High-risk pulmonary embolism with persistent right ventricular (RV) failure after reperfusion remains a major therapeutic challenge. We report a 60-year-old man with thrombus in transit and pulmonary embolism who deteriorated despite catheter-directed aspiration and local thrombolysis. Surgical right atrial embolectomy and bilateral pulmonary artery thrombectomy were performed through median sternotomy on normothermic cardiopulmonary bypass. Although separation from bypass was initially successful, severe postoperative RV-predominant cardiogenic shock, pulmonary hypertension, acute kidney injury, and refractory hypoxemia developed. Because left ventricular function was preserved, femoral arterial access was unfavorable, and differential hypoxemia was a concern with peripheral venoarterial ECMO, venopulmonary ECMO was established using femoral venous drainage and pulmonary artery return. Hemodynamics and oxygenation improved promptly, allowing discontinuation of vasoactive support. After six days, RV function recovered and ECMO was successfully removed. Venopulmonary ECMO may provide targeted rescue support after surgical pulmonary thromboembolectomy when refractory RV failure and severe hypoxemia persist despite reperfusion.
Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is a rare yet life-threatening congenital cardiac anomaly in which the left coronary artery originates from the pulmonary trunk, leading to severe myocardial ischemia, infarction, and progressive heart failure if untreated. Definitive management requires surgical reimplantation of the anomalous artery into the aorta, supported by meticulously tailored cardioplegia to protect the vulnerable pediatric myocardium, whose perfusion is further complicated by right-to-left coronary collaterals. This manuscript reports the findings of a targeted narrative review of operative videos, technical tutorials, and institutional protocols, synthesising practical knowledge on myocardial protection strategies for ALCAPA repair. Three techniques emerged as the most widely adopted and technically distinct: (1) simultaneous aortic and pulmonary-root administration of cold Custodiol®, providing prolonged single-dose crystalloid protection; (2) antegrade cold-blood cardioplegia supplemented by direct left-coronary ostial perfusion after main pulmonary artery transection, allowing staged protection during extended cross-clamp times; and (3) a classical normothermic blood protocol with repeated root doses and routine half-dose ostial delivery, offering dynamic electrolyte control and familiarity to most congenital teams. For each strategy we summarise precise indications, operative setup, perfusion pressures, dosing schedules, and practical tips for managing collateral-driven early electrical activity. By distilling evidence and expert practice into a concise technical comparison, this narrative review provides congenital cardiac surgeons with an up-to-date, step-by-step reference for safe, effective myocardial protection in ALCAPA repair.
Background Anticoagulation practices during cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) are critical for the success of these procedures, yet there exists significant variation in these practices across different regions and among healthcare professionals and institutes. Methods An international survey was conducted targeting perfusionists and other healthcare professionals involved in CPB and ECMO procedures. The survey collected data on professional roles, geographic practice locations, heparin usage in prime solutions, initial and maintenance dosing, anticoagulation monitoring methods, and alternative anticoagulants for patients with Heparin-Induced Thrombocytopenia (HIT). Results Responses were received from professionals in over 20 countries, predominantly perfusionists. A majority of respondents use heparin in the prime solution for CPB, with typical initial doses ranging from 3,000 to 10,000 units. Heparin administration before initiating CPB typically varies between 300 to 400 Units/Kg whereas for ECMO, doses are generally lower. Monitoring of anticoagulation primarily employs Activated Clotting Time (ACT), with a notable number also using Thromboelastography (TEG). For HIT cases, Bivalirudin and Argatroban were the most cited alternatives. Conclusion The survey highlights a diversity of anticoagulation practices in CPB and ECMO across different regions, reflecting variations in clinical protocols, regional standards, and available resources. This diversity highlights the need for ongoing international dialogue and standardization efforts to optimize outcomes in patients who require these critical procedures.
