Small, smaller, smallest. Steps towards bloodless neonatal and infant cardiopulmonary bypass

Abstract

In open heart surgery in neonates and small children, the cardiopulmonary bypass circuit surface and the priming volume are relatively large in relation to patient size and blood volume. Therefore, the use of allogeneic blood is inevitable to maintain the optimal hematocrit level during bypass. To avoid the deleterious effects of blood transfusion, as well as to reduce the contact surface of blood with artificial materials, we stepwise reduced the bypass circuit size. Use of the commercially available minimized elements and an adjusted set-up of the system allowed us to reduce usage of allogeneic blood in the prime and during the bypass. However, other supplemental measures are needed to obtain asanguineous cardiopulmonary bypass for neonatal and infant patients.

Timing of adding blood to prime affects inflammatory response to neonatal cardiopulmonary bypass

“…Regardless, addition of blood to the pump after exposure to cardiopulmonary bypass resulted in an acceptable haematocrit at the end of the study, in fact the end haematocrit was significantly higher in the asanguinous groups that received blood late compared with animals whose blood was transfused as blood prime, no demonstrable increase in lactic acid production from the period of "anaemia", and a more favourable pattern of cytokine expression compared with animals receiving a blood prime. Although numerous previous studies, from our group and others, 9,12,13 have reproducibly demonstrated the benefit of an asanguinous prime for neonates, this is the first study to ask the question and to demonstrate that blood added after exposure to cardiopulmonary bypass is less inflammatory than blood added before exposure to cardiopulmonary bypass.…”

Cardiopulmonary bypass without the use of donor blood components in heart surgery in an 8-kg infant: case report

“…Особенно актуальна она для детей младшего возраста по причине низкой массы тела, ане-мии, которая нередко встречается у них, и повышенной склонности к развитию системного воспалительно-го ответа [1,7]. Несоответствие массы тела ребенка и объема заполнения контура ИК зачастую обуславливает необходимость в компонентах донор ской крови с це-лью коррекции избыточной гемодилюции и кислород-транспортной функции крови.…”

Specific requirements for bloodless cardiopulmonary bypass in neonates and infants; a review

“…These percentages were reduced in 2008 to 94% and 80%, respectively 34 . At present, pediatric oxygenators with integrated arterial line filters offer a new opportunity to create a smaller CPB circuit.…”

“…However, between 2006 and 2008, induction only diminished the hematocrit value from 39% to 35%. That, consequently, allowed less homologous blood transfusion during CPB 34 .…”