During the past decade, the mortality rates following pediatric and adult cardiopulmonary bypass (CPB) procedures have been significantly reduced. But, the morbidity is still a significant clinical problem. Particularly, high-risk cardiac patients suffer cerebral, renal, and myocardial dysfunction after CPB. Several investigations now focus on research in minimizing the adverse effects of CPB in high-risk patients. The mode of perfusion (pulsatile or non-pulsatile) has a direct impact on vital organ recovery. Modern perfusion pumps provide the option of pulsatile and non-pulsatile flow. Despite the growing evidence for the possible benefits of pulsatile flow, the majority of institutions still choose to use non-pulsatile flow. The reasons for not using pulsatile flow relate to controversies and lack of sufficient evidence. These will be addressed in this editorial. In addition, step-by-step guidelines for the use of pulsatile flow in clinical patients for future investigations will be described. Particularly, the quantification of pressure-flow waveforms in terms of energy equivalent pressure and total hemodynamic energy levels, different types of pulsatile and non-pulsatile pumps, and the pressure drops seen in membrane oxygenators and aortic cannulas will be included.

Keywords : Pulsatile flow, non-pulsatile flow, cardiopulmonary bypass