Paediatric perfusion practice in North America: an update

Abstract

In August 1994, an updated survey questionnaire was mailed to each paediatric open-heart surgery programme in North America as a follow-up to the 1989 paediatric survey. The survey requested demographic data, equipment selection criteria and specific perfusion techniques for paediatric patients. The earlier survey revealed a wide range of clinical practice. Data from the recent survey were compared with the 1989 survey to identify current programme demographics and trends in equipment use and techniques. Responses were received from 125 hospitals (110 active programmes and 15 programmes that do not perform paediatric open-heart surgery) for a response rate of 74%. Of the 110 active centres, 77 perform both adult and paediatric cardiac surgery, and 33 perform paediatric surgery exclusively. Forty-three centres reported that they perform paediatric cardiac transplantation, an increase from 35 centres in 1989. Total caseload increased by more than 8% per year from 1988 to 1994. In 1994, 18% of the patients were operated upon during the first month of life (versus 15% in 1989), and 46% were operated on during the first year of life (versus 45% in 1989). While the 1989 survey was characterized by a high degree of heterogeneity in equipment and techniques, the recent survey reveals a trend toward homogeneity among respondents. The use of membrane oxygenation and arterial line filtration has become universal, and there was an increase in the use of all types of safety devices in the cardiopulmonary bypass circuit.

Ultrafiltration reduces blood transfusions following cardiac surgery: a meta-analysis

“…The benefits of UF, particularly MUF, are so pronounced in pediatric patients that MUF has been adopted as the standard of care in this population [14]. In adults, however, this technique is rarely used [15].…”

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

“…Most commonly, these methods comprise centrifugal cell washing and blood prime ultrafiltration. While centrifugal cell washing as of 2004 was used in 60% of congenital heart surgery centers (16) and has been shown to be effective in correcting pH and lowering potassium, lactate and glucose (17)(18)(19), several studies have reported that the process increases cell wall fragility and leads to increased hemolysis (20)(21)(22). Blood prime ultrafiltration has also been reported to make the prime physiologic, but without the attendant hemolysis or additional disposables cost (23)(24)(25)(26).…”

The effects of modified ultrafiltration on clinical outcomes of adult and pediatric cardiac surgery

“…Out of the 76 responding centers, 53 (70%) hospitals. Interestingly, MUF was used in 75% of those centers [20]. The routine use of MUF after adult cardiac surgery can potentially be a cost effective and complication-free technique.…”