Background Recirculation during veno-venous extracorporeal membrane oxygenation (VV ECMO) is an important phenomenon which limits the efficiency of support. Femoro-jugular (FJ) cannulation may be associated with lower recirculation than femoro-femoral (FF) configurations. Local practice is to routinely overlap cannula in the FJ configuration, this approach remains poorly described and its impact on recirculation is not understood. Methods The saturations-based formula was used to assess recirculation fraction amongst 24 patients receiving VV ECMO between July 2018 and March 2025 in this single centre retrospective study. All received VV ECMO via a multistage drainage cannula, and single stage return. Factors considered relevant to recirculation were also collected at the time of a recirculation assessment, and cannula separation was obtained from chest Xray imaging. Recirculation was compared between configurations, with further analysis where an overlap of cannula was present. Univariate and multivariate regression was performed to evaluate influence on recirculation and clinical outcomes. Results Demography was similar between configurations, with the majority of VV ECMO indications being ARDS secondary to bacterial pneumonia. Patients in whom recirculation was assessable were similar to those excluded. Recirculation was non significantly lower amongst patients with FJ cannulation and lacked clear relationship to extracorporeal blood flow and drainage tip position. There were no significant differences in clinical outcomes between cannula configurations, however numerically higher rates of tracheostomy and awake ECMO were observed for FJ cannulations. Older age and higher vasoactive burden were associated with length of stay and survival. Conclusion There are a dearth of studies investigating recirculation in patients with deliberate overlap of femoral and jugular cannula, particularly in the context of large calibre multistage drainage devices. Prospective study is necessary to systematically evaluate the influence of this practice on VV ECMO efficiency, ideally using advanced recirculation measurements and contemporaneous cardiac output monitoring.
Background: Dosing albumin to normalize colloid osmotic pressure is an underutilized strategy within the application of cardiopulmonary bypass. The negative sequelae of third-spacing and edema post-bypass are well known and documented within the literature, yet it is not common practice for perfusionists to calculate albumin dilution or tailor albumin administration to each individual patient. Methods: The author explored relevant literature to justify quantifying albumin dosing and concentration within the application of cardiopulmonary bypass. Sequelae following edema in the cardiac patient were also explored and presented, justifying investigation of this topic. Formulae to quantify albumin dilution, resultant drop in colloid osmotic pressure, and suggested albumin dosing, were presented and unified into a model. Results: A spreadsheet-based model was developed to quantify albumin dilution that may be accessed or recreated by the reader for information purposes or for clinical use. This model enables the user to solely quantify their albumin dilution during bypass, or more proactively calculate albumin concentration and dosing in an attempt to mitigate large colloid osmotic pressure changes during bypass. Conclusions: Intentional albumin management can yield more physiologically normal albumin concentrations and colloid osmotic pressures undergoing cardiopulmonary bypass, reducing the sequelae previously described. The model presented enables informed albumin dosing by the perfusionist, and use of this model may be of especially great benefit to patients who are hypovolemic, underweight, or pediatric.
Background The adoption of Electronic Medical Records (EMRs) for Cardiopulmonary Bypass (CPB) procedures has been slow within the perfusion community, despite the widespread use of EMRs in hospitals. This consensus statement aims to provide recommendations for the implementation and use of EMRs in CPB-related care. The goals include promoting EMR adoption, ensuring standardization across platforms, facilitating quality improvement initiatives, and encouraging participation in data registries. Methods Using a modified Delphi methodology, the consensus group identified 16 key elements for EMR use during CPB, categorized into selection/ acquisition/ installation, perioperative, and post-procedure stages. Results There were 82 statements identified across the 16 EMR elements, with 80.4% (n=66) achieving an average consensus score of 7.0 and higher. Consensus was not achieved in 19.5% (n=16) of the element statements. Key recommendations include integration with digital outputs of bypass pumps, connectivity with patient monitors, adherence to security standards, and the ability to customize and adapt EMR systems to specific institutional needs. Conclusion The survey results underscore the significance of user-friendly perfusion data acquisition systems in minimizing cognitive load, highlighting their ease of use and ability to enhance workload efficiency. Essential elements include connectivity and interfacing, especially with equipment and physiological data integration, along with the necessity for dependable data storage and backup solutions. Further research is needed to investigate the potential advantages of integrating clinical decision support and pharmaceutical information integration. By addressing these elements, the consensus statement aims to improve the quality of perfusion practice and patient outcomes in CPB procedures.
