Perfusion for Congenital Heart Surgery

The Norwood Stage 1 procedure - conduct of perfusion: 2017 Survey results from NPC-QIC member institutions

“…However, the use of whole blood or reconstituted whole blood in the prime should eliminate the need to add albumin. 12 As previously mentioned, 75% of respondents either add FFP, reconstituted whole blood or whole blood to the prime. With 74% adding albumin to the prime, some respondents seem to be adding both albumin and a blood product besides PRBCs to their prime.…”

“…Priming Techniques and Constituents – As with many of the techniques covered in this survey, CPB circuit priming solutions, additives and protocols for the Norwood Stage 1 procedure are institutionally dependent and may vary depending on individual patient needs. 12 All respondents use a base crystalloid priming solution, with Plasma-Lyte A 7.4 being the most frequently used at 90%.…”

“…Norwood Stage 1 patients generally receive exceedingly small doses of cardioplegia and the entire dose must be properly cooled and mixed. 12,23 Should multiple doses be required over time, it may be necessary to flush the delivery line when using single-pass systems to ensure an appropriate solution temperature and composition upon administration.…”

“…31 Additionally recommended is the use of CPB arterial outlet blood temperature as a surrogate for cerebral temperature management during CPB 32,33 (Class I, Level C). 31 Hyperthermia during CPB has been associated with neurological injury and acute kidney injury, 12,13,33–35 necessitating a focus on temperature management. While these recommendations are primarily from the adult literature and animal studies, they are based upon the desire to protect the brain and other organs against hyperthermia during the warming period.…”

“…Common temperature ranges are normal/tepid (32-35°C), mild (28-32°C), routine or moderate (24-28°C), deep (18-24°C) and profound (<18°C). 12 Most respondents to this survey use some degree of hypothermia for their Norwood patients. The degree of hypothermia often depends on the surgical technique used; for example, deep hypothermia is used more with circulatory arrest cases, while moderate hypothermia may be used for SCP cases.…”