THE COLLEGE OF CLINICAL PERFUSION SCIENTISTS OF GB AND IRELAND

EXAMINATION GUIDE

This guide covers general information relating to requirements for the Written Examination
of the College, (and for the Practical and Viva Perfusion Examination conducted by the
Society).

1. WRITTEN EXAMINATION GUIDANCE

1.1. General

A written examination is required by the College for (i) Limited Registrants who have
secured a job in the UK or Ireland, and who have a primary perfusion qualification from
overseas, and a minimum experience of 12 months’ post-qualifying experience (before
sitting the exam, candidates must have met English-language requirements) and (ii) British
accredited perfusionists who have not practised for 4 years or more.

There are normally at least two opportunities each year to sit these exams, usually during
April and October. Additional exams can be set if demand requires.

NB. It is the policy of the College that we do not provide example exam papers. However,
described below is a detailed format of the current exam papers.

1.2. Exam Format

Each exam consists of two papers: a Medical Science paper and a Perfusion paper, with a
time limit of 3 hours allowed for each paper.

1.2.1. Medical Science Paper

This paper is divided into 3 sections:

- Anatomy and Physiology

- Pathology and Congenital
- Pharmacology

Each of these sections consists of 4 questions: candidates are expected to answer 3 of

these questions. Thus, candidates should allocate approximately 20 minutes to answer
each question (ie. approx. 1 hour per section). The answers should be in the format of a
short essay; diagrams to illustrate and clarify the answer are encouraged and expected.

Each question has a maximum of 10 marks.

A pass mark for this exam is 50%.

1.2.2. Perfusion Paper

This paper is divided into 2 sections:

- Essay
- Short-answer questions
The Essay section typically has a choice of 3 questions, and candidates are expected to
answer one of these. A time allocation of 1 hour should be anticipated for this question,
and it should be answered in full as a long essay. The essay has a maximum of 40 marks.

The Short answer section has a choice of 8 questions, and candidates are expected to
answer 6 of these questions. Typically, the questions can be divided into subsections, and
relatively short, concise and accurate answers are expected. Each question should take
approx. 20 minutes, and has a maximum of 10 marks.

A pass mark for this exam is 50%.

The marks for both exams are combined, and the overall pass mark is 50%. Thus,
candidates can theoretically fall below 50% in one exam but bring the mean mark above
50% by doing well in the other exam (which will result in an overall pass). However,
candidates with lower than 40% in either exam cannot pass overall.

1.3. NESCOT

The exam questions are based on the Perfusion Science course (for post-graduate
certificate, post-graduate diploma and MSc) that is taught at the North East Surrey College
of Technology (NESCOT). This course is underwritten by the University of Surrey, and is
accredited by the Society for Clinical Perfusion Scientists of GB & Ireland.

The course is modular, consisting of 4 taught modules in each of academic Years 1 and 2
(year 3 is a research project for MSc).

1.3.1. The Syllabus

In each year there are 3 core modules and a specialist Perfusion module:

Year 1: Systemic Physiology and Pathology

Perfusion Science
Haematology and Immunology
Perfusion 1

Year 2: Molecular Pathology

Cardiovascular Anaesthesia and Pharmacology
Perfusion-related Cardiovascular Pathology
Perfusion 2

A brief synopsis of what is involved in each of these modules is described below. This
should provide some indication of the range of potential subject areas covered by the
exam (see later).

1.3.1.1. Systemic Physiology and Pathology

The physiological functions of the major systems in the body relevant to perfusion science
and the associated abnormalities in diseases associated with them.

This covers the anatomy, physiology and pathology of the heart, lungs, liver, kidney and
endocrine system.

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1.3.1.2. Perfusion Science

The properties of the materials used in cardiopulmonary bypass circuits, and the effect on
blood of these materials and bypass components.

This covers structure and properties of polymers, ceramics and metals; fluid and gas
mechanics; oxygenator manufacture; natural materials and surface modifications.

1.3.1.3. Haematology and Immunology

The nature of blood and its interface with the immune system, and includes blood
components and blood grouping, haemostatic mechanisms, immunology and inflammation
and the immune response to bypass.

