Description
Cardiopulmonary bypass (CPB) is a vital technology used during cardiac surgery to temporarily take over the functions of the heart and lungs. In the digital age, CPB has been enhanced by the integration of advanced technologies, improving patient safety and surgical outcomes.
CPB machines now incorporate digital interfaces that allow precise monitoring and control of various parameters during bypass procedures. The digital age has seen the development of miniaturized CPB circuits, reducing the priming volume and enhancing biocompatibility.
Digital sensors embedded in CPB circuits provide real-time feedback on oxygenation, temperature, pressure, and flow, allowing for immediate adjustments. Advanced data analytics in CPB systems help identify trends and patterns, aiding in the early detection of complications.
The digital age has brought about the use of artificial intelligence algorithms to optimize CPB management, predicting patient responses and optimizing perfusion strategies.
Summary Listen
- Cardiopulmonary bypass (CPB) is a technique used to temporarily take over the function of the heart and lungs during cardiac surgery. This allows surgeons to operate on a still and bloodless heart, especially crucial in pediatric cases. Dr. Clarence Dennis performed the first experimental CPB operation in 1951, while Dr. John Gibbon completed the first successful human procedure in 1953. Dr. Walton-Dillay pioneered controlled cross-circulation, connecting a parent to a child to act as a temporary heart-lung machine.
- CPB involves diverting blood from the heart, circulating it through a machine that oxygenates and filters it, and then returning it to the body. The machine consists of a pump, an oxygenator, circuits, and a prime solution. Hemodilution, anticoagulation, and hypothermia are key physiological considerations during CPB. The goal is to oxygenate blood, remove carbon dioxide, maintain circulation, cool the patient, rewarm the patient, and provide a bloodless surgical field.
- The CPB circuit includes a venous reservoir, arterial pump, heat exchanger, oxygenator, filter, and cardioplegia delivery system. Two main types of pumps exist: roller pumps and centrifugal pumps, with the latter being less traumatic to blood cells. The heat exchanger regulates the blood temperature, while the oxygenator performs gas exchange. An arterial line filter removes debris before the blood returns to the patient.
- Before CPB, the patient is anticoagulated with heparin, cannulated, and monitored closely. During CPB, the perfusionist manages perfusion pressure, pump flows, and temperature, with continuous monitoring of blood gases and central nervous system function. The process involves circuit selection, priming, anticoagulation, cannulation, initiating bypass, myocardial protection, weaning off bypass, and terminating bypass.
- Crystalloid or colloid solutions are used for priming. Heparin is used for anticoagulation, monitored via ACT (activated clotting time) and reversed with protamine after surgery. Cannulation can be arterial, venous, or for cardioplegia, typically involving the aorta and right atrium. Cardioplegia, a potassium-rich solution, is delivered to arrest the heart in diastole and protect the myocardium.
- Hypothermia is intentionally induced to reduce metabolic demand. Different cannulation sites are chosen based on the specific surgical needs. Potential adverse effects of CPB include end-organ damage, dependent on duration of bypass and patient age. Continuous monitoring of blood gases, urine output, electrolytes, ACT, reservoir level, and blood flow is essential to maintain physiological parameters during CPB.
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About the Speakers
Dr. Prabhatha Rashmi
Alumni- Narayana Hrudayalaya Sr. consultant & HOD of Pediatric Cardiac Surgery, Sri Satya sai Sanjeevani Hospitals
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