Over the past 40 years, the trend has been to perform more complex, corrective and fewer palliative procedures on younger and smaller patients. Today, more than 50% of pediatric open-heart operations are performed in infants less than one year of age with more than 20% of all pediatric heart procedures performed during the first month of life. The outcomes following surgery for congenital heart disease have improved significantly in recent decades, which is in part due to advances made in our understanding and techniques of cardiopulmonary bypass (CPB).Pediatric perfusionists must have specialized knowledge related to pediatric physiology and congenital heart disease as well as the ability to utilize perfusion circuits adapted to a wide range of patient sizes. Pediatric perfusion cases can sometimes be very long due to the complexity of the cardiac repairs.

The composition of the fluid used to prime cardiopulmonary bypass (CPB) circuits has been a source of great interest and debate ever since the inception of cardiopulmonary bypass in 1953. There has been significant progress in our understanding, but the ideal priming solution has still to be agreed upon and practice continues to vary widely between cardiac units. Circuits must be carefully de-aired with a compatible priming solution in order to prevent gas emboli from passing into the patient’s circulation at the commencement of CPB. Crystalloid and colloid priming solutions are now commonplace.

Deep hypothermic circulatory arrest (DHCA), either alone or in combination with other perfusion strategies, has become the mainstay of vital organ protection for a variety of pathologies and surgical procedures that necessitate the complete cessation of blood flow. DHCA provides a near blood-less operating field, albeit of limited duration, while ameliorating the major adverse consequences of vital organ ischemia.Cooling of the brain – the organ at greatest ischemic risk – reduces cerebral metabolic rate, extending the period of "safe" ischemia from 3-4 minutes at normothermia to >20 minutes.