Modified CPB circuit for postoperative rescue of high-risk patients following cardiac repair: are we keeping safe?

Extracorporeal membrane oxygenation (ECMO) is commonly used to treat postcardiotomy cardiopulmonary dysfunction in small children. System readiness, need for additional blood products, and exposure to new surfaces are important considerations, particularly when used for resuscitation. We reviewed our experience with a cardiopulmonary bypass (CPB) system modified to provide extended circulatory support system after surgery in patients considered at high risk. When not used in the operating room, the system was recirculated for 24 hours. Before being discarded, blood samples were obtained for activated clotting time, arterial blood gas, and blood cultures from 10 circuits. Between January 2004, and December 2005, 44 patients underwent cardiac repair using this CPB system. ECMO support was initiated in the operating room in 8 patients, and six circuits were used after patient arrival in the intensive care unit. Blood sampling after 24 hours on standby circuits revealed acceptable values for pH, Pao2, hematocrit, ionized calcium, potassium level, and ACT. All blood cultures were negative at 5 days. Survival for patients who received a circuit on standby was 64%.This modified cardiopulmonary circuit can be transformed into a simple, safe, and effective ECMO support system. Deployment of a CPB circuit previously used for cardiac repair has many advantages and maximizes utilization of resources.