Since first case in 1953, ECC has progressed by leaps and bounds to the point where it has become commonplace. It is largely disposable and includes many safety systems that were not present in the early models: bubble monitor, arterial and venous filters, SaO2 and SvO2 monitoring, reservoir pump control, etc.
Off-pump surgery has demonstrated that by itself, ECC is not responsible for all the morbidity associated: coagulopathy, SIRS, neurological, renal and pulmonary complications, etc. Part of its disadvantage comes from anticoagulation, but new biocompatible systems allow for less heparinisation..
Currently, work is focused on the biocompatibility of contact surfaces, on reducing the inflammatory reaction and on the miniaturisation of the whole system. However, the management of compact systems without venous reservoirs requires increased attention, because these devices are less complicated and work on a just-in-time basis. The introduction of new computer technologies is aimed at finer management of haemodynamics and greater sophistication of control systems. By simplifying the perfusionist task, ECC extends its field of application outside cardiac surgery, such as cardiogenic shock or certain invasive thoracic and vascular operations. In these situations, however, the development of new circulatory support systems with (ECMO) or without (Impella, TandemHeart, etc.) oxygenator has replaced ECC because they are simpler to use and remain functional for a longer period (7-12 days).
© CHASSOT PG, GRONCHI F, April 2008, last update, December 2019