Pediatric Perfusion Systems

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Pediatric Perfusion Systems

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The Challenge

• Miniaturization of the neonatal or pediatric
  cardiopulmonary bypass circuit can be especially
  challenging.
• How will your choice of oxygenator, heart-lung
  machine and other devices achieve the lowest
  prime circuit for the smallest of patients?

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The Challenge

• As surgical techniques have advanced, the need
  for cardiopulmonary bypass in neonates to repair
  congenital heart defects has increased
  dramatically over the past two decades.
• Minimizing the circuit prime volume for neonatal
  patients is key in reducing the need for
  allogeneic blood products for the smallest of
  patients.

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The Challenge

• The potentially harmful effects of CPB in these
  patients is more pronounced than those seen in
  larger pediatric or adult patients.
• The ability to control essential perfusion
  parameters may be compromised by using devices
  intended for larger patients.
• Neonates are more prone to inflammatory response
  as a result of foreign surface area exposure.

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The Challenge

• When small infants are overdiluted, additional
  side effects can include, but are not limited to
• Increased post-op bleeding¹
• Reduction in oncotic pressure (of up to 50)2
• Pulmonary edema 3
• Hyperglycemia4
• Infection 5

• Huyzen, R.J., van Oeveeren, W., Wei,F.,et al.
  Invivo effect of hemodilution on Act and
  high-dose thrombin time during cardiopilmonary
  bypass. Ann Thorac Surg.199683459-65
• Shupbach, P., Perfusate oncotic pressure during
  cardiopulmonary bypass, optinum levels as
  determined by metabolic acidosis, tissue edema,
  and renal function. Vox Sang. 35332-334,1978
• Puri, V.K., Michaels, S., and Carlson,R. W.
  Pulmonary edema associated with reduction in
  Plasma oncotic pressure.Surg. 10721, July 1971
• Benzing, G, 111, et al. Glucose and insulin
  changes in infants and children undergoing
  hypothermic open-heart surgery. Am J Cardiol.
  1983 52133-36.
• Frater,R.M.W., Santos,G.H. Sources of infection
  in open heart surger. N.Y. State J Med 1984
  2368-74

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The Challenge

• Measures used to counteract the effects of
  hemodilution have historically included the
  addition of allogeneic blood.
• However, this exposes the neonatal patient to
  additional risks, including blood-borne diseases
  and infection.
• Although a lesser concern, the additional cost of
  whole blood remains a consideration.

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The Low Prime Pediatric Circuit
The Solution

• There are several methods now used to effectively
  reduce the prime volume of a CPB circuit for
  pediatric patients
• The most direct course of action has been to
  reduce both the length and diameter of the
  circuit tubing.
• The entire circuit has been repositioned closer
  to the patient, and is placed level with the
  right atrium.
• Vacuum-assisted venous drainage has allowed
  perfusionists to further reduce the length of the
  venous lines.

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The Solution
The Low Prime Pediatric Circuit

• The Importance of Devices
• The oxygenator, reservoir and filter chosen for
  the pediatric circuit will have a direct and
  dramatic impact on priming volume and ability to
  control key perfusion parameters.
• Sorin Group has solved this challenge with the
  first dedicated perfusion system specially
  designed for neonatal patients The Kids Dideco
  D100 Neonatal Oxygenator.

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The Solution
The Low Prime Pediatric Circuit

• The Importance of Devices (cont.)
• The new D100 KIDS oxygenator from Sorin Group has
  a priming volume of just 31mlless than half the
  volume of the previous generation of oxygenators.
  
• The advanced reservoir design further reduces
  priming volume and provides additional safety
  features.
• The new D130 KIDS arterial filter offers the
  lowest prime volume arterial filter in clinical
  use today, just 16 ml.

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The Solution
The Low Prime Pediatric Circuit

• Safety Considerations
• The main drawback to the shorter line lengths of
  a low prime circuit is that there is less
  reaction time for the perfusionist.
• Sorin Group has addressed this dilemma with the
  Electric Remote-Controlled tubing clamp (ERC)an
  unprecedented safety feature that immediately
  occludes the arterial line when certain
  conditions are detected (level, bubble or
  retrograde flow).
• The S5s warnings and automated alarms are
  recorded and listed chronologically on the system
  display. Critical situations can be quickly
  detected and cleared.

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Want to Know More?

• Let the professionals at Sorin Group show you how
  were uniquely qualified to help you achieve
  your vision of a low prime circuit for pediatric
  procedures.
• Ask about Sorin Groups unique Prime Volume
  Calculator
• If you have questions regarding better bypass,
  call Sorin Group at
  1-800-221-7943