Management of Pediatric Cardiopulmonary Bypass
The development of cardiopulmonary bypass (CPB) and the modern era of open-heart surgery arose from early attempts to correct intracardiac congenital heart defects in children using extracorporeal circulation. This chapter explains that the safe performance of CPB in pediatric heart surgery can be exceedingly more complex and nuanced than in adult heart surgery, primarily due to patient age, size, anatomy, physiology, and operational complexity. The safe conduct of CPB in the neonate and infant requires a comprehensive understanding of the unique physiologic and anatomic complexities associated with extracorporeal perfusion in children with congenital heart disease. The use of smaller circuits and prime volume is aimed at decreasing hemodilution and decreasing the total foreign surface area with which the smaller circulating volume of the pediatric patient will make contact. Pediatric heart surgery often involves more complex interventions over greater temperature ranges than adult cardiac surgery.
