A. Lal et al.: J Extra Corpor Technol 2025, 57, 164--167 167
Table 1. Preoperative priming volumes and patients’ demographics for both cases.
Patient No.
Weight( kg)
Estimated blood volume( mL)
Hematocrit prior to CPB(%)
Full CPB circuit volume( mL)
Estimated Hematocrit on CPB with no RBC’ s added(%) s5 MES( mL)
Estimated Hematocrit s5 MES with no RBC’ s added
Quantum MES( mL)
Hematocrit on Quantum MES with no RBC’ s added(%)
1 |
3.3 |
281 |
35 |
300 |
17 |
80 |
27 |
120 |
25 |
2 |
3.4 |
289 |
31 |
300 |
15 |
80 |
24 |
120 |
22 |
utilization of the MES may attenuate the inflammatory response and its consequences. Using this strategy, pediatric intensivists commented on less post-operative bleeding and blood product requirements, potentially due to the reduced surface area and priming volume. Limiting blood product usage to a single unit of packed red blood cells( RBC), reduces the risk of immunological complications such as transfusion-related acute lung injury( TRALI) and febrile non-hemolytic reactions, as the prevalence of transfusion reaction in children is twice that of adults [ 8, 4, 9, 10 ].
A comparison of the Quantum MES and s5 MES identified the following features below.
The Quantum MES used the CentriMag pump to control patient flow, with the safety feature of an arterial occluder linked to the bubble detector. The Quantum MES also allows for a smaller footprint in the theatre environment. Nonetheless, the limitations of this setup are: include perfusion control across both the ECMO cart and Quantum MES, no line pressure regulation, and no level sensor function. In the unlikely event of the reservoir emptying, the bubble detector located on the reservoir outlet and arterial line occluder would activate to prevent patient air. Although the circuit was without pressure regulation, an audible alarm would be activated within target pressure limits.
Using the s5 MES to carry out this procedure, the stated limitations of the Quantum MES were overcome. The s5 MES allowed the roller pump of the s5 HLM to control the blood flow and have a functional level sensor. By using the roller to control flow, the centrifugal pump head remained in situ; however, at a reduced pump speed, so it remained patent for potential conversion back to ECMO. The team needed to be aware that pressure regulation was monitored pre-oxygenator, rather than post-oxygenator, as in our conventional CPB circuit. Thus, circuit line pressure would measure considerably higher.
Further modification of the s5 MES could be carried out by dividing the venous line between the pump head and the oxygenator of the ECMO circuit. This would enable kineticassisted venous drainage via the centrifugal pump head. However, this was not possible with our current ECMO circuit design, due to multiple connectors in this position.
This report shows that converting the patient from ECMO to CPB is not without its risks; however, by using this technique the extensive foreign surface exposure is reduced, along with the use of blood products and their associated detrimental effects. This novel strategy also has the flexibility of conversion back to ECMO after cardiac surgical revision, if required.
Funding The authors did not receive any financial support for this work.
Conflicts of interest The authors declare no conflicts of interest.
Data availability statement All available data are incorporated into the article.
Author contribution statement
A. L, DM & W. L designed the approach, A. L & W. L performed both approaches, A. L & D. M provided expertise in clinical data analysis. A. L & D. M wrote the manuscript and all authors contributed to the final version.
Ethics approval There are no ethical declarations relevant to this case report.
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Cite this article as: Lal A, Machin D & Lansdowne W. A novel strategy for conversion from pediatric V-A ECMO to CPB circuit. J Extra Corpor Technol 2025, 57, 164 – 167. https:// doi. org / 10.1051 / ject / 2025027.