This covers function and composition of blood; inflammatory cytokines and cell signals;
haematopoiesis; innate immunity; antigens and antibodies; acquired immunity; blood
equipment; haemostasis, platelets.

1.3.1.4. Perfusion 1

A detailed description of the cardiopulmonary bypass circuit and its interaction with the
anatomy and physiology of the patient.

This covers the design, function and limitations of oxygenators, pumps and filters; adult
perfusion circuits; cardiological techniques and safety; cardioplegia; imaging; mini-bypass.

1.3.1.5. Molecular Pathology

The nature of human disease at the molecular and cellular level, including aetiologies and
cellular aberrations associated with important human diseases, plus normal cellular
physiology and biochemistry, and the associated pathological changes associated with
diseases.

This covers genetic basis of disease; bacterial pathogens; radiation physics; reactive
oxygen species; imaging techniques; apoptosis.

1.3.1.6. Cardiovascular Anaesthesia and Pharmacology

The mechanisms by which pharmacologically active substances produce their effects on

the body, and incorporating general anaesthesia.

This covers hypertension; autonomic nervous system; cholesterol; NO; general and
cardiothoracic anaesthesia and drug metabolism; diabetes; anaemias; anticoagulants;
arrhythmias.

1.3.1.7. Perfusion-related Cardiovascular Pathology

A detailed understanding of cardiovascular disease relevant to perfusion, including

knowledge of congenital and acquired cardiovascular diseases, infection and its control,
and relevant sterilization procedures.

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This covers embryology, histology and control of blood and cardiovascular system;
vascular diseases; cardiomyopathies; valve diseases; haemolysis; effects of
cardiopulmonary bypass on organs; haemodynamic disturbances.

1.3.1.8. Perfusion 2

Complementing Perfusion 1 by demonstrating how to interact within a complex team, and

the application of artificial circuits to a variety of pathological conditions.

This covers blood conservation; cardiopulmonary bypass in non-cardiac surgery; intra-

aortic balloon pumping; ECMO; immunological responses; pulmonary problems; paediatric
surgery and perfusion; heart transplantation; medium and long-term support; perfusion set-
up.

1.4. Potential Subject Areas of Exam

The following list gives an indication of subject areas that may be covered in any
examination; however, this is not exhaustive.

1.4.1. Anatomy
 Structure and function of contents of thorax and mediastinum
 Great vessels, valves, cardiac chambers, coronary arteries
 Embryological development

1.4.2. Physiology
 Cardiovascular physiology
 Renal physiology, structure and glomerular filtration
 Blood flow and distribution
 Temperature regulation
 Starling’s Law, La Place’s Law, Boyle’s Law, Charles’ Law
 Gas exchange and calculation of O2 content of blood
 Normal values for blood gases and electrolytes
 Autonomic nervous system
 Cardiac cycle
 Pressure changes in cardiac chambers during cardiac cycle
 Cerebral autoregulation

1.4.3. Pathology and Pharmacology

 Agonist and antagonist differences
 Modes of action
 Vasodilators and vasoconstrictors
 Anticoagulants (heparin, warfarin etc), alternatives to heparin
 Antifibrinolytics
 Pharmacological agents for blood loss
 Antiplatelet drugs
 Cardiac drugs (Ca-channel blockers, -blockers, K-channel blockers,
antiarrhythmics)
 Antibiotics
 Anaesthetic drugs (muscle relaxants, analgesics, inhalation anaesthetics)

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1.4.4. Adult Pathology and Surgical Correction
 Atherosclerosis (surgical options, conduits)
 Valve pathology (surgical options, valve types)
 Marfanoid conditions
 Pathology of the aorta (surgical options)
 Cardiomyopathies
 Cardiogenic shock
 Left ventricular failure (surgical options)
 Grown-up congenital conditions
 Surgery for heart/heart-lung transplantation

1.4.5. Perfusion Management

 Circuits
 Oxygenators
 Pumps
 Primes
 Cannulation techniques
 Filtration
 Coatings
 Hypothermia
 Acid-base management
 Myocardial preservation
 IABP
 Cerebral perfusion
 Blood flow
 Blood conservation techniques
 ECMO
 Problem solving scenarios

1.5. References

The potential references/books to cover all aspects of Clinical Perfusion is extensive, and
it is not the remit of this guide to provide an exhaustive list. However, some potentially
useful suggestions are provide below:

1.5.1. Books:

Gravlee GP, Davis RF, Stammers AH, Ungerleider RM. Cardiopulmonary Bypass:
Principles and Practice. Lippincott Williams and Wilkins, 3 rd Ed (2007).

