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Retrospective analysis of eliminating modified ultrafiltration after pediatric cardiopulmonary bypass
Craig M McRobb1, Richard J Ing2, D Scott Lawson1
11 Department of Perfusion, Children's Hospital Colorado, Aurora, CO, USA.
Abstract:
Modified ultrafiltration (MUF) is a technique which is commonly used immediately post-cardiopulmonary bypass (CPB) for open heart surgery in children. There are many advantages of MUF, but there are also a number of less reported disadvantages. At our institution, after considering all of the available data, a decision was made to no longer perform MUF. The primary motivation being the simplified and miniaturized CPB circuit would reduce hemodilution, decrease our likelihood of reaching our transfusion trigger during CPB and, potentially, improve safety. This study reports the before and after data from this practice change. A total of 160 patients less than 8kg were studied over 38 months and divided into neonatal and pediatric cohorts. Parameters reported in this study include: demographics, hematocrit, blood product transfusion, hemostasis, hemodynamics and outcomes. Although retrospective, our analysis supports an advantage of preventing hemodilution (via circuit miniaturization) versus reversing hemodilution (via MUF) at our institution with the patient population we examined.
Insights
Modified ultrafiltration (MUF) is a pediatric cardiac surgery technique. This study found that preventing hemodilution with miniaturized cardiopulmonary bypass (CPB) circuits is more advantageous than reversing it with MUF.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiopulmonary Bypass Techniques
- Hemodilution Management
Background:
- Modified ultrafiltration (MUF) is a common post-cardiopulmonary bypass (CPB) procedure in pediatric open-heart surgery.
- While MUF offers benefits, less-reported disadvantages exist, prompting a re-evaluation of its use.
- Institutional practice shifted away from MUF, prioritizing simplified and miniaturized CPB circuits.
Purpose of the Study:
- To compare outcomes before and after discontinuing MUF in pediatric patients undergoing open-heart surgery.
- To evaluate the impact of a miniaturized CPB circuit on hemodilution and transfusion requirements.
- To assess the safety and efficacy of preventing hemodilution versus reversing it with MUF.
Main Methods:
- Retrospective analysis of 160 pediatric patients (<8kg) over 38 months.
- Patients divided into neonatal and pediatric cohorts.
- Key parameters analyzed: demographics, hematocrit, blood product transfusion, hemostasis, hemodynamics, and outcomes.
Main Results:
- The study compared data before and after the discontinuation of MUF.
- Analysis focused on the benefits of preventing hemodilution through circuit miniaturization.
- Findings support the advantage of preventing hemodilution over reversing it with MUF in the studied population.
Conclusions:
- Preventing hemodilution via miniaturized CPB circuits demonstrates advantages over reversing hemodilution with MUF.
- This approach may reduce transfusion needs and improve safety in pediatric cardiac surgery.
- The findings support a practice change towards optimized CPB circuit design.
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