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 edema3
• Hyperglycemia4
• Infection5

1. Huyzen, R.J., Van Oeveeren, W., Wei,F.,et al.
In vivo effect of hemodilution on ACT and
high-dose thrombin time during cardiopulmonary
bypass. Ann Thorac Surg.199683459-65 2.
Shupbach, P., Perfusate oncotic pressure during
cardiopulmonary bypass, optimum levels as
determined by metabolic acidosis, tissue edema,
and renal function. Vox Sang.
35332-334,1978 3. Puri, V.K., Michaels, S., and
Carlson,R. W. Pulmonary edema associated with
reduction in Plasma oncotic pressure. Surg.
10721, July 1971 4. Benzing, G, et al. Glucose
and insulin changes in infants and children
undergoing hypothermic open-heart surgery. Am J
Cardiol. 1983 52133-36 5. Frater, R.M.W.,
Santos, G.H. Sources of infection in open heart
surgery. 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 Solution The Low Prime Pediatric Circuit

• 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 D100
  Neonatal Oxygenator.

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The Solution The Low Prime Pediatric Circuit

• The Importance of Devices (cont.)
• The 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 D130 KiDS arterial filter offers the lowest
  prime volume arterial filter in clinical use
  today, just 16ml.

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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 withthe
  Electric Remote-Controlled tubing clamp (ERC)an
  unprecedented safety feature that
  immediatelyoccludes the arterial line when
  certain conditions aredetected (level, bubble or
  retrograde flow).
• The S5 and C5s automated alarms and warnings
  are recorded and listed chronologically on the
  system display. Critical situations can be
  quickly detected and cleared.

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For More Information

• 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 at 1-800-221-7943.