Cardiopulmonary Bypass Flashcards
How to bypass the heart and lungs?
1 drain venous blood 2 collect in reservoir 3 pump it through a device 4 oxygenate and filter 5 return via aorta
Why bypass the heart and lungs? For _____ heart procedures, ________ that do not tolerate mechanical manipulation, ______, distal ___________.
Open heart procedures
Unstable hearts
Transplants
Distal airway reconstruction
What are the components of CPB?
Biosurface Reservoir Roller pumps Centrifugal pump Oxygenators Anticoagulation
What are two kinds of biosurface?
Terumo and Medtronic
Terumo is an X-coating (what does this mean?) which is ______ and ______. It ______ protein desaturation and platelet adhesion.
Amphiphilic and biopassive
Reduces
Three kinds of Medtronic biosurface?
Balance
Carmeda
Trillium
Which Medtronic biosurface is not heparin coated?
Balance
Which Medtronic biosurface are hydrophilic?
Balance
Trillium
Which Medtronic is negatively charged?
Trillium
Which Medtronic is nonleaching?
Carmeda
The hard shell reservoir has
Stable blood levels
High visibility scale
The Levelsens is a ______ reservoir with
Soft shell
Low level alarm
Review the centrifugal pump cause the pictures I printed are too small to read
Go do that
Oxygenators
Review the membrane lung vs natural lung chart
Oxygenators assembled
Fill this in later…
Anticoagulation is achieved through ______ at _____ units per kg. the activated clotting time (ACT) is
Unfractionated heparin (UFH)
300
>400 seconds
The HMS Medtronic Plus uses ______ heparin concentration based anticoagulation with heparin _______ and automated ______ titration
Patient specific
Heparin dose response
Automated protamine titration
What is monitored on CPB?
CO, SVO2, SVR
Arterial blood gases
Temperature
Urine output
What is the equation for SVR?
SVR = (MAP-CVP)/CO
Arterial blood gases on the CPB are monitored every
30-60 min
What factors contribute to myocardial protection?
Pre CPB stable hemodynamics
Anesthetic preconditioning
Adequate cardioplegia (intentional and temporary cessation of cardiac function)
Myocardial temperature
Weaning from CPB
Adequate repair Confirmed by echocardiologist Rewarm De aired heart Repercussion rhythm Adequate hemodynamics Appropriate ABG, gas exchange, electrolytes
What needs to be done post CPB?
Protamine to reverse UFH
ABGs
Follow up hematology studies
How does protamine reverse UFH?
Binds to it to form a stable ion pair that does not have anticoagulant properties
What are the follow up hematology studies?
ACT
TEG
PT/INR/PTT, fibrinogen, thrombin time
Complications of CPB?
Cardiovascular collapse - graft failure, thrombosis, coronary spasm, residual defects, L/R heart failure, dysrhythmias
Pulmonary complications
Coagulopathy
Metabolic disturbances
Bedside CPB
Rapid cardiopulmonary support (CPS)
Ventricular Assist Device
Kid holding up his shirt
