Neonatal & Pediatric Perfusion Flashcards

In neonatal perfusion, which strategy best describes 'regional cerebral perfusion' (RCP) used during aortic arch repair?

Answer: Selective antegrade perfusion of cerebral vessels via innominate/carotid cannulation during systemic arrest

RCP (antegrade cerebral perfusion) delivers oxygenated blood directly to the brain via the innominate or right carotid artery at 20–50 mL/kg/min during systemic circulatory arrest.

A 4.2 kg neonate's calculated circulating blood volume is 340 mL. The circuit prime volume is 280 mL. To achieve a target hematocrit of 28% on bypass, the child's pre-bypass hematocrit is 42%. How should the perfusionist approach priming?

Answer: Add packed red blood cells to the prime to achieve target hematocrit

When the prime volume nearly equals the blood volume, significant hemodilution occurs; adding PRBCs to the prime is necessary to maintain the target hematocrit at initiation of bypass.

Which of the following best describes the Qp:Qs ratio that indicates balanced pulmonary and systemic circulation in a Norwood stage I patient?

Answer: 1:1

A Qp:Qs of 1:1 indicates equal pulmonary and systemic blood flow, which is the goal to optimize both oxygen delivery and cardiac workload in single-ventricle physiology.

During pediatric CPB, the perfusionist notices glucose of 280 mg/dL. The most appropriate action is:

Answer: Administer insulin to correct hyperglycemia and avoid neurological injury

Hyperglycemia during CPB, especially in neonates, worsens ischemic neurological injury; insulin therapy should be initiated to maintain glucose in the 80–150 mg/dL range.

Which cannulation strategy is most commonly used for total CPB support in a neonate undergoing repair of total anomalous pulmonary venous return (TAPVR)?

Answer: Ascending aortic cannulation with bicaval venous cannulation

Ascending aortic arterial cannulation with separate bicaval venous cannulation provides optimal decompression of the heart and access to the pulmonary venous confluence in TAPVR repair.

Aminocaproic acid (Amicar) is used in pediatric perfusion primarily to:

Answer: Inhibit fibrinolysis and reduce post-bypass bleeding

Aminocaproic acid is an antifibrinolytic agent that inhibits plasminogen activation, reducing fibrinolysis and post-CPB bleeding in pediatric patients.

In a neonate on ECMO for post-operative cardiac support, the circuit shows increasing pre-membrane pressures with normal post-membrane pressures. This finding most likely indicates:

Answer: Oxygenator thrombosis or clot obstruction

Rising pre-membrane pressure with normal post-membrane pressure indicates increasing resistance across the oxygenator, most commonly due to clot formation within the membrane.