Conduct of Cardiopulmonary Bypass

  • Bradley J. Harlan
  • Albert Starr
  • Fredic M. Harwin
  • Alain Carpentier


The first successful use of mechanically supported circulation and respiration during open cardiac surgery, by Gibbon18 in 1953, opened the door for the explosive growth in heart surgery that has occurred during the past four decades. Equipment and techniques for cardiopulmonary bypass are exceptionally safe, and now there is almost no risk associated with properly performed cardiopulmonary bypass.


Cardiopulmonary Bypass Circulatory Arrest Blood Conservation Profound Hypothermia Hypothermic Cardiopulmonary Bypass 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Aren C: Heparin and protamine during cardiac surgery. Perfusion 4:171,1989.CrossRefGoogle Scholar
  2. 2.
    Austin JW, Harner DL: The Heart-Lung Machine and Related Technologies of Open Heart Surgery. Phoenix Medical Communication, 1990.Google Scholar
  3. 3.
    Barratt-Boyes BG, Neutze JM, Clarkson PM, Shardey GC, Brandt PWT: Repair of ventricular septal defect in the first two years of life using profound hypothermiacirculatory arrest techniques. Ann Surg 184:376,1976.PubMedCrossRefGoogle Scholar
  4. 4.
    Barratt-Boyes BG, Simpson M, Neutze JM: Intracardiac surgery in neonates and infants using deep hypothermia with surface cooling and limited cardiopulmonary bypass. Circulation 43(Suppl I):I–25,1971.Google Scholar
  5. 5.
    Bashein G, Townes BD, Nessly ML, Bledsoe SW, Hornbein TF, Davis KB, Goldstein DE, Coppel DB: A randomized study of carbon dioxide management during hypothermic cardiopulmonary bypass. Anesthesiology 72:7,1990.PubMedCrossRefGoogle Scholar
  6. 6.
    Bixler TJ, Flaherty JT, Gardner TJ, Bulkley BH, Schaff HV, Gott VL: Effects of calcium administration during post-ischemic reperfusion on myocardial contractility, stiffness, edema, and ultrastructure. Circulation 58(Suppl I): I–184,1978.Google Scholar
  7. 7.
    Brenner WI, Wallsh E, Spencer FC: Efficiency of aortic vents in the prevention of air embolism. Surg Forum 21:139,1970.PubMedGoogle Scholar
  8. 8.
    Brunberg J, Doty D, Reilly E: Choreoathetosis in infants following cardiac surgery with deep hypothermia and circulatory arrest. J Pediatrics 84:232,1974.CrossRefGoogle Scholar
  9. 9.
    Brusino FG, Reves JG, Smith LR, Prough DS, Stump DA, Mclntyre RW: The effect of age on cerebral blood flow during hypothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 97:541,1989.PubMedGoogle Scholar
  10. 10.
    Castaneda AR, Lamberti J, Sade RM, Williams RG, Nadas AS: Open-heart surgery during the first three months of life. J Thorac Cardiovasc Surg 68:719,1974.PubMedGoogle Scholar
  11. 11.
    Cohn LH, Fosberg AM, Anderson WP, Collins JJ: The effects of phlebotomy, hemodilution, and autologous transfusion on systemic oxygenation and whole blood utilization in open-heart surgery. Chest 68:283,1975.PubMedCrossRefGoogle Scholar
  12. 12.
    Cooley DA, Crawford ES, Howell JF, Beall AC: Open heart surgery in Jehovah’s Witnesses. Am J Cardiol 13:779,1964.PubMedCrossRefGoogle Scholar
  13. 13.
    Cosgrove DM, Thurer RL, Lytle BW, Gill CG, Peter M, Loop FD: Blood conservation during myocardial revascularization. Ann Thorac Surg 28:184,1979.PubMedCrossRefGoogle Scholar
  14. 14.
