Cardiopulmonary Bypass: Dr. Ravi Gadani MS, Fmas
Cardiopulmonary Bypass: Dr. Ravi Gadani MS, Fmas
Cardiopulmonary Bypass: Dr. Ravi Gadani MS, Fmas
Bypass
Dr. Ravi Gadani
MS, FMAS
Introduction
History
Technique
Personnel
Uses &
Cardiopulmonary Bypass
• Process which allows systemic blood to bypass the heart and lungs.
• Blood oxygenated and pumped via external pump/oxygenator back
into the systemic circulation.
Cardiopulmonary Bypass
• Main functions of cardiopulmonary bypass (CPB)
1. Maintain adequate ventilation/Regulate PO2 and CO2
2. Maintain circulation/Minimize damage to blood constituents (i.e.
platelets, RBCs)
3. Controlled hypothermia
Introduction
History
Technique
Personnel
Uses &
History
• Dr. John H. Gibbon, Jr. was the
inventor of Cardiopulmonay
bypass machine.
• First model in 1939.
• On May 6, 1953 he and his staff,
with the help of his latest-
designed heart-lung machine
“Model II,” closed atrial septal
defect of 18 year-old Cecelia
Bavolek.
History
• Dr. Gibbon and former patient
Cecelia Bavolek pose before the
Plexiglas-covered “lung” ten
years after the landmark
operation, 1963.
Introduction
History
Technique
Personnel
Uses &
Mechanism
• CPB mechanically circulates and oxygenates blood for the body while
bypassing the heart and lungs.
• The surgeon places a cannula in right atrium, vena cava, or femoral
vein to withdraw blood from the body.
• The cannula is connected to tubing filled with isotonic crystalloid
solution. Venous blood that is removed from the body by the cannula
is filtered, cooled or warmed, oxygenated, and then returned to the
body.
• The cannula used to return oxygenated blood is usually inserted in the
ascending aorta, but it may be inserted in the femoral artery.
Mechanism
• The patient is administered heparin to prevent clotting, and
protamine sulfate is given after to reverse effects of heparin.
• During the procedure, hypothermia is maintained; body temperature
is usually kept at 28ºC to 32ºC (82.4–89.6ºF).
• The blood is cooled during CPB and returned to the body. The cooled
blood slows the body’s basal metabolic rate, decreasing its demand
for oxygen.
• Cooled blood usually has a higher viscosity, but the crystalloid
solution used to prime the bypass tubing dilutes the blood.
The CPB Circuit
The CPB Circuit
Components
• Two main functional units
• The pump and
• The oxygenator
• Tubing-The components of the CPB circuit are interconnected by a
series of tubes made of silicone rubber or PVC.
Components
• Pumps
• Roller pump
• The pump console usually comprises several rotating motor-driven pumps that
peristaltically "massage" tubing. This action gently propels the blood through the
tubing. This is commonly referred to as a roller pump, or peristaltic pump.
• Centrifugal pump
• Many CPB circuits now employ a centrifugal pump for the maintenance and
control of blood flow during CPB. By altering the speed of revolution (RPM) of the
pump head, blood flow is produced by centrifugal force.
• This type of pumping action is considered to be superior - action of the roller
pump by many because it is thought to produce less blood damage (Hemolysis).
Components
• Oxygenator
• The oxygenator is designed to transfer oxygen to infused blood and remove
carbon dioxide from the venous blood
• Cannulae
• A venous cannula removes oxygen deprived blood from a patient's body.
• An arterial cannula is sewn into a patient's body and is used to infuse oxygen-
rich blood.
• A cardioplegia cannula is sewn into the heart to deliver a cardioplegia solution
to cause the heart to stop beating.
Introduction
History
Technique
Personnel
Uses &
Perfusionist
• Controls pump/oxygenator
• Gives blood products/cardioplegic solution, monitors and treats
electrolyte derangements and pH/acid/base status during CPB
• Ensures correlation of aortic and radial arterial pressure waveforms
Anesthetic Management During CPB
• Diabetics : Expect increased blood glucose after cardioplegia, Tight
glycemic control with regular insulin infusion and BG checks q half
hour.
• Renal : Monitor urine output for oliguria, Hemodialysis prior to
surgery, Avoid hypotension, ‘renal dose dopamine’
• During CPB hypothermia helps to decrease neuronal activity.
However during rewarming these increase thus necessitating greater
depth of anesthesia.
Cardioplegia
• What is it?
• It’s a solution of dextrose and potassium.
• What does it do?
• The elevated levels of extracellular potassium increase the transmembrane
potassium gradient. This inhibits cellular repolarization of myocardial muscle
cells thus preventing myocardial muscle contraction.
Introduction
History
Technique
Personnel
Uses &
Clinical Uses
• Coronary artery bypass surgery
• Cardiac valve repair and/or replacement (aortic valve, mitral valve,
tricuspid valve, pulmonic valve)
• Repair of large septal defects (atrial septal defect, ventricular septal
defect, atrioventricular septal defect)
• Repair and/or palliation of congenital heart defects (Tetralogy of
Fallot, transposition of the great vessels)
Clinical Uses
• Transplantation (heart transplantation, lung transplantation, heart–
lung transplantation)
• Repair of some large aneurysms (aortic aneurysms, cerebral
aneurysms)
• Pulmonary thromboendarterectomy
• Pulmonary thrombectomy
Complications
• Postperfusion syndrome (also known as Pumphead)
• Hemolysis
• Clotting of blood in the circuit – can block the circuit (particularly the
oxygenator) or send a clot into the patient.
• Air embolism
• Leakage – a patient can rapidly exsanguinate (lose blood perfusion of
tissues) if a line becomes disconnected.
• 1.5% of patients that undergo CPB are at risk of developing Acute
Respiratory Distress Syndrome.
Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.
Alternative Proxies: