Optimizing circuit design using a remote-mounted perfusion system

There is a considerable amount of literature published on the detrimental effects of banked blood exposure in cardiac surgery. Likewise, in an effort to minimize blood exposure, many of these articles involve modifications to the heart-lung machine or its components to reduce priming volumes, therefore decreasing the need for banked blood administration caused by hemodilution. In this study, using Terumo's System 1 Advanced Heart-Lung machine, all the pump heads were remotely mounted off the pump base closer to the patient and to all the pump components. For example, cardioplegia, ultrafiltration, and vent and cardiotomy lines are now close to the oxygenator and to the patient, minimizing any excess tubing length. Cardiopulmonary bypass (CPB) blood use and priming volumes were compared before and after changing from a fixed perfusion system to a remote-mounted perfusion system using the same disposables and protocols. The mean differences of pump prime and CPB blood use were compared in four weight classes. In the 8- to 12-kg class, blood use was reduced from 1.84 +/- 0.55 to 1.10 +/- 0.36 units. Priming volume was reduced from 751.2 +/- 68.4 to 360.4 +/- 51.7 mL. In the 13- to 20-kg class, blood use was reduced from 1.80 +/- 0.42 to 1.04 +/- 0.28 units. Priming volume was reduced from 829.6 +/- 69.6 to 476. +/- 81.4 mL. In the 21- to 40-kg class, blood use was reduced from 1.60 +/- 0.57 to 0.92 +/- 0.49 units. Priming volume was reduced from 994.0 +/- 137.2 to 713.6 +/- 121.8 mL. In the 41+-kg class, blood use was reduced from 1.62 +/- 0.88 to 0.42 +/- 0.54 units. Priming volume reduced from 1306.3 +/- 112.9 to 875.5 +/- 96.6 mL. In conclusion, using a remote-mounted perfusion system resulted in reducing priming volumes and also significantly decreased the need for banked blood, subsequently saving the patient excessive exposure to banked blood.