Optimizing circuit design using a remote-mounted perfusion system.

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Anesthesiology

Background:

• Banked blood exposure during cardiac surgery is associated with adverse outcomes.
• Minimizing blood exposure is a key goal, often achieved by reducing heart-lung machine priming volumes.
• Previous strategies focused on modifying heart-lung machine components to decrease hemodilution and the need for banked blood.

Purpose of the Study:

• To evaluate the impact of a remote-mounted perfusion system on priming volumes and banked blood usage during cardiopulmonary bypass (CPB).
• To compare blood use and priming volumes before and after implementing a remote-mounted system.
• To assess the effectiveness of this modification in reducing patient exposure to banked blood.

Main Methods:

• Utilized Terumo's System 1 Advanced Heart-Lung machine with remotely mounted pump heads.
• Minimized excess tubing length by positioning components closer to the patient and oxygenator.
• Compared CPB blood use and priming volumes in four weight classes before and after system modification, using identical disposables and protocols.

Main Results:

• Significant reductions in priming volumes were observed across all weight classes (e.g., 8-12 kg: 751.2 to 360.4 mL; 41+ kg: 1306.3 to 875.5 mL).
• Substantial decreases in banked blood usage were recorded (e.g., 8-12 kg: 1.84 to 1.10 units; 41+ kg: 1.62 to 0.42 units).
• Reductions were consistent across all pediatric weight categories studied.

Conclusions:

• Implementing a remote-mounted perfusion system effectively reduces priming volumes in cardiac surgery.
• This system modification significantly decreases the requirement for banked blood administration during CPB.
• The reduction in banked blood use translates to less patient exposure to allogeneic blood products, improving safety.