    DelRossi AJ, Cernaianu AC, Vertees RA, et al: Platelet-rich plasma reduces postoperative blood loss after cardiopulmonary bypass. J Thorac Cardiovasc Surg 100: 281,1990.PubMedGoogle Scholar
  15. 15.
    Ehyai A, Fenchel G, Bender H Jr: Incidence and prognosis of seizures in infants after cardiac surgery with profound hypothermia and circulatory arrest. JAMA 252:3165,1984.PubMedCrossRefGoogle Scholar
  16. 16.
    Esposito RA, Culliford AT, Colvin SB, Thomas SJ, Lackner H, Spencer FC: The role of the activated clotting time in heparin administration and neutralization for cardiopulmonary bypass. J Thorac Cardiovasc Surg 85:174,1983.PubMedGoogle Scholar
  17. 17.
    Fox LS, Blackstone EH, Kirklin JW, Bishop SP, Bergdahl LAL, Bradley EL: Relationship of brain blood flow and oxygen consumption to perfusion flow rate during profoundly hypothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 87:658,1984.PubMedGoogle Scholar
  18. 18.
    Gibbon JH Jr: Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 37:171,1954.PubMedGoogle Scholar
  19. 19.
    Giordano GF, Rivers SL, Chung GKT, et al: Autologous platelet-rich plasma in cardiac surgery: effect on intraoperative and postoperative transfusion requirements. Ann Thorac Surg 46:416,1988.PubMedCrossRefGoogle Scholar
  20. 20.
    Gourin A, Streisand RL, Greinder JK, Stuckey JH: Protamine sulfate administration and the cardiovascular system. J Thorac Cardiovasc Surg 62:193,1971.PubMedGoogle Scholar
  21. 21.
    Heimbecker R, Robert A, McKenzie FN: The extracorporeal pump filter-saint or sinner? Ann Thorac Surg 21:55,1976.PubMedCrossRefGoogle Scholar
  22. 22.
    Hickey RF, Hoar PR: Whole body oxygen consumption during low-flow hypothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 86:903,1983.PubMedGoogle Scholar
  23. 23.
    Hikasa Y, Shirotani H, Satomura K, Muraoka R, Abe K, Tsushimi K, Yokota Y, Miki S, Kawai J, Mori A, Okamoto Y, Koie H, Ban T, Kanzaki Y, Yokoto M, Mori C, Kamiya T, Tamura T, Mishii A, Asawa Y: Open heart surgery in infants with an aid of hypothermic anesthesia. Arch Jpn Chir 36:495,1967.Google Scholar
  24. 24.
    Hofer BO, Vocelka CR, Gilles B, Tobe C, Sepulvada R, Verrier ED: Does autologous platelet rich plasma infusion reduce blood loss and product utilization after coronary artery surgery? A prospective, randomized, blinded study. J Thorac Cardiovasc Surg 105:1007,1993.PubMedGoogle Scholar
  25. 25.
    Horrow JC: Protamine: a review of its toxicity. Anesth Analg 64:348,1985.PubMedCrossRefGoogle Scholar
  26. 26.
    Johnsson P, Algotsson L, Ryding E, Stahl E, Messeter K: Cardiopulmonary perfusion and cerebral blood flow in bilateral carotid artery disease. Ann Thorac Surg 51:579,1991.PubMedCrossRefGoogle Scholar
  27. 27.
    Jones JW, McCoy TA, Rawitscher RE, Lindsley DA: Effects of intraoperative plasmapheresis on blood loss in cardiac surgery. Ann Thorac Surg 49:585,1990.PubMedCrossRefGoogle Scholar
  28. 28.
    Kaplan JA, Cannarella C, Jones EL, Kutner MH, Hatcher CR, Dunbar RW: Autologous blood transfusion during cardiac surgery: a re-evaluation of three methods. J Thorac Cardiovasc Surg 74:4,1977.PubMedGoogle Scholar
  29. 29.
