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cover, pumps, dual pump, peditrics

Cardiopulmonary Bypass in A Child with Severe Factor XII Deficiency

We report the case of a 14.7 kg girl undergoing CPB with a pre-admission FXII concentration of <1% and aPTT >200 seconds. The child was transfused with fresh-frozen plasma to replenish FXII, allowing safe ACT monitoring of heparin anticoagulation throughout CPB.

cover, pediatrics, reservoir, cardiotomy

Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass

Compensatory Reserve Index monitoring after CHS with CPB seems feasible and safe. Early changes in CRI may precede meaningful clinical outcomes, but this requires further study.

cover, reservoir, pediatric

Updating an Empirically Based Tool for Analyzing Congenital Heart Surgery Mortality

The updated STAT metrics reflect contemporary practice and outcomes. New empirically based STAT 2020 Scores and Category designations are assigned to a larger set of procedure codes, while accounting for risk associated with multiple component operations. Updating STAT metrics based on contemporary outcomes facilitates accurate assessment of case mix.

cover, bloodgas, heart

Cardiac Biomarkers for Risk Stratification of Acute Kidney Injury After Pediatric Cardiac Surgery

Preoperative plasma galectin-3 and NTproBNP and the first postoperative galectin-3 and ST2 levels were independently associated with AKI in children ≥2 years old. The performance of cardiac biomarkers after cardiac surgical procedure is affected by age, and research is required to develop biomarkers for children <2 years old.

surgery with hands

Total Circulatory Arrest as A Support Modality in Congenital Heart Surgery: Review and Current Evidence

This review analyzes the history, physiology, techniques of DHCA, as well as other alternative strategies like selective cerebral perfusion and presents the current available evidence.

perfusion timers

Avoiding Use of Total Circulatory Arrest in The Practice of Congenital Heart Surgery

In this review we have discussed the various physiological and technical factors involved in conduct of SACP in paediatric cardiac surgery and outcomes with SACP.


Contrast Media Exposure in The Perioperative Period Confers No Additional Risk of Acute Kidney Injury in Infants and Young Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass

For pediatric patients who are soon to undergo on-pump cardiac procedures, there appears to be no need to hesitate in performing the diagnostic imaging investigations requiring CM, or delay CPB after CM exposure. These patients may benefit from increased diagnostic utility without increasing their risk of postoperative AKI.


Nadir Oxygen Delivery During Pediatric Bypass as A Predictor of Acute Kidney Injury

The lowest suitable DO 2i during CPB in the present population undergoing pediatric cardiac surgery was 353 mL/min/m 2. And below this threshold, there was a high probability of inducing CS-AKI.


Tidal Flow Perfusion for the Artificial Placenta: A Paradigm Shift

Parameters of the tidal flow group were comparable with those of DLC. Single lumen jugular cannulation using tidal flow is a promising vascular access strategy for AP support. Successful miniaturization holds great potential for clinical translation to support extremely premature infants.


Switching to Centrifugal Pumps May Decrease Hemolysis Rates Among Pediatric ECMO Patients

These data suggest decreasing rates of hemolysis with centrifugal pumps compared to roller pumps. Since hemolysis was also associated with increased risk of death, these data support the switch from roller to centrifugal pumps at ECMO centers.


Cardiopulmonary Bypass-Induced Coagulopathy in Paediatric Patients: The Role of Platelets in Postoperative Bleeding. A Preliminary Study

Postoperative bleeding in children undergoing cardiac surgery with CPB was linked to younger age, longer CPB duration and significant postoperative reduction in platelet count and function. Larger studies are needed to confirm our results and define strategies to reduce postoperative bleeding in these patients.


Dose Estimation for Bivalirudin during Pediatric Cardiopulmonary Bypass

Bivalirudin infusion in children should be started after loading dose at rates greater than those used in adults. Dose in neonates remains uncertain because neither pharmacokinetics nor coagulation pharmacodynamics have been adequately characterized.

cover, bloodgas, heart

Hyperoxia During Cardiopulmonary Bypass Is Associated With Mortality in Infants Undergoing Cardiac Surgery

Hyperoxia during cardiopulmonary bypass was an independent risk factor for mortality and may be a modifiable risk factor. Furthermore, hyperoxia during cardiopulmonary bypass was associated with four-fold greater odds of mortality within 30 days of surgery.


