Abstract
Cardiac surgery is uniquely complex, as it requires a significant amount of artificial support, because the heart is exposed to extreme manipulation and incisions. Most cardiac operations use an extra-corporeal device, called the heart-lung machine, to provide cardiopulmonary bypass (CPB).
The main task of the heart-lung machine, which we refer to as the CPB machine throughout this chapter, is to siphon all the patient’s anticoagulated, deoxygenated venous blood into a reservoir. The blood then is pressurized by the main pump to pass through the artificial lung or oxygenator, where it is oxygenated, and CO2 is removed. Next, the blood is passed through a heat exchanger, which cools the blood to hypothermic temperature (32-34ο C) for bypass or warms the blood to normal body temperature prior to separation from CPB. Blood is then returned to the aorta, completely bypassing the heart and lungs. The perfusionist delivers a cardioplegia solution via an accessory pump to induce electromechanical cardiac arrest; with the heart in arrest, the surgeon can operate on a nonfunctioning, decompressed heart. The CPB machine has other, separate accessory pumps. One is connected to a ventricular drain (if needed), called “vent,” which empties the heart during bypass. Another is linked to a pump sucker to clear the surgical field of blood. The CPB machine monitors and regulates gas exchange, cardiac output, and blood temperature, and delivers medications and blood products. Filters are incorporated in the circuit to remove air and microemboli from the circulating blood. During CPB, the perfusionist is responsible for maintaining the patient’s systemic perfusion, oxygenation, and hemodynamic stability and protecting the myocardium.
Anesthesia providers who use CPB machines must be fully knowledgeable in their components, circuits, and operation. This chapter reviews the fundamentals of the CPB machine, equipment, and technique of conduct.
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Further Reading
Kyriakos Anastasiadis. Principles of miniaturized ExtraCorporeal circulation from science and technology to clinical practice. 2013.
Gravlee GP. Cardiopulmonary bypass and mechanical support: principles and practice fourth edition. 2016.
Ghosh S. Cardiopulmonary bypass. 2nd ed; 2016.
Hessel EA II. What’s new in cardiopulmonary bypass. J Cardiothoracic Vascul Anesthes. 2019.
Iaizzo PA. Handbook of cardiac anatomy, physiology, and devices. 2015.
Mongero LB. On bypass: advanced perfusion techniques. 2010.
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The Heart lung machine. This video provides a general overview of the cardio-pulmonary bypass machine. It also complements the chapter “FUNDAMENTALS OF CARDIOPULMONARY BYPASS MACHINE EQUIPMENT AND TECHNIQUE” by Michael Hancock, Certified Cardiovascular Perfusionist (CCP), and Enrique Pantin, M.D. This chapter is part of the book titled “Cardiac Anesthesia-The Basic Evaluation and Management”, Springer Publisher, Inc., 2019, edited by Dr. Ahmed Awad. (MP4 37153 kb)
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Hancock, M., Pantin, E.J. (2021). Fundamentals of Cardiopulmonary Bypass Machine Equipment and Technique. In: Awad, MD, MBA, A.S. (eds) Cardiac Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-030-51755-7_13
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DOI: https://doi.org/10.1007/978-3-030-51755-7_13
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