Opie LH. Heart Physiology: from Cell to Circulation. Lippincott Williams and Wilkins, 4 th Ed
(2003).

Katz AM. Physiology of the Heart. Lippincott Williams and Wilkins, 5 th Ed (2011).

Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Kirklin/Barratt-Boyes
Cardiac Surgery. Churchill Livingstone 3rd Ed (2003).

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Aaranson PI, Ward JPT. The Cardiovascular System at a Glance. Wiley-Blackwell 3 rd Ed
(2007).

Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology. McGraw-Hill
Medical, 12th Ed (2012).

Allman KG, Wilson IH. Oxford Handbook of Anaesthesia. Oxford University Press 3 rd Ed
(2011).
Barnard M, Martin B. Cardiac Anaesthesia. Oxford University Press (2010).

1.5.2. Journals:

Perfusion. Sage Journals. 1986 – present.

Journal of ExtraCorporeal Technology. AmSECT. 1967 – present.

European Journal of Cardio-thoracic Surgery. Oxford University Press. 1987 – present.

Annals of Thoracic Surgery. Elsevier. 1965 – present.

Journal of Thoracic and Cardiovascular Surgery. Elsevier. 1965 – present.

Journal of Cardiothoracic and Vascular Anaesthesia. Elsevier. 1997 – present.

2. PRACTICAL EXAMINATION GUIDANCE

As part of the registration process, prospective perfusion scientists must sit a Practical
Examination and a Perfusion viva.

2.1. Practical Examination

Perfusion students are examined whilst running a case, and will be expected to be
proficient in the areas listed below (at least).

 Pre-bypass preparation
 Aseptic technique
 Circuit assembly
 Priming of circuit
 Initiation of bypass
 Levels
 Flow and pressure
 Temperature
 Other physiological parameters
 Communication
 Records
 Termination
 Post-bypass awareness

Candidates are required to achieve a mark of at least 50% to pass this practical
examination. If they fail any of the above areas (ie. obtain zero marks), the practical
examination will be terminated and they will be deemed to have failed.

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If the practical examination is passed, the candidates will then be given a viva in various
aspects of perfusion.

2.2. Perfusion Viva Revision Topics

Revision topics for this viva are detailed below:

(a) Emergency procedures

- pump boot/centrifugal pump changeout
- oxygenator changeout
- reservoir changeout
- gross air embolism
- power failure

(b) Filters
- pre-bypass
- in reservoir
- arterial line
- haemofiltration
- leukocyte depleting

(c) Myocardial protection

- cardioplegia, route of administration, antegrade/retrograde, content
- hypothermia vs normothermia
- blood vs crystalloid
- cross-clamp fibrillation

(d) Priming solutions

- crystalloids
- colloids
- diuretics
- bicarbonate
- albumin
- blood
- mannitol

(e) Pumps
- roller pumps
- centrifugal pumps
- pulsatile vs continuous

(f) Parameters
- acid-base management
- temperature management
- pressure management

(g) Vents
- root
- LV
- PA

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(h) Drugs
- phentolamine
- metaraminol
- noradrenaline
- magnesium
- potassium
- milrinone
- fentanyl
- sodium nitroprusside
- trasylol
- heparin
- protamine

(i) Safety features

- level alarm
- bubble alarm
- temperature alarm
- pressure alarm

(j) Blood conservation

- cell salvage
- haemoconcentration
- pre-op autologous donation
- trasylol

(k) Inflammatory response

- platelets
- clotting cascade
- leukocytes
- cytokines
- thrombocytopaenia

This list is not exhaustive.

The pass mark for the viva is 50%.