Prediction of Bleeding in Pediatric Cardiac Surgery Using Clinical Characteristics and Prospective Coagulation Test Results

Prospective coagulation testing marginally improves prediction of CCB during and after cardiac surgery but the clinical impact of this is small when compared to prediction using clinical characteristics.


Management of Congenital Cardiac Surgery During COVID-19 Pandemic

In this article, we present crucial precautions that were applied in paediatric cardiovascular surgery and extensive list of cases in order to deliver highest level of the patient safety and protection for the surgical team.

cover, bloodgas, heart

The Great Ormond Street Hospital Immunoadsorption Method for ABO-Incompatible Heart Transplantation: a Practical Technique

We have subsequently used this technique in all children undergoing ABO-incompatible heart transplantation and become convinced of its efficacy in this population while observing no adverse effects. This article outlines the practical details required to perform the technique in order to avoid hyperacute rejection.


In Vitro Evaluation of Flow Distribution in All-Region Perfusion during the Norwood Operation

For all-region perfusion during the Norwood operation, primary CPB arterial flow should be divided to the head and coronary circulation with an independent pump delivering flow to the descending aorta. This should avoid cerebral over-circulation and insufficient flow to the lower body.


Sustained Total All-Region (STAR) Perfusion: An Optimized Perfusion Strategy for Norwood Reconstruction

STAR perfusion allows the Norwood procedure to be completed with mild hypothermia and continuous perfusion to all vascular beds with reduced cardiopulmonary bypass as well as total operative times. This technique is successfully achieved with minimal changes to circuitry, minor modifications to heart-lung machine servoregulation and few additional cannulation disposables.


Investigation of Myocardial Protection During Pediatric CPB: Practical Experience in 100 Chinese Hospitals

In conclusion, the essence of myocardial protection management during pediatric CPB was cardiac arrest induced by cardioplegia under systemic hypothermia. However, there is no uniform standard for the type of cardioplegia, or dosages. Therefore, well-designed multicenter randomized controlled trials are warranted to provide tangible evidence for myocardial protection of cardioplegia in pediatric CPB.

cover, ecmo, ecls, oxy

Pediatric Intensive Care Preparedness and ECMO Availability in Children With COVID-19: An International Survey

In conclusion, both the experience in managing patients and the availability of neonatal/pediatric ECMO in the centers the responders are working
seemed to increase physicians’ preparedness.


Efficacy and Safety of Corticosteroids Prophylaxis in Cardiac Surgery: A Protocol for Systematic Review and Meta-Analysis

This study will compare the efficacy of prophylactic corticosteroids for adults and children undergoing cardiac surgery with CPB. Due to the nature of the disease and intervention methods, randomized controlled trials may be inadequate, and we will carefully consider inclusion in high-quality, non-randomized controlled trials, but this may result in high heterogeneity and affect the reliability of the results.

Machine for cardiopulmonary bypass

Impact of Corticosteroids on Cardiopulmonary Bypass Induced Inflammation in Children:A Meta-Analysis

CS were found to have a favorable impact on postoperative fluid balance and may be associated with shortening the duration of mechanical ventilation. While CS had no impact on mortality, they may be beneficial, particularly in neonates and those undergoing high complexity surgery.


American Society of ExtraCorporeal Technology: Development of Standards and Guidelines for Pediatric and Congenital Perfusion Practice (2019)

The Standards and Guidelines for Pediatric and Congenital Perfusion Practice is an essential tool for pediatric perfusionists and serves as the backbone for institutionally based protocols, promotes improved decision-making, and identifies opportunities for future research and collaboration with other disciplines.


Goal-Directed Perfusion to Reduce Acute Kidney Injury after Paediatric Cardiac Surgery (GDP-Akip): Study Protocol for A Prospective Randomised Controlled Trial

In total, 166 paediatric patients undergoing cardiac surgery will be randomly allocated to the GDP group or control group. Patients in the GDP arm will be treated with a GDP strategy during CPB aimed to maintain DO2i at ≥360 mL/min/m2 .