    Moran JM, Babka R, Silberman S, Rice PL, Pifarre R, Sullivan HJ, Montoya A: Immediate centrifugation of oxygenator contents after cardiopulmonary bypass: role in maximum blood conservation. J Thorac Cardiovasc Surg 76:510,1978.PubMedGoogle Scholar
  30. 30.
    Murkin JM, Farrar JK, Tweed WA, McKenzie FN, Guiraudon G: Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of pCO2. Anesth Analg 66:825,1987.PubMedGoogle Scholar
  31. 31.
    Murkin JM. Con: blood gases should not be corrected for temperature during hypothermic cardiopulmonary bypass: alpha-stat mode. J Cardiothorac Anesth 2: 705,1988.PubMedCrossRefGoogle Scholar
  32. 32.
    Okies JE, Goodnight SH, Litchford B, Connell RS, Starr A: Effects of infusion of cardiotomy suction blood during extracorporeal circulation for coronary artery bypass surgery. J Thorac Cardiovasc Surg 74:440,1977.PubMedGoogle Scholar
  33. 33.
    Page US, Bigelow JC, Carter CR, Swank RL: Emboli (debris) produced by bubble oxygenators: removal by filtration. Ann Thorac Surg 18:164,1974.PubMedCrossRefGoogle Scholar
  34. 34.
    Patel RL, Turtle MRJ, Chambers DJ, Venn GE: Effect of differing acid-base regulation on cerebral blood flow autoregulation during cardiopulmonary bypass. Eur J Cardio-thorac Surg 6:302,1992.CrossRefGoogle Scholar
  35. 35.
    Pliam MB, McGoon DC, Tarhan S: Failure of transfusion of autologous whole blood to reduce banked blood requirements in open-heart surgical patients. J Thorac Cardiovasc Surg 70:338,1975.PubMedGoogle Scholar
  36. 36.
    Prough DS, Rogers AT, Stump DA, Mills SA, Gravlef GP, Taylor C: Hypercarbia depresses cerebral oxygen consumption during cardiopulmonary bypass. Stroke 21:1162,1990.PubMedCrossRefGoogle Scholar
  37. 37.
    Prough DS, Stump DA, Troost BT: PaCO2 management during cardiopulmonary bypass: intriguing physiologic rationale, convincing clinical data, evolving hypothesis? Anesthesiology 72:3,1990.PubMedCrossRefGoogle Scholar
  38. 38.
    Rahn H, Reeves RB, Howell BJ: Hydrogen ion regulation, temperature, and evolution. Am Rev Respir Dis 112:165,1975.PubMedGoogle Scholar
  39. 39.
    Rahn H: Body temperature and acid-base regulation (review article). Pneumonologie 151:87,1974.PubMedCrossRefGoogle Scholar
  40. 40.
    Reed CC, Kurusz M, Lawrence AE Jr: Safety and Techniques in Perfusion. Stafford, Texas, Quali-Med Inc., 1988.Google Scholar
  41. 41.
    Reeves RB: An imidazole alphastat hypothesis for vertebrate acid-base regulation: tissue carbon dioxide content and body temperature in bullfrogs. Respir Physiol 14:219,1972.PubMedCrossRefGoogle Scholar
  42. 42.
    Reeves RB: The interaction of body temperature and acid-base balance in ectothermic vertebrates. Annu Rev Physiol 39:559,1977.PubMedCrossRefGoogle Scholar
  43. 43.
    Schaff HV, Hauer JM, Bell WR, Gardner TJ, Donahoo JS, Gott VL, Brawley RK: Autotransfusion of shed mediastinal blood after cardiac surgery. J Thorac Cardiovasc Surg 75:632,1978.PubMedGoogle Scholar
  44. 44.
    Severinghaus JW: Blood gas calculation. J Appl Physiol 21:1108,1966.PubMedGoogle Scholar
  45. 45.
    Soma Y, Hirotani T, Yozu R, Onoguchi K, Misumi T, Kawada K, Inoue T: A clinical study of cerebral circulation during extracorporeal circulation. J Thorac Cardiovasc Surg 97:187,1989.PubMedGoogle Scholar
  46. 46.
