Transfusion-free cardiopulmonary bypass in Jehovah's Witness patients weighing less than 5 kg.

Performing cardiac surgery on pediatric Jehovah's Witness patients is a great challenge for the surgical team and especially for the perfusionist. Jehovah's Witnesses reject blood transfusions on the grounds of their literal interpretation of passages of the Bible. In accordance with this belief, Jehovah's Witnesses feel that it is also forbidden to retransfuse autologous blood that has been separated from their own circulatory system. We report the use of cardiopulmonary bypass (CPB) during open-heart surgery in three infants with a body weight of 4.5 kg, 3.5 kg, and 3.1 kg, respectively, without transfusion of blood components. A small-volume CPB circuit with a priming volume of 200 mL, including the arterial line filter, was designed to decrease the degree of hemodilution. A dedicated pediatric heart lung machine console with remote pump heads and intensive blood conservation efforts allowed the operation without the use of donor blood. The CPB circuits were primed with crystalloid solution only. The procedures were performed in normothermia or in moderate hypothermia. Pre-CPB hemoglobin levels were 10.8 g/dL, 10.6 g/dL, and 8.5 g/dL. The hemoglobin concentrations measured during CPB ranged from 5.9 to 6.5 g/dL, 6.4 to 6.8 g/dL, and 5.5 to 5.9 g/dL, respectively. The patients did not receive any blood or blood products during their entire hospital stay.

Transcontinental transport of a patient with an AbioMed BVS 5000 BVAD.

In patients with severe cardiogenic shock requiring implantation of a short-term assist device transportation to a specialized heart center for further therapy may be necessary. We report the first successful transcontinental air transport (from Singapore to Berlin, Germany) of a patient with fulminating myocarditis requiring implantation of a biventricular assist device.

New approach in treatment of acute cardiogenic shock requiring mechanical circulatory support.

In 12 patients with acute cardiogenic shock who required mechanical circulatory support a short-term Abiomed BVS 5000 extracorporeal assist device was implanted using the inflow and outflow cannulas of the BerlinHeart extracorporeal assist device. In 7 patients suitable for long-term support the Abiomed pumps were later exchanged for BerlinHeart pumps. This approach avoids the risks associated with repeat sternotomy and use of cardiopulmonary bypass and decreases the total costs of patient care.

Reduction of microemboli count in the priming fluid of cardiopulmonary bypass circuits.

Microemboli may impair cognitive function in patients undergoing heart surgery. Prebypass filtration has been shown to reduce particle load in the cardiopulmonary bypass (CPB) priming fluid. This study was performed to detect the embolic load of CPB priming fluid, to determine the efficacy of a 0.2 microm prebypass filter (PBF) in reducing emboli in the range of 0.1-5 microm and to provide guidelines for the handling of the device. A total of 12 CPB circuits were tested in two groups, using a laser light scattering particle counter, sensitive to microemboli in the range of 0.1-5 microm. In control group A, priming fluid before administration to the CPB circuit was analyzed. Group B circuits contained microporous membrane oxygenators (N = 5); group C consisted of CPB circuits with excluded membrane oxygenators (N = 7). When group A was compared to groups B and C, significantly more microemboli were found in the categories 0.2 microm, 0.5 microm, 0.8 microm for both groups B and C (p < .05). Group C circuits had higher microemboli counts in the categories 1.5 microm and 3 microm (p < .05) when compared to group B. Microemboli bigger than 0.2 microm could be eliminated after 2 min of prebypass filtration with a CPB flow of 5 L/min. The number of microemboli smaller than 0.2 microm was reduced substantially. Small microemboli with a size of 0.1 microm originate mainly from the priming solution. Microemboli in the range of 0.2 microm, 0.5 microm, and 0.8 microm originate mainly from the CBP circuit. In circuits with bypassed membrane oxygenators, a higher microemboli count in the range of 1.5 microm and 3 microm may be explained by a possible filtering capacity of membrane oxygenators. The 0.2 microm PBF is an effective tool to reduce the particle load in the CPB priming fluid.