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Pediatric cardiopulmonary bypass: a review of current practice
1Perfusion Department, Virginia Heart Center at Fairfax Hospital, Falls Church, USA.
Insights
Pediatric cardiopulmonary bypass (CPB) techniques are evolving, with increased adoption of safety devices like membrane oxygenation and arterial line filtration. This trend shows a move towards more standardized CPB practices in pediatric care.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Device Technology
Background:
- Pediatric cardiopulmonary bypass (CPB) techniques and devices are continuously evolving.
- Literature frequently reports new advancements in CPB.
- Periodic surveys are crucial for tracking the clinical application of these advancements.
Purpose of the Study:
- To survey current practices in pediatric cardiopulmonary bypass.
- To identify trends in the adoption of new CPB techniques and devices.
- To document the evolution of CPB in pediatric cardiac surgery.
Main Methods:
- Analysis of published literature and clinical practice reports.
- Comparison of current CPB techniques with those from earlier periods.
- Identification of universally adopted technologies and increasing trends in safety device usage.
Main Results:
- Widespread adoption of membrane oxygenation and arterial line filtration in pediatric CPB.
- Increased use of various safety devices during pediatric CPB procedures.
- Integration of techniques like modified ultrafiltration, centrifugal cell washing, and aprotinin use into common practice.
Conclusions:
- Pediatric CPB practices are converging towards greater uniformity.
- Technological advancements and safety measures are becoming standard in pediatric cardiac centers.
- Periodic surveys effectively measure current practice and record historical progress in pediatric CPB.
Abstract:
Devices and techniques used for pediatric cardiopulmonary bypass are ever changing. There are frequently reports in the literature about new techniques and new devices. Periodic surveys are helpful because they reveal the actual extent to which these techniques and devices are applied to clinical practice. Advances in research are bringing about a better understanding of the intricate aspects of CPB and the effects of CPB on pediatric patients. There appears to be a trend from widely divergent approaches to CPB for pediatric patients to more uniformity in practice. For example, the use of membrane oxygenation and arterial line filtration has become universal, and there is an increase in the use of all types of safety devices. Techniques reported in the medical literature at the beginning of the decade, such as, the use of modified ultrafiltration, the use of centrifugal cell washers to process packed red blood cells before adding them to the prime, and the use of the antifibrinolytic drug, aprotinin, have become part of practice at a large number of pediatric heart centers. Periodic surveys are useful, as they provide a measurement of current practice. They also provide a historical record of the advances in the field.
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