Cardiopulmonary Bypass Priming Practices and Blood Product Availability in Neonatal Cardiac Surgery: A European Survey

Neonatal cardiac surgery requires cardiopulmonary bypass (CPB) strategies that minimize hemodilution while maintaining adequate oxygen delivery and hemostatic balance. Despite increasing emphasis on patient blood management (PBM), contemporary CPB priming and perioperative hemostasis practices across European neonatal cardiac surgery programs remain poorly characterized. This prospective, 26-item, web-based cross-sectional survey was designed to evaluate current practices in CPB priming, availability of blood products, and perioperative coagulation management strategies in neonatal cardiac surgery across Europe. The participants included anesthesiologists, congenital cardiac surgeons, and perfusionists from active neonatal cardiac surgery programs. A 26-item survey was distributed to 122 identified European neonatal cardiac surgery centers; 71 centers from 32 countries responded (58% response rate). Three main CPB machine platforms and four oxygenator types were reported. Priming volumes varied substantially across centers, ranging from 75 mL to 450 mL. Packed red blood cells were incorporated into the CPB prime in 58 centers (82%), while plasma products were used in 37 centers (52%). Coagulation factor concentrates were available in nearly half of the responding centers, and 64% reported that their use did not require hematology approval. Point-of-care coagulation testing was used to guide intraoperative hemostasis management in 86% of centers, although device availability and turnaround times varied widely. These results provide a contemporary snapshot and highlight substantial heterogeneity across European neonatal cardiac surgery programs in CPB priming strategies, blood product availability, and perioperative hemostasis management. While many centers have adopted point-of-care-guided PBM approaches and targeted factor replacement strategies, considerable variability persists in circuit configuration, priming volume, and transfusion resources. These findings highlight opportunities for collaborative research and for developing consensus-driven PBM frameworks to optimize neonatal CPB and perioperative hemostasis management.