Adult Cardiopulmonary Bypass
Clinical Procedure
 
Aliases:
Adult cardiac bypass
Adult cpb
Adult heart lung bypass
Adult heart-lung bypass
Adult cardio-pulmonary bypass

Topic aliases are alternate phrasings for a particular topic.


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Mechanical circulatory support provided during open-heart surgery, bypassing the heart to facilitate surgery on the heart or major vessels.
The body's venous supply of blood is oxygenated and then pumped back into the arterial system.
The bypass machine also provides intracardiac suction, filtration, and temperature control.
Some of the more important components of these machines include pumps, oxygenators, temperature regulators, and filters. (UMDNS, 1999) www.nlm.nih.gov/cgi/mesh/...

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May 14, 2012
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A femoral to radial arterial pressure gradient exists during cardiopulmonary bypass. This may lead to underestimation of the central blood pressure and result in overuse of vasoconstrictors. refl.in/j5

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Sep 24, 2011
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If the arterial pressure is low coming off bypass, check the pressure bag is adequately inflated first as it may have deflated during a long bypass period. #safety

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Jun 21, 2012
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Transduce central pressures off the proximal lumen (white). This way you know the distal lumens are intravascular.

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Feb 20, 2012
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Administer heparin when the surgeon requests it, prior to commencing bypass. Take sample >4mins after administration and ensure that the ACT is >400

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Nov 22, 2012
300-400U/kg, although to avoid unecessary delays due to under dosing and then having to wait another 10mins for the repeat ACT result, err on the side of the larger dose ( #BS #mmc)
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When the surgeon asks for deflation of the lungs, "lungs down", consider disconnecting the ETT from circuit as well as switching off the ventilator. This minimises the risk that the APL valve may be accidently left closed which would result in hyperinflation. This is particularly relevant if there are two anesthesiologists operating the ventilator.

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In general, disconnecting the circuit is more problematic than not opening the APL valve. If one can remember to disconnect one should be able to remember to open the valve.
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Remember that the sidestream gas analyser withdraws 100 ml plus of gas from anaesthetic circuit each minute. So need to provide a " leak" into circuit if not ventilating for a prolonged period eg cpbypass to avoid negative pressure developing in the circuit. Hence leave APL valve open and maintain 0.5 l.min fresh gas flow when on bypass. #safety

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The above is unnecessary on our machines. When the anaesthetic machine is placed in Standby mode then the side stream turns off. When in Man/Spont or a ventilator mode fresh-gas-flows are a minimum 0.2L/min. No negative pressure is possible.
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I think he was referring to an older machine from another institution. Would be interesting to know which. I have attached an image of this phenomenon on an older ULCO machine we don't use for cardiac surgery anymore.
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If depending on volatile agent for anaesthesia, remember to notify the perfusionist to administer volatile agent to the bypass circuit. #safety

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Jan 09, 2012
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Midazolam 1mcg/kg/min for children <1yr old.

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If needing to reduce blood pressure at the time of aortic decannulation, rapid ventricular pacing is a more rapid onset/offset alternative to pharmacological hypotension. This involves turning off atrial pacing and increasing the ventricular rate to 110-120bpm.

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If the pump blood bag is getting full, use the empty intravenous fluid bag to take up some of the excess to relieve the pressure and prevent it bursting. #safety #example

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Checklist prior to coming off bypass:
Haemostasis;
Valve function adequate;
Air free chambers;
Aorta intact (no dissection);
Rate & Rhythm check;
No ischemia on ECG;
Myocardial function adequate;
Temperature 35-37 degrees,
Hemoglobin adequate;
Electrolytes and acid-base within normal;
Ventilation and gas exchange adequate. Miller 6th Ed p1981

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Potential causes of ventricular dysfunction following cardiopulmonary bypass:
Exacerbation of existing dysfunction;
Inadequate myocardial protection;
Ischemia/infarction (coronary artery or graft spasm, air or particulate emboli, surgical graft issue);
Reperfusion injury;
Residual lesions (HOCM, valve gradients, shunts) Miller 6th Ed p1987

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Important aspects of the case to handover to ICU: Relevant history,
surgical details,
IV and arterial access;
blood products administered;
haemodynamics and inotropes,
bypass time, cross clamp time,
haemaglobin,
any electrolyte abnormalities,
ventilation parameters.

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