Abstract Background: Hemofiltration during pediatric cardiopulmonary bypass (CPB) is essential to mitigate hemodilution, inflammatory responses, and postoperative complications. Conventional ultrafiltration (CUF) is widely practiced, but novel methods such as subzero balanced ultrafiltration combined with simple modified ultrafiltration (SBUF-SMUF) may offer superior outcomes. Objective: To compare the clinical efficacy and safety of CUF versus SBUF-SMUF in pediatric patients undergoing open-heart surgery. Methods: In this prospective randomized, outcome-assessor-blinded clinical trial, 80 pediatric patients with congenital heart disease were allocated to either CUF (n=40) or SBUF-SMUF (n=40) during CPB. Baseline demographics, intraoperative characteristics, fluid balance, blood product utilization, and postoperative outcomes were assessed. Statistical analysis was conducted using independent t-tests, Chi-square tests, and Fisher’s exact tests. Statistical significance was defined as a two-tailed p-value of less than 0.05. Results: Demographic and preoperative variables were comparable between groups. Mean fluid balance was significantly positive in the CUF group (+192.1 ± 178.8 mL) but negative in the SBUF-SMUF group (–105.0 ± 78.9 mL, p < 0.001). The SBUF-SMUF group required significantly less intraoperative PRBC (141.7 ± 70.2 vs. 261.0 ± 68.8 mL, p < 0.001) and postoperative FFP transfusion (2% vs. 10%, p = 0.020). Post-bypass hematocrit levels were higher (31.2% vs. 27.3%, p = 0.001) and extubation occurred earlier in the SBUF-SMUF group (1.05 ± 1.03 vs. 2.27 ± 2.37 days, p = 0.006). No significant differences were observed in potassium levels or incidence of acute kidney injury. Conclusion: The SBUF-SMUF technique is safe, effective, and superior to CUF in optimizing fluid balance, reducing blood product utilization, and facilitating earlier extubation in pediatric cardiac surgery. No additional risk of oliguria or electrolyte imbalance was observed compared to CUF. Its simplicity and reproducibility support its consideration as a standard approach in pediatric CPB.
Background Although the literature on extracorporeal cardiopulmonary resuscitation (ECPR) has grown substantially, coherent integrative paradigms remain limited. This study synthesizes two decades of research to elucidate knowledge gaps and orient future inquiry. Methods A mapping review of studies from 2004-2024 was performed via PubMed and EMBASE. Only studies comparing ECPR to conventional cardiopulmonary resuscitation were included. Data were extracted and synthesized thematically. Results A total of twenty studies were included, the majority being retrospective and observational design, including three interventional studies. Mortality rates following ECPR remain high and more or less constant, up to 86%. Focusing on improving chances of survival, several factors need to be considered. First is patient selection: age limit, initial cardiac rhythm, bystander resuscitation with sufficient efficacy, and maximum low-flow time are common criteria, although inconsistently applied. Some studies suggest higher ECPR survival rates in specific clinical scenarios, but none of the previous studies have yet succeeded in formulating an algorithm that facilitates the identification of the (most) suitable candidates. The second factor affecting outcomes is the pathophysiologic processes during ECPR. This is largely unexplored territory, with current knowledge limited to observational studies of low-flow injury. Most studies do not report on factors including temperature management during support, pump flow, target mean arterial pressures, and oxygenation strategies. Lastly, and potentially most significantly is the timing of ECPR initiation. Timely restoration and maintenance of circulation and oxygenation halt the accumulation of oxygen debt and commences oxygen debt repayment. To date, data on optimal initiation timing thresholds remain undetermined. Conclusion Current ECPR literature lacks knowledge in three interdependent domains, which require an integrated approach: validated selection criteria, a mechanistic understanding of ischemia-reperfusion injury, and precise initiation timing strategies. A multidisciplinary research agenda is needed to unlock the true value of ECPR in cardiac arrest care.
Background Allogenic blood product transfusion has well-documented risks and adverse outcomes. To limit perioperative transfusions for neonates and infants undergoing cardiac surgery, our institution launched a blood conservation program in May, 2021. Over the past several years, our standard has changed from blood priming the cardiopulmonary bypass (CPB) circuit for most patients ≤ 12 kilograms (kg) to administering an asanguinous prime to all patients with an adequate baseline hematocrit (HCT), regardless of weight. For those requiring transfusion, the technique of modified blood priming (MBP), introduced herein, presents an intermediate solution between a clear and standard blood prime, with the goal of administering the minimum amount of packed red blood cells (PRBC) to maintain safe oxygen-carrying capacity while on CPB. Methods The crystalloid prime in the core of the CPB circuit (venous reservoir, arterial pump boot, and oxygenator) is displaced with a pre-calculated amount of PRBC to maintain an on-bypass HCT of > 24%. In addition, the crystalloid in the arterial and venous lines is replaced with patient blood volume via retrograde and venous autologous priming (RAP and VAP). Once CPB is established, the remaining crystalloid in the ultrafiltration (UF) and cardioplegia (CPG) circuits is displaced into a syringe with circulating blood to minimize any further hemodilution. Results We have applied MBP to 26 patients weighing less than 7 kg. The mean amount of PRBC these patients received during CPB, including in the prime, was half the amount when compared to the initial amount of PRBC we include in our institution’s standard blood prime alone. Conclusion The MBP technique allows safe initiation of CPB in the subset of neonates and infants with a post-dilutional hematocrit (PDHCT) calculated at less than 24% while avoiding excessive transfusion of exogenous blood products.
