Cardiopulmonary Bypass (CPB) and ECMO
Most children who need heart surgery will have to be placed on the heart-lung machine. This is also known as cardiopulmonary bypass, or CPB, for short. If your child requires a heart repair that involves CPB, we will discuss this with you at your consultation.
CPB is a machine which is surgically connected to the child’s main blood vessels and does the work of the heart and lungs. By taking over the function of the heart and lungs, the heart and the lungs can remain still. This provides the surgeon with a completely still field with no blood in the way, thus giving us clear vision and a safe space to work within. We can then open the heart and do the most delicate and complex surgery inside the still, empty heart; during this time, the patient is kept safe by the CPB machine. At the conclusion of the repair, the heart and lungs are turned back on, the child is weaned off the machine and the machine is surgically disconnected from the child. This is a routine part of most children’s heart surgery procedures.
The technology to safely perform CPB (and thus perform true open heart surgery) has been around since the 1960s and has continuously improved in terms of safety and reliability. In the current era, we can put a patient of almost any size and age on CPB and expect a safe outcome. Our program has had continuous experience using CPB in open heart surgery for more than 30 years. The men and women who run the CPB machine are called perfusionists, and our vast experience (over thousands of cases and counting) means that your child’s perfusionist is a dedicated, expert professional. Our perfusionists have trained in the best centers and have considerable experience specifically with children. This is important, as not all centers are able to offer dedicated children’s perfusionists, and this assures you as a patient or parent that this important member of the surgical team is the best possible perfusionist available.
Although safe for the vast majority of children, there remains an approximately 1 percent or less chance of having a complication related to CPB. If your child has special circumstances that make this baseline risk level higher, we will discuss this with you during your surgical consultation. Most CPB-related complications can be treated and do not result in major problems down the road.
For some babies who undergo the heart surgery, a special CPB machine called ECMO (extracorporeal membrane oxygenation) is required to support the baby in the first few days after the procedure. In these cases, the machine does the same job – taking over for the heart and lungs. This allows babies to recover from an especially long or difficult procedure and protects their other organs (kidneys, brain, etc.) while their heart and lungs recover.
At Rady Children’s Hospital-San Diego, we have had a cardiac ECMO program for more than 25 years (since 1988) and have utilized ECMO more than 270 times in heart patients; we have saved many children with this technology who might not have otherwise had a chance. Only a few percent of children in our unit have required ECMO over the past five years. It can be very difficult to predict who will need this special support. The risk is higher with ECMO than with CPB, but each child represents a special circumstance; we will discuss your child’s unique condition thoroughly with you if your child requires this technology.