title: Retrospective analysis of eliminating modified ultrafiltration after pediatric cardiopulmonary bypass.
abstract: Modified ultrafiltration (MUF) is a technique which is commonly used immediately post-cardiopulmonary bypass (CPB) for open heart surgery in children. There are many advantages of MUF, but there are also a number of less reported disadvantages. At our institution, after considering all of the available data, a decision was made to no longer perform MUF. The primary motivation being the simplified and miniaturized CPB circuit would reduce hemodilution, decrease our likelihood of reaching our transfusion trigger during CPB and, potentially, improve safety. This study reports the before and after data from this practice change. A total of 160 patients less than 8kg were studied over 38 months and divided into neonatal and pediatric cohorts. Parameters reported in this study include: demographics, hematocrit, blood product transfusion, hemostasis, hemodynamics and outcomes. Although retrospective, our analysis supports an advantage of preventing hemodilution (via circuit miniaturization) versus reversing hemodilution (via MUF) at our institution with the patient population we examined.
authors.affiliation: 1 Department of Perfusion, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Craig M
authors.initials: CM
authors.lastname: McRobb
authors.affiliation: 2 Department of Anesthesiology, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Ing
authors.affiliation: 1 Department of Perfusion, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lawson
authors.affiliation: 3 Department of Congenital Cardiac Surgery, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: James
authors.initials: J
authors.lastname: Jaggers
authors.affiliation: 2 Department of Anesthesiology, Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Twite
mesh_terms: D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D006324:Heart Arrest, Induced / Q000295:instrumentation / Q000379:methods*; D006400:Hematocrit; D006439:Hemodynamics; D006487:Hemostasis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D014462:Ultrafiltration / Q000295:instrumentation / Q000379:methods*
keywords: cardiac surgery; cardiopulmonary bypass; conventional ultrafiltration; inflammatory mediators; modified ultrafiltration; pediatric; transfusion; ultrafiltration; vasoactive inotrope score