Background: Adenosine is a vital medication in cardiac surgery, particularly in valvular heart procedures. While its use has been linked to improved postoperative cardiac function in some studies, there remains significant uncertainty regarding the optimal dosage for achieving the best clinical outcomes. This lack of consensus poses challenges for surgeons, perfusionists, and anesthesiologists alike. This study aims to explore the impact of adenosine on clinical outcomes in patients undergoing valvular heart surgery. Method: This prospective randomized controlled trial was conducted over a three-month period. Sixty patients undergoing valvular heart surgery were enrolled using a continuous sampling method and randomly allocated into two equal groups of 30 patients each. The intervention group received adenosine-enriched aortic root reperfusion immediately prior to aortic declamping, while the control group underwent standard warm blood aortic root reperfusion. Both groups were matched for demographic and clinical characteristics to ensure comparability. Results: Results indicated no significant differences in mean cardiopulmonary bypass (CPB) time, aortic cross-clamping duration, or mechanical ventilation between the intervention and control groups. However, the intervention group that received adenosine had a higher rate of antiarrhythmic agent usage in the operating room (P<0.05). Inotropic agent usage was similar in both groups during surgery and in the ICU. Additionally, laboratory parameters on the first day of ICU admission were comparable between groups. Conclusion: Results in control group showed more favorable outcomes in terms of anti-arrhythmic drug usage, electroshock application, and arrhythmia prevalence. This study showed advantages for the standard warm blood aortic root reperfusion technique in managing post-operative cardiac rhythm disturbances.
Introduction: The global prevalence of morbid obesity is increasing, presenting challenges in cardiac surgery. Morbid obesity (body mass index ≥40 kg/m²) is associated with a high burden of cardiometabolic comorbidities and obesity-specific physiological alterations that increase perioperative risk and complicate surgical, anesthetic, and cardiopulmonary bypass management. As the number of obese patients presenting for cardiac surgery rises, a synthesis of current evidence and perioperative strategies is needed to optimize outcomes in this high-risk population. Methods: This narrative review identified relevant literature through targeted searches of PubMed and Google Scholar, supplemented by screening the reference lists of key articles. Search terms included combinations of “cardiac surgery,” “morbid obesity,” “obesity,” “cardiopulmonary bypass,” “anesthesia,” “perfusion,” “postoperative complications,” and “critical care.” Studies were mapped to perioperative domains, including anesthesia and respiratory management, surgical and wound related considerations, perfusion and cardiopulmonary bypass strategy, intensive care unit (ICU) outcomes, renal complications, atrial fibrillation, bleeding, thromboembolism, and mortality. The evidence base was predominantly observational and review based, with limited randomized evidence. Discussion: Obesity poses multifactorial challenges in cardiovascular surgery by altering cardiac morphology, hemodynamics, and perioperative outcomes. Associated comorbidities such as diabetes, obstructive sleep apnea, and pulmonary hypertension increase operative risk and complicate anesthetic and perfusion management. Obese patients demonstrate altered pharmacokinetics, reduced pulmonary compliance, and heightened inflammation, requiring individualized strategies. Available evidence suggests that lean body mass informed perfusion, selected off-pump CABG, and early extubation may reduce complications, although high quality randomized evidence remains limited. Conclusion: Cardiac surgery in morbidly obese patients requires a coordinated, physiology-driven perioperative strategy to address obesity-specific anatomical and functional challenges. Tailored anesthetic, perfusion, and surgical approaches, supported by close multidisciplinary collaboration, are central to optimizing outcomes. Further research is needed to refine perioperative protocols, improve risk stratification beyond BMI, and clarify long term cardiovascular outcomes following surgery in this population.
