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Congenital Defects (exam 1) > Topic 4: CPG and MUF > Flashcards

Topic 4: CPG and MUF Flashcards

1
Q

Choosing a CPG system what are 4 characteristics we want?

A

Small prime
Good heat exchange
Air handling capabilities
A versatile system

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2
Q

Retrograde CPG – what pressure need to be maintained and where??

A

Flow should be titrated to maintain a coronary sinus pressure of 30-40 mmHg

DO NOT EXCEED 40 mmHg on kidlets

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3
Q

Myocardial-protection strategy aims to do what two things?

A
  1. To halt the mechanical contractions of the heart and to allow intracardiac procedures to be performed in a motionless, bloodless field.
  2. Designed to sufficiently reduce myocardial oxygen consumption, so that myocardial function can resume at the end of the procedure with minimal dysfunction
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4
Q

Action Potential

Phase 0

A

Na+ influx

intracellular
Blocking this is the mechanism of Na arrest

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5
Q

Action Potential

Phase 1

A

Transient K+ efflux

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6
Q

Action Potential

Phase 2

A

Ca++ influx

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7
Q

Action Potential

Phase 3

A

K+efflux

Blocking this is the mechanism of K Arrest

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8
Q

Action Potential

Phase 4

A

Na/K ATPase

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9
Q

What are the %s that blood CPG and crystalloid CPG are used in US?

A

86% Blood based CP

14% Crystalloid based

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10
Q

Most popular blood based CPG used ?

A

Del Nido solution (1:4) —–38%

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11
Q

Most popular crystalloid based CPG?

A

Custodiol (7% out of the 14%)

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12
Q

Moderate (28° to 31°C) hypothermic cardiopulmonary bypass is more common with what population?

A

in neonates and infants

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13
Q

Longer intervals between cardioplegia doses were associated with what solutions?

A

surgeons using del Nido and Custodiol solutions (these solutions were commonly administered with a single dose regardless of aortic cross-clamp time)

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14
Q

Del Nido Osmolarity?

A

Osmolarity 340 mOsm/L

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15
Q

Del Nido Dosing: Arrest? Maintenace?

A

Dosing: 20 mL/kg arrest

10 mL/kg maintenance

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16
Q

Del Nido Delivery mL/min?

A

Deliver at 90-180 mL min

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17
Q

Ingredients in St. Vincents CPG solution?

A

Dextrose 5%
THAM
Citrate Phosphate Dextrose Solution

18
Q 
CUSTODIAL SOLUTION (BRETSCHNEIDER)
what mechanism is arrest ?
A

Intracellular solution
Low Na arrest
Single administration: up to 2 hours

19
Q 
CUSTODIAL SOLUTION (BRETSCHNEIDER)
ingredients ?
A

Histidine:buffer-against acidosis during XC
Trytophan:stabilizes cell membrane
Ketoglutarate:improves ATP production during reperfusion

20
Q

Histidine does what?

A

buffer-against acidosis during XC

21
Q

Trytophan does what?

A

stabilizes cell membrane

22
Q

Ketoglutarate does what?

A

improves ATP production during reperfusion

23
Q

Why would Mg be added to CPG solution?

A

May provide a protective effect on the hypoxic-ischemic immature heart.

Mg is exchanged for calcium during reperfusion

24
Q

How does Mg help protect the hypoxic-ischemic immature heart?

A

This effect probably due to the antiarrhythmic effect of Mg, inhibited entry of calcium into the myocytes, and decreased uptake of Na by myocytes during ischemia.
Mg is exchanged for calcium during reperfusion

25
Q

MUF allows?

A

To allow recovery of the pump blood for the patient, while allowing the patient to be in a hemodynamic state to accept the volume is the a significant advance for pediatric perfusionists

26
Q

who was MUF developed by?

A

Developed Mr. Martin Elliott (Great Ormand

Street/Hospital for Sick Children London UK) in 1985

27
Q

MUF does what 7 things

A

A. Raising Hct
B. Extravascular fluid crosses (rapid, large increase in COP and OSMO)
C. Removes inflammatory mediators
D. C-Reactive Proteins cross
E. Protein reactive cytokines cross
F.Complement activation factors cross (C3a, sC56-9, C3 bound)
G. Pulmonary effects > Systemic effects with IL-6, IL-8, and TNF

28
Q

What Complement activation factors cross in MUF?

A

C3a, sC56-9, C3 bound

29
Q

Pulmonary effects > Systemic effects with what factors when MUF is used?

A

IL-6, IL-8, and TNF

30
Q

How long is MUF after CPB in infants sustained?

A

results in immediate improvements in both static and dynamic pulmonary compliance, but the effect was not sustained after admission to the PICU or 24 hours after the operation.

31
Q

Why is MUF not sustained in infants? (3 main things?)

A

–Possibly - pulmonary compliance is affected both by excess fluid from the hemodilutional effect of bypass, As well as by the systemic inflammatory response
–decreases total body water and removes inflammatory cytokines.
(However, the initiation of the systemic inflammatory response most likely occurs during rewarming)
(MUF starts after the inflammatory cascade has been activated)
–Maybe that the salutary effects of
hemoconcentration and removal of water after bypass by MUF are unable to overcome the ongoing effects of capillary leak possibly caused by an activated ongoing inflammatory response.

32
Q

MUF setup?

A

Using the MUF technique, an ultrafilter is interposed in the CPB circuit between the aortic arterial line and the venous.
After weaning from CPB, the blood is removed
from the patient via the aortic canula and fed through the ultrafilter.
The outlet of the ultrafilter is fed to the right atrium of the patient.

33
Q

Max BF through the MUF?

A

approximates 20mL/kg/min max.

34
Q

When suction is applied to MUF what is the ultrafiltration rate?

A

ultrafiltration rate of 100 to 150 mL per
minute.
A constant left atrial or right atrial pressure is maintained, achieving continued hemodynamic stability in the patient.

35
Q

What is the end point time or HCT level that we want to achieve during ultrafiltration ?

A

with the end point being either time (10– 20 minutes) or the achievement of a hematocrit value of approximately 40-50

36
Q

Benefits of MUF ? (5)

A
  • total body water is reduced as a direct result of removing the ultrafiltrate
  • Reduced edema
  • Reduced hospital stay
  • Reduced ventilation times
  • Reduced incidence of pleural and pericardial effusions
37
Q

Possible negatives of MUF? (5)

A

-Possible air embolism
-Remember that air would be entering venous side
-Circuit complexity and cost
-Prolonged exposure to foreign surface
-“Patient can be concentrated before coming
of CPB”

38
Q

What does filtration do to total-body weight post-op?

A

have smaller increases in total-body weight

39
Q

Hemofiltration increases the hematocrit which does what for the body?

A

which translates into increased oxygen-carrying capacity

40
Q

MUF is associated to what clinically ?

A

-Increased ventricular systolic function
-Improved cerebral blood flow (CBF), cerebral metabolic activity, cerebral oxygen delivery
-Pulmonary function, decreased postoperative ventilation
-Decreased postoperative bleeding, chest-tube drainage, pleural effusions
They equal short hospital stays

Congenital Defects (exam 1) (4 decks)

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