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Introduction to Solid Supported Membrane Based Electrophysiology
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ECMO to CPB: A single circuit approach.

Jeffrey Zalfa1, Daniel Duncan1, Paul Kerins1

  • 1Nemours Children's Hospital, 1600 Rockland Road, Wilmington, DE, 19803, USA.

The Journal of Extra-Corporeal Technology
|December 17, 2025
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Summary

This study demonstrates an effective technique for converting pediatric heart surgery patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to cardiopulmonary bypass (CPB) using the same circuit, simplifying support during complex procedures.

Keywords:
CPBCongenital heart diseaseECMOPediatric heart surgeryPerfusion

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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.