Extracorporeal membrane oxygenation to cardiopulmonary bypass with a single circuit exposure

Abstract

Due to the short supply of donor organs available, many patients decompensate or die while waiting for transplantation. Options for mechanical support for infants and pediatrics with congenital heart disease are limited because of the patient's size and device availability. Extracorporeal membrane oxygenation (ECMO) is the most common means of cardiac and respiratory support for these patients. One of the many indications for ECMO use in cardiac patients is as a bridge to transplantation, with patients being transported to the operating room (OR) on ECMO support. Converting the ECMO circuit to an open cardiopulmonary bypass system in the OR minimizes the patient's exposure to new circuitry, decreases further donor exposures and provides continuous support for patients in cardiac and/or respiratory failure. In addition, the ability to use modified ultrafiltration post-bypass aids in reducing extracellular fluid, increasing the hematocrit and improving hemodynamic stability following an extended duration of ECMO and bypass support. The integrity of the ECMO circuit is maintained and can be converted back to ECMO for support postoperatively if needed.

Impact of delayed systemic heparinization on postoperative bleeding and thromboembolism during post-cardiotomy extracorporeal membrane oxygenation in neonates

“…Over the last 20 years, innovative modifications of ECMO technology evolved to optimize patient outcome. 11,12,21,22 Aims were minimization of surface exposure using single circuits 21,22 or dose reduction of anticoagulants using heparin coated circuit components. 11,12 However, we went one step further: we used non-heparin coated circuit components and delaying systemic anticoagulation for 18 hours on average.…”

Minimizing bleeding associated with mechanical circulatory support following pediatric heart surgery☆

“…Several centers have reported innovative modifications of standard ECMO systems for use in postcardiotomy patients, including configuring the ECLS system for direct conversion to and from cardiopulmonary bypass to minimize new circuit surface exposure [19,20], and using heparin-coated circuit components to minimize the requirement for systemic anticoagulation [16,21,22]. During recent years, approximately 30% of centers in the United States have reported using centrifugal ECLS pumps (ELSO Registry data).…”

Modification of an extracorporeal life support circuit for intraoperative correction of complex congenital heart disease

“…Although the decision to use an existing ECLS circuit varies from patient to patient, any reduction of patient exposure to new circuitry has been shown to be beneficial. A slightly more complex system utilizing the existing ECLS circuit and parts of a conventional heart-lung machine have been described for infants undergoing heart transplantation who have been bridged to transplant on ECLS 4 . This system also allows for the use of modified ultrafiltration in a very controlled environment.…”