Cardiopulmonary Bypass

Question 0

How to bypass the heart and lungs?

Answer 0

1 drain venous blood
2 collect in reservoir
3 pump it through a device
4 oxygenate and filter
5 return via aorta

Question 1

Why bypass the heart and lungs? For _____ heart procedures, ________ that do not tolerate mechanical manipulation, ______, distal ___________.

Answer 1

Open heart procedures
Unstable hearts
Transplants
Distal airway reconstruction

Question 2

What are the components of CPB?

Answer 2

Biosurface
Reservoir
Roller pumps
Centrifugal pump
Oxygenators
Anticoagulation

Question 3

What are two kinds of biosurface?

Answer 3

Terumo and Medtronic

Question 4

Terumo is an X-coating (what does this mean?) which is ______ and ______. It ______ protein desaturation and platelet adhesion.

Answer 4

Amphiphilic and biopassive

Reduces

Question 5

Three kinds of Medtronic biosurface?

Answer 5

Balance
Carmeda
Trillium

Question 6

Which Medtronic biosurface is not heparin coated?

Answer 6

Balance

Question 7

Which Medtronic biosurface are hydrophilic?

Answer 7

Balance

Trillium

Question 8

Which Medtronic is negatively charged?

Answer 8

Trillium

Question 9

Which Medtronic is nonleaching?

Answer 9

Carmeda

Question 10

The hard shell reservoir has

Answer 10

Stable blood levels

High visibility scale

Question 11

The Levelsens is a ______ reservoir with

Answer 11

Soft shell

Low level alarm

Question 12

Review the centrifugal pump cause the pictures I printed are too small to read

Answer 12

Go do that

Question 13

Oxygenators

Answer 13

Review the membrane lung vs natural lung chart

Question 14

Oxygenators assembled

Answer 14

Fill this in later…

Question 15

Anticoagulation is achieved through ______ at _____ units per kg. the activated clotting time (ACT) is

Answer 15

Unfractionated heparin (UFH)
300
>400 seconds

Question 16

The HMS Medtronic Plus uses ______ heparin concentration based anticoagulation with heparin _______ and automated ______ titration

Answer 16

Patient specific
Heparin dose response
Automated protamine titration

Question 17

What is monitored on CPB?

Answer 17

CO, SVO2, SVR
Arterial blood gases
Temperature
Urine output

Question 18

What is the equation for SVR?

Answer 18

SVR = (MAP-CVP)/CO

Question 19

Arterial blood gases on the CPB are monitored every

Answer 19

30-60 min

Question 20

What factors contribute to myocardial protection?

Answer 20

Pre CPB stable hemodynamics
Anesthetic preconditioning
Adequate cardioplegia (intentional and temporary cessation of cardiac function)
Myocardial temperature

Question 21

Weaning from CPB

Answer 21

Adequate repair
Confirmed by echocardiologist
Rewarm
De aired heart
Repercussion rhythm
Adequate hemodynamics
Appropriate ABG, gas exchange, electrolytes

Question 22

What needs to be done post CPB?

Answer 22

Protamine to reverse UFH
ABGs
Follow up hematology studies

Question 23

How does protamine reverse UFH?

Answer 23

Binds to it to form a stable ion pair that does not have anticoagulant properties

Question 24

What are the follow up hematology studies?

Answer 24

ACT
TEG
PT/INR/PTT, fibrinogen, thrombin time

Question 25

Complications of CPB?

Answer 25

Cardiovascular collapse - graft failure, thrombosis, coronary spasm, residual defects, L/R heart failure, dysrhythmias
Pulmonary complications
Coagulopathy
Metabolic disturbances

Question 26

Bedside CPB

Answer 26

Rapid cardiopulmonary support (CPS)

Question 27

Ventricular Assist Device

Answer 27

Kid holding up his shirt