005 Mr Caddy
[52] WIT 0120 0163 - 0164 Mr Wisheart
[53] WIT 0120 0170 Mr Wisheart
[54] WIT 0143 0019 Mr Caddy
[55] WIT 0489 0002 Mr Nicholson
[56] WIT 0489 0004 Mr Nicholson
[57] WIT 0489 0006 - 0007 Mr Nicholson