Summary of Standards and Statements

Document Overview

Design and created by Guideline Central in participation with the American Society of Extracorporeal Technology.

Pediatric and Congenital Perfusion Practice (2025 Update)

American Society of Extracorporeal Technology

Publication Date: Apr 1, 2025

Page Last Updated: May 5, 2026

Standards

Standard 6.1: Pressure monitoring of the arterial line, cardioplegia delivery systems, and venous reservoir (when augmented venous drainage is utilized) shall be employed during cardiopulmonary bypass procedures.
- The pressure monitor shall be either servo-regulated to control the arterial/cardioplegia pump or to allow interruption to the arterial/cardioplegia flow.
- The pressure monitor shall include an audible and visual alarm.
Standard 6.2: A bubble detector shall be employed during cardiopulmonary bypass procedures.
- The gross/macro bubble detector shall be used to control the arterial pump or to allow interruption of the arterial blood flow.
- The detector system shall include an audible and visual alarm and be positioned according to manufacturer instructions for use to enable timely identification and action.
Standard 6.3: A level sensor shall be employed during cardiopulmonary bypass procedures utilizing a (hard-shell) reservoir.
- The level sensor shall be either servoregulated to control the arterial pump or to allow interruption of the arterial blood flow.
- The level sensor shall include an audible and visual alarm and be positioned according to manufacturer’s instructions to allow an appropriate reaction time and a safe operational volume.
Standard 6.4: Temperature monitoring of the arterial outflow from the oxygenator shall be employed during cardiopulmonary bypass procedures.
- The temperature sensor shall include an audible and visual alarm to prevent high arterial outlet temperatures.
Standard 6.5: An arterial-line filter, external or integrated, shall be employed during cardiopulmonary bypass procedures.
Standard 6.6: A one-way valve in the vent line shall be employed during cardiopulmonary bypass procedures.
Standard 6.7: A method for retrograde flow avoidance when using a centrifugal pump shall be employed during cardiopulmonary bypass procedures.
- Examples of retrograde avoidance systems may include the following:
- One-way flow valves
- Hard stop detent controls to prevent accidental reduction in pump speed
- Electronically activated arterial line clamps
- Low speed visual and audible alarm
Standard 6.8: An anesthetic gas scavenge line shall be employed whenever inhalation agents are introduced into the circuit during cardiopulmonary bypass procedures.
Standard 6.9: Hand cranks shall be readily available during cardiopulmonary bypass procedures.
Standard 6.10: A back-up gas supply shall be readily available during cardiopulmonary bypass procedures.
Standard 6.11: The cardiopulmonary bypass machine shall have a backup power source that allows for uninterrupted power supply during cardiopulmonary bypass procedures.

Standards

Standard 7.1: Patient arterial blood pressure shall be monitored continuously during cardiopulmonary bypass procedures.
Standard 7.2: Arterial line pressure shall be monitored continuously during cardiopulmonary bypass procedures.
Standard 7.3: Arterial blood flow shall be monitored continuously at a point in the cardiopulmonary bypass circuit where it accurately reflects the flow delivered to the patient during cardiopulmonary bypass procedures (e.g., distal to intra-circuit shunts).
Standard 7.4: Cardioplegia dose, temperature, delivery method, line pressure (antegrade), coronary sinus pressure (retrograde) and ischemic intervals shall be monitored continually during cardiopulmonary bypass procedures.
Standard 7.5: Patient and device temperatures shall be monitored continually during cardiopulmonary bypass procedures.
- Patient (e.g. nasopharyngeal, rectal, bladder, esophageal)
- Heart lung machine (arterial, venous, and cardioplegia)
- Heater cooler (H20 temperature)
Standard 7.6: Blood gas analysis shall be monitored continually or at regular intervals during cardiopulmonary bypass procedures (Appendix D).
Standard 7.7: Continuous blood gas monitoring shall be used during cardiopulmonary bypass procedures.
Standard 7.8 Hematocrit (or hemoglobin) shall be monitored continuously during cardiopulmonary bypass procedures.
Standard 7.9: Oxygen fraction and gas flow rates shall be monitored continually during cardiopulmonary bypass procedures.
Standard 7.10: The percentage of venous line occlusion of the venous occluder shall be monitored continually during cardiopulmonary bypass procedures.
Standard 7.11: Venous oxygen saturation shall be monitored continuously during cardiopulmonary bypass procedures.
Standard 7.12: Arterial oxygen saturation shall be monitored continuously during cardiopulmonary bypass procedures.
Standard 7.13: Cerebral oximetry shall be monitored continuously during cardiopulmonary bypass procedures.

Document Overview

Document Title: Pediatric and Congenital Perfusion Practice

Authoring Society: American Society of Extracorporeal Technology

Document Publication Date: Apr 1, 2025

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: amsect.org/LinkClick.aspx?fileticket=BOQNMkPK0KY%3d&portalid=0

Document Scope, Criteria, and Use Cases

Document Objectives: To provide Perfusionists with a framework to guide safe and effective extracorporeal support care to their patients. AmSECT recommends that clinical teams use this document as a guide for developing institution-specific protocols for patients receiving extracorporeal support.

Scope: Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D010477 - Perfusion

Keywords: congenital heart disease, mechanical circulatory support, mechanical ventilation

Inclusion Criteria: Male, Female, Adolescent, Child

Health Care Settings: Emergency Care, Hospital, Operating and Recovery Room

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Pediatric and Congenital Perfusion Practice (2025 Update)

Summary of Standards and Statements

1. Development of Institutionally-based Protocols

Standards

Guidelines

2. Qualification, Competency and Support Staff

Standards

Guidelines

3. Communication

Standards

Guidelines

4. Perfusion Record

Standards

Guidelines

5. Checklist

Standards

Guidelines

6. Safety Devices

Standards

Guidelines

7. Monitoring

Standards

Guidelines

8. Anticoagulation

Standards

Guidelines

9. Gas Exchange

Standards

Guidelines

10. Blood Flow

Standards

Guidelines

11. Blood Pressure

Standards

Guidelines

12. Circuitry

Standards

Guidelines

13. Priming

Standards

Guidelines

14. Protamine and Cardiotomy Suction

Standards

15. Blood Management

Standards

Guidelines

16. Fluid Management

Standards

Guidelines

17. Level of Readiness

Standards

Guidelines

18. Staffing

Standards

Guidelines

19. Duty Hours

Standards

Guidelines

20. Quality Assurance and Improvement

Standards

Guidelines

21. Maintenance

Standards

22. Crisis Management

Standards

Guidelines

Appendices

Appendix A: Patient information

Appendix B: Information sufficient to accurately describe the procedure, personnel, and equipment

Appendix C: Patient Physiological and Perfusionist Practice Parameters Documented at a Frequency Determined by Institutional Protocol

Appendix D: Blood gas, electrolyte and anticoagulation monitoring results

Document Overview

Document Scope, Criteria, and Use Cases