A simplified and economic technique for immediate postcardiotomy pediatric extracorporeal membrane oxygenation

We report a simplified modification of the cardiopulmonary bypass (CPB) circuit to create a closed extracorporeal membrane oxygenation (ECMO) circuit for short-term cardiac support. From November 2001 to December 2004, a specially designed CPB circuit was indicated for 25 patients in whom the need of ECMO was expected. A bypass containing a nonprimed ECMO bladder was inserted in the venous line, bypassing the cardiotomy reservoir. The hemofilter was placed in the arterial line and conventional oxygenators were used. If ECMO was needed, the bypass was open and the cardiotomy reservoir with its lines was discarded. Eight patients received ECMO with this technique. Patient age ranged from 5 days to 5 years, with a median of 8 days. Support time ranged from 12 hours to 6 days, with a mean of 3.1 days. Six patients recovered function and five were weaned and decannulated. Four patients (50%) survived to hospital discharge, without late deaths. Common complications were bleeding requiring reexploration (four patients), brain injury (three patients), oxygenator failure (three patients), and sepsis (one patient). Converting an open CPB circuit to a closed ECMO circuit is viable with adequate results. The advantages are less exposure to blood products, hemodynamic stability, and cost reduction.