J Extra Corpor Technol 2025, 57, 164 – 167 Ó The Author( s), published by EDP Sciences, 2025 https:// doi. org / 10.1051 / ject / 2025027
Available online at: ject. edpsciences. org
CASE REPORT A novel strategy for conversion from pediatric V-A ECMO to CPB circuit
Amita Lal( ACP, LCCP) *, David Machin( AACP, FCCP), and William Lansdowne( ACP, LCCP)
Perfusion Department, Bristol Royal Hospital for Children, Bristol, United Kingdom Received 18 December 2024, Accepted 19 May 2025
Abstract – This article describes two novel strategies to convert a veno-arterial extracorporeal membrane oxygenator( V-A ECMO) supported pediatric patient circuit to a cardiopulmonary bypass( CPB) circuit. Modification of the existing ECMO circuit incorporated a venous reservoir, cardioplegia circuit, ultrafiltration circuit, and cardiotomy suckers, allowing all aspects of cardiac surgery to be performed. This approach eliminated the need for conversion to an additional CPB circuit, thereby reducing surface area exposure and blood product requirement. We found that these patients had no major post-operative coagulopathies or observable neurological dysfunction.
Key words: ECMO, CPB, Pediatric, Cardiac surgery, Conversion. Overview
The prevalence of pediatric heart disease in the UK is estimated at 1 in 133 babies every year, and globally, approximately 1 in 100 [ 1 ]. Of which, either surgical or interventional care is required in approximately 33 – 50 % of cases [ 2 ]. The variety of pediatric congenital heart defects can be complex, and this can make the surgical intervention more complicated. Thus, post-operatively, some patients may require further support.
The purpose of V-A ECMO is to bridge the gap for these patients to support the heart and lungs in recovery or transplant. While on this modality, clinicians can assess the cardiac function and effectively treat these patients. However, it can be decided that further surgical cardiac intervention is needed. This requires the patient to be removed from the ECMO circuit and supported by the CPB circuit. However, this exposes the patient to an additional extracorporeal circuit, increasing native blood to foreign surface area exposure and its consequences [ 3 ]. Furthermore, the high CPB circuit volume to pediatric patient blood volume ratio requires additional blood products to prime the CPB circuit, which again has associated risks [ 4 ].
With the aforementioned concerns, we describe a modification of our existing ECMO circuit. Previous reports have shown similar modifications. However, in this report, the equipment used and the technique carried out were changed [ 5 ]. The amendments to our ECMO circuit provided the features of a CPB circuit by incorporating a venous reservoir, cardioplegia circuit, hemofiltration circuit, cardiotomy suckers, and safety devices. The technique was performed on two pediatric
* Corresponding author: amitablal @ gmail. com patients, supported on CentriMag Ò V2 Console ECMO system( Abbott Cardiovascular, Maidenhead, UK), using either the Quantum CPB system( Spectrum Medical, Cheltenham, UK) or the Stockert s5 heart-lung machine( Sorin Group, Mirandola, Italy).
Description
Two patients on V-A ECMO support required further cardiac surgery after ECMO was established. Both patients used the techniques described herewith.
Patient one was 5 days old, 3.3 kg male, with hypoplastic left heart syndrome, who required V-A ECMO post-Norwood procedure and returned to theatre 5 days post-operative for repair of the systemic aortic valve. This patient was converted from ECMO to CPB using the Quantum Modified ECMO System( MES).
Patient two was 8 days old, a 3.4 kg female, with Transposition of the Great Arteries, who required V-A ECMO support following an arterial switch operation. The patient returned to theatre for an aortic valve repair and main pulmonary artery enlargement and was converted from ECMO to CPB using the s5 MES.
V-A ECMO to CPB conversion using Quantum MES
To convert the patient from ECMO to CPB, the Quantum MES and the CentriMag ECMO circuit were used simultaneously. In this configuration, the main pump flow was regulated by the CentriMag console and centrifugal pump of the ECMO circuit. The Quantum CPB system managed the ventilation
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