Securing data management systems in perfusion: A narrative review on cybersecurity and clinical risk

BackgroundThe increasing digitization of perfusion practice has led to the integration of advanced data management systems (DMS) that record and analyze intraoperative variables in real time. While these systems improve accuracy, traceability, and clinical decision-making, they also expose perfusion workflows to significant cybersecurity risks. Given that perfusion data directly reflect artificial circulation, any loss of integrity or service can have immediate clinical consequences.Materials and MethodsA comprehensive narrative review was conducted to synthesize current knowledge on cybersecurity in perfusion informatics and performance. The research strategy combined systematic database searches (PubMed, Scopus, IEEE Xplore, and Web of Science) with targeted grey literature review (regulatory frameworks and institutional reports). Inclusion criteria focused on articles published between 2010 and 2024 addressing healthcare cybersecurity, perfusion informatics, and medical device security. Studies were analyzed qualitatively to identify recurring themes, technological approaches, and governance models. Reference cross-checking ensured comprehensive coverage, and terminology was standardized according to ISO/IEC 27001 principles. The review followed an integrative, non-meta-analytic design, emphasizing conceptual synthesis rather than statistical aggregation.ResultsThirty-three primary and secondary sources were identified. The literature reveals a consistent pattern of vulnerabilities across clinical DMS, with perfusion systems being particularly exposed to ransomware, data tampering, and service interruption. The review highlights the centrality of the Confidentiality-Integrity-Assurance of Service triad as a guiding model. Key strategies identified include encryption and role-based access control, blockchain audit trails, federated learning, and post-quantum cryptography. However, empirical studies focusing specifically on perfusion remain scarce, underscoring a major research gap.ConclusionsCybersecurity in perfusion informatics must evolve from a technical adjunct to a clinical mandate. Integrating security frameworks into perfusion workflows supported by legal compliance (HIPAA, GDPR, ISO 27001) and ethical governance is essential to preserve patient safety. Future research should prioritize multicenter simulations, resilience testing, and cross-disciplinary training to ensure the continuity, integrity, and trustworthiness of digital perfusion systems.