Cardiopulmonary bypass in the pediatric population.

Cardiopulmonary bypass (CPB) facilitates the repair of cardiac lesions in adults and children. Surgical mortality has decreased with improvements in technique allowing for the successful repair of complex heart defects in neonates of increasingly low body weight and gestational age. The physiological effects of CPB are more significant in children. The presence of intracardiac shunts and other anatomic variants further complicates CPB in patients with congenital heart disease. Special techniques and monitors are often necessary. Protocols are often established within individual institutions to standardize the approach to CPB. The anesthesiologist caring for the patient must understand the physiology of CPB to facilitate the initiation and separation from bypass, and to be able to treat complications. Evidence supporting a particular technique of CPB in pediatric population is still largely from uncontrolled or nonrandomized trials, observational studies, extrapolation from adult studies, and expert opinion. The heterogeneity of congenital heart disease makes randomized controlled trials or meta-analyses challenging, and thus they are limited in the literature.