At Children's Hospital & Medical Center, we treat each surgery case with the utmost safety and care. If your child has a congenital heart condition that requires surgery, he/she may need to undergo a closed heart surgery procedure. Closed heart surgery requires the operation of a heart-lung machine, which keeps a patient alive by pumping oxygenated blood throughout the body while the heart is being operated on. The heart-lung machine is also capable of regulating oxygen, carbon dioxide and blood chemistry.
This machine is operated by our highly trained and experienced staff of perfusionists. Perfusionionists are responsible for setting up and operating the heart/lung machine during cardiac surgery and other procedures that require cardiopulmonary bypass. While the surgical procedure is taking place, the perfusionist monitors the patient's blood circulation and keeps the rest of the surgical team informed of any changes. The perfusionist ensures that the circulatory and respiratory needs of the patient are being met, which allows the rest of the surgery team to focus on the actual surgical procedure. The perfusionist is also responsible for providing long-term support of the patient's circulation after the operation is concluded, if needed, using a procedure called Extracorporeal Membrane Oxygenation (ECMO).
Other responsibilities of the perfusionist include autologous blood recovery and processing (cell saver), adult and infant Extracorporeal Membrane Oxygenation (ECMO) as well as monitoring of anticoagulation, electrolyte, acid-base balance and blood-gas composition.
Autologous Blood Recovery Program (Cell Saver)
If your child is undergoing surgery in which there is potential for a considerable amount of bleeding, he or she may be recommended for autologous blood recovery, an alternative to a blood transfusion. Autologous blood recovery is also a potential option for patients who have religious objections to receiving blood transfusions.
Autologous blood recovery involves the use of an intraoperative cell salvage machine, also known as the cell saver, which suctions, washes, and filters blood so it can be given back to the patient's body instead of being thrown away. An important advantage to this process is that the patient receives his/her own blood instead of donor blood, which eliminates the risk of contracting outside diseases. In addition, because the blood is recirculated, there is no limit to the amount of blood that can be given back to the patient.
ExtraCorporeal Membrane Oxygenation (ECMO)
Children's is the only hospital in the area that provides ECMO support for all patients from newborns to adults. ECMO is a potentially life-saving procedure that provides mechanical oxygenation and cardiac support for patients in cardiac, pulmonary or cardiopulmonary failure. Management of the ECMO is provided by a team of ECMO specialists that includes perfusionists, ICU physicians, respiratory therapists and registered nurses that have received training in this specialty.
The procedure involves removing blood from the body and bypassing the heart and lungs to allow a machine to oxygenate the blood and rest of the heart before returning it to the body. This procedure is primarily used for babies with damaged lungs to allow them to rest and repair themselves or patients who have had cardiac arrest.
In most cases, ECMO is used for approximately three days, although it can be used for much longer. Prolonged use of ECMO can cause additional complications due to the eventual failure of man-made devices or bleeding issues caused by the necessity of having the blood anti-coagulated or thinned to prevent it from clotting while using the ECMO machine.
ECMO is most commonly used in the Pediatric Intensive Care Unit for all patients who require ECMO support at Children's. It is about 75 percent effective in saving the newborn's life. ECMO is not an option for newborns under four and one-half pounds and thus is not recommended for most premature newborns. In some cases, newborn infants with a premature respiratory system or other birth defect may be placed on ECMO. However, the survival rates drop to roughly 33 percent for these infants.
ECMO is sometimes beneficial in adults with lung or heart disease. The survival rate for adults averages about 60 percent.