cardiopulmonary bypass
TRANSCRIPT
Canine Model of Cardiopulmonary Bypass
Surgery
Canine Model of Cardiopulmonary Bypass Surgery
Presented By-Dr. Md Mossabbir HossainDepartment of Surgery and ObstetricsBangladesh Agricultural University, Mymensingh
• Introduction• History• Importance• Principle• CPB Team• Physiology• Steps• Patients Monitors• Systemic Complications
What will We Talk
• Definition: CPB is a technique that temporarily diverting blood from heart and lungs and provides oxygenation and pump functions in the presence of a still bloodless heart.
• Uses: CPB is used in heart surgery requiring arrested heart either with or without opening of cardiac chambers to support the circulation during that period.
Cardiopulmonary Bypass (CPB)
• Dr.Gibbons, inventor of the Heart & Lung machine Also known as, cardio-pulmonary bypass machine (CPB).
• 1935 –maintained a cat’s circulation on CPB while closing the pulmonary artery.
• 1953 –Cecelia Bavolek First patient to undergo open heart surgery using CPB to repair an atrial septal defect
History of CPB
History of CPBMore than 40 years of Innovation,
Research, and Hard Work
Why CPB
• To facilitate a surgical intervention
• Provide a motionless field • Provide a bloodless field
• Coronary Artery Disease (CAD) • Valve Disease • Congenital Heart Defects • Dissections • Transplants :- Heart, liver, lung,
trachea • Others: limb cancer, hypothermic
rescue
In Which Cases
• Deoxygenated blood (Venous Return) taken away from the body to the CPB machine.
• Then pumped and oxygenated to returned back to the body (Arterial system)
Principle of CPB
• Venous and arterial cannulas• Venous Reservoir• Centrifugal pump• Oxygenator, heat exchanger , venous
reservoir • Microfilter bubble trap on the arterial
side• Suction system for cardiotomy
reservoir and filter returns to venous reservoir
• Field blood washed in a cell saver system returned as packed RBCs.
• Partial and occluding clamps to direct and regulate flow
• Various ports in the system to obtain blood samples.
• Cardioplegic system, LV Vent.
Components of CPB
• Surgeon: Determines the planned operation, target perfusion temperatures, methods of cardioplegia, cannulations.
• Perfusionist: Setting up and priming the CPB machine, safety checks, monitoring anticoagulation, adding prescribed drugs, maintaining records.
• Anesthetist: “Troubleshooter” of complex procedures
The CPB Team Role
• Hemodilution • Anticoagulation • Hypothermia.• Flow rate & Blood Pressure.• Blood gas control
CPB Physiology
Mainly there are Seven steps of CPB
Steps for CPB
• Heparin
Step 1 for CPB
• Exposure of the heart & Check Aorta.
• Pericardial cradle/sutures.
Step 2 for CPB
Step 3 for CPB
• Check ACT• Aortic Cannulation • Remove arterial clamp.
• Atrial (venous) Cannulation • Remove venous clamp • Command “On bypass” • Turn lungs ventilation off.
Step 4 for CPB
• Place cardioplegia cannula • Reduce pump flow/Clamp
aorta.• Resume full flow/check line
pressure.• Start cardioplegia.
Step 5 for CPB
• Release cross-clamp after warm cardioplegia.
• Remove all air from heart.• Begin respirations (start lungs)• Check Good contractility &
Stable heart rhythm.• No bleeding.• Desired patient temp.
Step 6 for CPB
• Wean slowly from CPB. • Begin Protamine assessing BP,
CVP.• When stable: Clamp venous line
and remove. • Remove vent/cardioplegia. • Be alert for hemodynamic
reactions.• Remove arterial cannula after all
protamine in.• Keep lines clamped and ready for
any emergency.
Step 7 for CPB
• Radial/brachial/femoral arterial catheter.
• CVP via jugular venous catheter.• Urine output.• Temperature – Nasopharyngeal or
tympanic membrane temp used more commonly.
• Arterial line temp. correlates best with jugular venous bulb temp
Patient Monitors
• Cardiac Post-op cardiac dysfunction Subject to emboli, cytotoxins Myocardial “stunning ”reperfusion injury.• Lung• Pulmonary edema (complement
activation )• CPB reduces effect of natural surfactant .• ARDS• Kidney Hemodilution, microemboli,
catecholamines, diuretics, hypothermia, aprotinin all impair renal function.
Systemic Complications
GI Peptic ulcers (surgical stress). Pancreatitis and mild jaundice. Gastroenteritis (increase inflammatory
response).Brain Most sensitive organ exposed to injury
by CPB. Difficult to assess with difficult
outcomes as stroke, delirium & coma Risk increases with age (>60)M Protection strategies Mild hypothermia,
cerebral perfusion, off-pump.
Systemic Complications
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