ECMO to CPB: A single circuit approach

Area of Science:

• Pediatric Cardiac Surgery
• Cardiopulmonary Support
• Extracorporeal Life Support

Background:

• Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and cardiopulmonary bypass (CPB) are critical for cardiopulmonary support in pediatric heart surgery.
• Simultaneous use of CPB and ECMO circuits can occur during the same surgical period.
• This technique article details the conversion from VA-ECMO to CPB using a modified ECMO circuit.

Purpose of the Study:

• To describe a novel technique for converting VA-ECMO to CPB.
• To evaluate the feasibility and outcomes of this conversion method in pediatric congenital heart patients.
• To present a simplified approach for managing cardiopulmonary support during complex pediatric cardiac surgeries.

Main Methods:

• The study involved converting patients from VA-ECMO to CPB by integrating a cardiotomy reservoir into the existing ECMO circuit.
• This technique was applied in a series of pediatric patients requiring surgical intervention.
• The focus was on the seamless transition of cardiopulmonary support.

Main Results:

• Eight conversion procedures were performed on seven pediatric patients.
• The mean nadir hematocrit during CPB was 31.1% ± 6.06.
• Mean blood product usage on CPB was 238 mL ± 155 mL, with successful decannulation from both VA-ECMO and CPB.

Conclusions:

• Conversion from VA-ECMO to CPB utilizing the same circuit is an effective strategy.
• This technique is particularly beneficial for congenital heart patients requiring surgical intervention while on VA-ECMO.
• The method offers a streamlined approach to cardiopulmonary support management in complex pediatric cardiac surgery.