Cardiopulmonary bypass

Canine Model of Cardiopulmonary Bypass

1. Canine Model of Cardiopulmonary Bypass Surgery

2. Canine Model of Cardiopulmonary Bypass Surgery Presented By- Dr. Md Mossabbir Hossain Department of Surgery and Obstetrics Bangladesh Agricultural University, Mymensingh

3. Introduction History Importance Principle CPB Team Physiology Steps Patients Monitors Systemic Complications What will We Talk

4. Definition: CPB is a technique that temporarily diverting blood from heart and lungs and provides oxygenation and pump functions in the presence of a still bloodless heart. Uses: CPB is used in heart surgery requiring arrested heart either with or without opening of cardiac chambers to support the circulation during that period. Cardiopulmonary Bypass (CPB)

5. Dr.Gibbons , inventor of the Heart & Lung machine Also known as, cardio-pulmonary bypass machine (CPB ) . 1935 –maintained a cat’s circulation on CPB while closing the pulmonary artery . 1953 –Cecelia Bavolek First patient to undergo open heart surgery using CPB to repair an atrial septal defect History of CPB

6. History of CPB More than 40 years of Innovation, Research, and Hard Work

7. Why CPB To facilitate a surgical intervention Provide a motionless field Provide a bloodless field

8. Coronary Artery Disease (CAD) Valve Disease Congenital Heart Defects Dissections Transplants :- Heart, liver, lung, trachea Others: limb cancer, hypothermic rescue In Which Cases

9. Deoxygenated blood (Venous Return) taken away from the body to the CPB machine . Then pumped and oxygenated to returned back to the body (Arterial system) Principle of CPB

10. Venous and arterial cannulas Venous Reservoir Centrifugal pump Oxygenator, heat exchanger , venous reservoir Microfilter bubble trap on the arterial side Suction system for cardiotomy reservoir and filter returns to venous reservoir Field blood washed in a cell saver system returned as packed RBCs . Partial and occluding clamps to direct and regulate flow Various ports in the system to obtain blood samples . Cardioplegic system, LV Vent. Components of CPB

11. Surgeon: Determines the planned operation, target perfusion temperatures, methods of cardioplegia , cannulations . Perfusionist : Setting up and priming the CPB machine, safety checks, monitoring anticoagulation, adding prescribed drugs, maintaining records . Anesthetist : “ Troubleshooter” of complex procedures The CPB Team Role

12. Hemodilution Anticoagulation Hypothermia . Flow rate & Blood Pressure . Blood gas control CPB Physiology

13. Mainly there are Seven steps of CPB Steps for CPB

14. Heparin Step 1 for CPB

15. Exposure of the heart & Check Aorta. Pericardial cradle/sutures. Step 2 for CPB

16. Step 3 for CPB Check ACT Aortic Cannulation Remove arterial clamp.

17. Atrial (venous) Cannulation Remove venous clamp Command “On bypass” Turn lungs ventilation off. Step 4 for CPB

18. Place cardioplegia cannula Reduce pump flow/Clamp aorta . Resume full flow/check line pressure . Start cardioplegia . Step 5 for CPB

19. Release cross-clamp after warm cardioplegia . Remove all air from heart . Begin respirations (start lungs ) Check Good contractility & Stable heart rhythm . No bleeding . Desired patient temp. Step 6 for CPB

20. Wean slowly from CPB. Begin Protamine assessing BP, CVP . When stable: Clamp venous line and remove. Remove vent/ cardioplegia . Be alert for hemodynamic reactions . Remove arterial cannula after all protamine in . Keep lines clamped and ready for any emergency. Step 7 for CPB

21. Radial/brachial/femoral arterial catheter . CVP via jugular venous catheter . Urine output . Temperature – Nasopharyngeal or tympanic membrane temp used more commonly . Arterial line temp. correlates best with jugular venous bulb temp Patient Monitors

22. Cardiac Post-op cardiac dysfunction Subject to emboli, cytotoxins Myocardial “stunning ”reperfusion injury. Lung Pulmonary edema (complement activation ) CPB reduces effect of natural surfactant . ARDS Kidney Hemodilution , microemboli , catecholamines , diuretics, hypothermia, aprotinin all impair renal function . Systemic Complications

23. GI Peptic ulcers (surgical stress). Pancreatitis and mild jaundice. Gastroenteritis (increase inflammatory response ). Brain Most sensitive organ exposed to injury by CPB. Difficult to assess with difficult outcomes as stroke, delirium & coma Risk increases with age (> 60)M Protection strategies Mild hypothermia, cerebral perfusion, off-pump . Systemic Complications

24. Any Questions or Comments???