Extracorporeal membrane oxygenation (ECMO) provides heart/lung support for critically ill patients. While advances in research have improved the overall design and performance of ECMO circuits, complications such as hemolysis and thrombosis persist, and the dysfunction of the ECMO machine itself can pose significant risk to patients. Many parameters need to be closely monitored during an ECMO run, and it is often labor and resource intensive. Currently, there are few commercially available automated ECMO circuit monitoring systems that can provide continuous, holistic monitoring for ECMO circuit health and provide real-time clinical recommendations. This mixed-methods review (through literature review and customer discovery interviews) discussed key parameters relevant to ECMO circuits and monitoring, including bleeding, thrombosis, hemolysis, flow and pressure conditions, and gas exchange. Their importance in ECMO monitoring, current practices, and available technologies were highlighted. In addition, a customer discovery study, supported by the New York regional I-Corps program, was conducted to identify the “pain points” in ECMO circuit monitoring through interviews with healthcare professionals and other stakeholders who are experienced with ECMO care/use. Findings from both the literature review and the customer discovery study indicated that ECMO monitoring and management require significant resources, due to the variability and complexity of patients’ conditions, challenges in collecting patient and ECMO circuit data, and the need for a comprehensive understanding of the entire patient-ECMO ecosystem. Improvements in better understanding the complex ECMO data, incorporating new sensors into the monitoring system, and establishing comprehensive ECMO data pipelines represent some key steps towards developing “smart” ECMO monitoring that can serve as a clinical decision support system.
Background During cardiopulmonary bypass many parameters are observed to ensure metabolic demand is met. Among the most important of those are measures of oxygen supply and demand. Historically this would have included arterial blood-gas sampling, continuous venous oxygen saturation by optical cuvette, and possibly in-line blood or oxygenator gas measurement. Subsequently, additional metrics have been suggested to measure adequacy of perfusion. Yet some of the most promising, such as DO2i area under the curve (AUC) and the largest single AUC deficit episode, are often limited to retrospective statistical analysis and not accessible to clinicians. Methods We have developed non-commercial software that interfaces with commercially available perfusion monitors and can be run on most personal computers. The application displays real-time DO2i AUC and tracks deficits using both numeric and graphical visualizations. Results The software successfully imports DO2i results from an in-line blood monitor (Terumo OneView) and displays the DO2i AUC and largest single AUC deficit episode in real-time.
Background Extracorporeal membrane oxygenation (ECMO) provides life support to patients undergoing cardiopulmonary surgeries when other interventions are ineffective. Unfractionated heparin (UFH) is routinely used during ECMO due to increased risk of thrombosis. However, in some cases, like antithrombin deficiency, UFH is not efficacious, and heparin resistance (HR) can develop. There is considerable confusion about HR and what additional management strategies should be taken. Objectives This study compared clinical and economic outcomes associated with antithrombin concentrate (ATc) + UFH versus bivalirudin in adult patients undergoing ECMO. Methods This retrospective cohort study used data from the 2014-2023 TriNetX database and the 2018-2021 Premier Healthcare Database. Adult patients treated with ATc + UFH or bivalirudin within 3 days of ECMO initiation who did not undergo cardiopulmonary bypass (CPB) or coronary artery bypass grafting (CABG) during their ECMO hospital stay were identified. Propensity score matching was performed to balance the groups. Thromboembolic events, bleeding events, heparin-induced thrombocytopenia, hospital mortality, length of stay, and total hospital cost were compared. Results A total of 1601 patients (276 ATc + UFH, and 1352 bivalirudin) were identified from TriNetX, and 1592 (264 ATc + UFH, and 1528 bivalirudin) from Premier. ATc + UFH was associated with lower odds of thrombotic and bleeding events compared to bivalirudin only. Length of stay and total hospital costs trended lower for patients prescribed antithrombin and UFH. Conclusions Antithrombin + UFH may be a preferable option for managing ECMO patients, particularly those with heparin resistance.