    Starr A: Oxygen consumption during cardiopulmonary bypass. J Thorac Cardiovasc Surg 38:46,1959.PubMedGoogle Scholar
  47. 47.
    Stephan H, Weyland A, Kazmaier S, Henze T, Menck S, Sonntag H: Acid-base management during hypothermic cardiopulmonary bypass does not affect cerebral metabolism but does affect blood flow and neurological outcome. Br J Anaesth 69:51,1992.PubMedCrossRefGoogle Scholar
  48. 48.
    Swain JA, McDonald TJ, Griffith PK, Balaban RS, Clark RE, Ceckler T: Low-flow hypothermic cardiopulmonary bypass protects the brain. J Thorac Cardiovasc Surg 102:76,1991.PubMedGoogle Scholar
  49. 49.
    Swan H, Sanchez M, Tyndall M, Koch C: Quality of control of perfusion: monitoring venous blood oxygen tension to prevent hypoxic acidosis. J Thorac Cardiovasc Surg 99:868,1990.PubMedGoogle Scholar
  50. 50.
    Tacker WA Jr, Guinn GA, Geddes LA, Bourland JD, Korompai FL, Rubio PA: The electrical dose for direct ventricular defibrillation in man. J Thorac Cardiovasc Surg 75:224,1978.PubMedGoogle Scholar
  51. 51.
    Taylor KM: Cardiopulmonary Bypass. Baltimore, Chapman and Hall Ltd., 1990.Google Scholar
  52. 52.
    Tinker JH: Cardiopulmonary Bypass: Current Concepts and Controversies. Philadelphia, WB Saunders Co, 1989.Google Scholar
  53. 53.
    Tinker JH, Campos JH: Pro: blood gases should be corrected for temperature during cardiopulmonary bypass: pH-stat mode. J Cardiothorac Anesth 2:701,1988.PubMedCrossRefGoogle Scholar
  54. 54.
    Tinker JH, Roberts SL: Management of cardiopulmonary bypass. In Kaplan JA (ed): Cardiac Anesthesia, 2nd ed. Philadelphia, Grune & Stratton, 1987, pp 895–926.Google Scholar
  55. 55.
    Treasure T, Naftel D, Conger K, Garcia JH, Kirklin JW, Blackstone EH: The effect of hypothermic circulatory arrest time on cerebral function, morphology, and biochemistry. J Thorac Cardiovasc Surg 86:761,1983.PubMedGoogle Scholar
  56. 56.
    Venugopal P, Olszowka J, Wagner H, Vlad P, Lambert E, Subramanian S: Early correction of congenital disease with surface-induced deep hypothermia and circulatory arrest. J Thorac Cardiovasc Surg 66:375,1973.PubMedGoogle Scholar
  57. 57.
    Weiler JM, Freiman P, Sharath MD, Metzger WJ, Smith JM, Richerson HB, Ballas ZK, Halverson PC, Shulan DJ, Matsuo S, Wilson RL: Serious adverse reactions to protamine sulfate: are alternatives needed? J Allergy Clin Immunol 75:297,1985.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 1995

Authors and Affiliations

  • Bradley J. Harlan
    • 1
    • 2
    • 3
  • Albert Starr
    • 3
    • 4
    • 5
  • Fredic M. Harwin
    • 6
  • Alain Carpentier
    • 7
  1. 1.Section of Thoracic and Cardiovascular SurgerySutter Memorial HospitalSacramentoUSA
  2. 2.Davis Medical SchoolUniversity of CaliforniaSacramentoUSA
  3. 3.Oregon Health Sciences UniversityPortlandUSA
  4. 4.Heart Institute at St. Vincent HospitalPortlandUSA
  5. 5.Starr-Wood Cardiac Group, P.C.PortlandUSA
  6. 6.Harwin StudiosPortlandUSA
  7. 7.Hôpital BroussaisUniversity of ParisParisFrance

Personalised recommendations