Additional veno-venous gas exchange as a problem-solving strategy for an oxygenator not transferring oxygen in paediatric cardiopulmonary bypass

Abstract

OBJECTIVES Oxygenator failure during cardiopulmonary bypass constitutes a life-Threatening event, especially when perfusion is conducted under normothermia. An alternative solution to emergency oxygenator changeover is described. METHODS A supplementary oxygenator is added in the venous line without interrupting perfusion. De-Airing is achieved through the cardiotomy reservoir. Oxygen supply is adapted to ensure physiologic partial oxygen pressure. RESULTS On 5 occasions in the past 4 years, Capiox Baby FX 05 oxygenator (n = 4) and Capiox FX15 (n = 1) failed to exchange blood gases after bypass run ranging from 290 min to 563 min. Hypoxia ensued with partial oxygen pressure values of 49-79 mmHg with a fraction of inspired oxygen of 1. An additional veno-venous Terumo Capiox FX 05 oxygenator immediately improved oxygenation with resulting partial oxygen pressure increasing to at least 291 mmHg. CONCLUSIONS An additional veno-venous oxygenator effectively corrects failing oxygenator during cardiopulmonary bypass. The method does not require circulation arrest. It does not carry the risk of air embolism. It can be carried out without any help from a second perfusionist or member of operation team.