Background: Pressure readings used in extracorporeal membrane oxygenation (ECMO) guide a variety of clinical interventions. However, several factors affect the accuracy of these measurements. We aimed to determine a model to mathematically predict expected pressure readings for different pediatric ECMO cannulae. Methods: We assembled an in-vitro circuit simulating those used clinically. Flow (mL/min) was adjusted and corresponding pressure drop (mm Hg) across the cannula was documented for various Medtronic Bio-medicus® and Life Support® cannulae. We utilized both water and blood product mixtures of differing hematocrit (Hct) levels – analogous to differing viscosities. Experimentally derived mathematical models were then applied to clinical data. Results: The relationship between flow and pressure drops across different cannulae and at different Hct levels was graphed and analyzed. At the same flow, larger cannula size corresponded to smaller drops in pressure and increased viscosity corresponded to larger drops in pressure. Using regression models of the experimental data, we estimated five exponential equations, which include Hct and flow, to predict expected pressure drop for different pediatric ECMO cannulae. There was high variability in data among patients with significant differences between clinically observed and expected pressures. Conclusion: Our models derived from in-vitro experimentation are the first steps towards defining the pressure-flow relationship and validating drainage pressure as a surrogate measure of intravascular volume for critically ill patients on ECMO. Further studies are still needed to refine these models and validate their clinical applicability.
Background: Applying platelet rich plasma (PRP) to the sternum immediately prior to approximation has been shown to enhance wound healing, lower the incidence of sternal wound infections, reduce costs associated with treating these infections and decrease post-operative pain scores. Multiple investigations have reported device-specific outcomes regarding PRP preparation yields from healthy volunteer blood donors, all with initial platelet counts in the normal range. What is missing from the literature is how accurately PRP preparations reflect device-specific yield target values, particularly under the clinical conditions encountered routinely in the cardiac surgery arena. Methods: The Magellan® group (30 cases) and the Angel® group (30 cases) comprised the two study groups (2 groups, 60 total cases,120 samples total). Pre and post processing blood samples from each group were analyzed for platelet counts. Platelet count increases were assessed for accuracy when compared to a specific target. Results: Individual yields from each tested device demonstrated some degree of limited variability. However, both groups mean values achieved and slightly exceeded the target value of a six-fold increase; Magellan group (M=6.58, SD=1.33), Angel group (M=6.31, SD=0.93). Conclusion: Both devices, on average, appear capable of accurately preparing PRP to meet the specific target value of a six-fold increase over baseline under conditions routinely encountered in cardiac surgery.
Extracorporeal carbon dioxide removal (ECCO2R) has emerged as a promising adjunctive therapy to mitigate hypercapnia and reduce invasive mechanical ventilation (IMV) settings. We present the cases of two post-lung transplant patients with severe hypercapnia and respiratory failure who were successfully treated with the ECCO2R. In both cases, we used a venovenous ECCO2R (V-ECCO2R) system, employing the Prismalung™ oxygenator integrated into a Prismaflex™ continuous renal replacement therapy (CRRT) platform. This technique proved efficacy in correcting hypercapnia, improving ventilatory parameters, and facilitating lung-protective strategies in post-lung transplant patients with respiratory failure. This technique represents a valuable adjunct to conventional mechanical ventilation, particularly in cases where hypercapnia poses a risk to graft function and patient stability. Further studies are warranted to establish optimal patient selection and refine treatment protocols for ECCO2R implementation in critical care settings.
Background In 2019, the American Society of Extracorporeal Technology (AmSECT) approved the inaugural Standards and Guidelines for Pediatric and Congenital Perfusion Practice . These standards and guidelines were created with the intent of periodic revision to ensure continued alignment with evolving best practices. In 2023, an AmSECT subcommittee initiated this review in consideration of the current literature and contemporary clinical practices. Methods The subcommittee, consisting of pediatric and congenital perfusionists, conducted a systematic literature review assessing each standard and guideline to determine if current evidence supports elevation of guidelines to standards, incorporation of new guidelines or standards, or whether existing standards and guidelines should remain unchanged. AmSECT's adult Standards and Guidelines for Perfusion Practice (2023) updates were also considered. Proposed revisions were reviewed by the 2024 AmSECT International conference attendees, AmSECT Pediatric and Congenital Perfusion Committee, AmSECT Fellows of Pediatric Perfusion (FPP), and the AmSECT International Consortium for Evidence-Based Perfusion (ICEBP). Results Regarding pediatric and congenital specific changes, 5 guidelines were elevated to standards, and 3 new guidelines and 1 standard were introduced. Additionally, 5 patient safety-related standards and 1 additional guideline were adopted from the Standards for Perfusion Practice (2023) document. Conclusion Over the course of 2 years, consisting of an extensive literature review and feedback from multiple stakeholders, the 2025 update to the Standards and Guidelines for Pediatric and Congenital Perfusion Practice was approved by AmSECT leadership, ratified by an AmSECT membership vote, and subsequently endorsed by the Congenital Heart Surgeons' Society.
