Rapid cardiopulmonary support for children with complex congenital heart disease

Background. Extracorporeal membrane oxygenation has limitations in children with congenital heart disease (prolonged setup times, increased postoperat ive blood loss, and difficulty during transport). We developed a miniaturiz ed cardiopulmonary support circuit to address these limitations. Patients and Methods. The cardiopulmonary support system includes a preasse mbled, completely heparin-coated circuit, a BP-50 Bio-Medicus centrifugal p ump, a Minimax plus membrane oxygenator, a Bio-Medicus now probe, and a Bio -trend hematocrit/oxygen saturation monitor. Short tubing length permits a 250-mL, bloodless prime in less than 5 minutes. From 1995 to 1997, 23 child ren with congenital heart disease were supported with this technique. Results. Overall survival to discharge was 48% (11 of 23 patients). Surviva l to discharge was 80% (4 of 5) in the preoperative support group, 20% (1 o f 5) in the postoperative failure to wean from cardiopulmonary bypass group , 44% (4 of 9) in the group placed on support postoperatively after transfe r to the intensive care unit, and 50% (2 of 4 patients) in the nonoperative group. Neonatal cardiopulmonary support survival to discharge was 46% (6 o f 13 patients). Conclusions. This pediatric cardiopulmonary support system is safe and effe ctive. Advantages over conventional extracorporeal membrane oxygenation inc lude rapid setup time, decreased postoperative blood loss, and simplified t ransport. (Ann Thorac Surg 2000;70:742-50) (C) 2000 by The Society of Thora cic Surgeons.