Cardiopulmonary Bypass

 

Description:

The third edition of Cardiopulmonary Bypass offers a comprehensive, and up-to-date reference text to extracorporeal cardiopulmonary support. This book provides a clinically-focused tutorial with chapters spanning the technical aspects, patient related considerations, and human factors essential to contemporary practice of cardiopulmonary bypass. Written concisely to allow the reader to gain and apply critical knowledge to the clinical setting and featuring artwork that has been extensively updated to include numerous figures and color plates imbedded into each chapter. A remarkable collection of international experts in the fields of perfusion, anesthesiology, and cardiac surgery were recruited to co-author chapters, providing a multidisciplinary approach to case management. This completely updated edition includes expanded content on developments in minimally invasive extracorporeal circulation, anticoagulation, organ injury, and human factors. The comprehensive coverage of perfusion practice in a concise, highly illustrated format makes it the go-to, portable reference manual for perfusionists, cardiac surgeons, and anesthesiologists.

 

Table of Contents:

 

Chapter 1 Human Factors and Teamwork in Cardiac Surgery

Error

The Human Factors Perspective

Teamwork

Leadership

Repair, Recovery and Resilience

Practical Solutions

Standardized Conversations

Briefing and Debriefing

Creating the Team

Non-Technical Skill Assessment Tools

Suggested Further Reading

Chapter 2 Equipment for Cardiopulmonary Bypass

History

Tubing

Arterial Cannulae

Venous Cannulae

Perfusion Pumps

Roller Pumps

Centrifugal Pumps

Reservoirs

Oxygenators

Gas Supply System

Filters and Bubble Traps

Suckers and Vents

Cardioplegia Delivery Systems

Hemofilters

Miniaturized Extracorporeal Circulation (MiECC)

Suggested Further Reading

Chapter 3 Monitoring during Cardiopulmonary Bypass

Heart Lung Machine

Blood and Gas Flow

Temperature

Pressure

Low Level and Air Bubble Detection

Calibration of Heart Lung Machine Monitoring Systems

Gas Exchange

In-line Blood Gas Analysis, Venous Saturation and Hematocrit Monitors

Cerebral Oxygen Saturation

Oxygen Delivery and Carbon Dioxide Extraction

Anticoagulation Monitoring

Hemodynamic Monitoring

Documentation of Intraoperative Monitoring Data: The Cardiopulmonary Bypass Record

Application of Electronic Perfusion Data

Registry

Suggested Further Reading

Chapter 4 Cardiopulmonary Bypass Circuit Setup and Safety Checks

Introduction

CPB Machine Preparation and Setup

CPB Components

CPB Setup

CPB Priming

Human Factors

The Pre-CPB Checklist

Safety Concerns prior to Commencing CPB

Minimal Extracorporeal Circulation Safety Features

Suggested Further Reading

Chapter 5 Priming Solutions for Cardiopulmonary Bypass Circuits

Hemodilution

Blood Flow

Clotting Factors

Drug Bioavailability

Controlling Hemodilution

Priming Solutions

Crystalloid Solutions

Colloid Solutions

Electrolyte Management

Sodium

Potassium

Calcium

Magnesium

Osmolarity and pH

Glucose

Prime Additives

Sodium Bicarbonate (NaHCO3)

Mannitol

Heparin

Corticosteroids

Suggested Further Reading

Chapter 6 Anticoagulation for Cardiopulmonary Bypass

Heparin

Pharmacology

Heparin Monitoring

Initiation of CPB

Maintenance of Heparin Effect

Heparin Resistance

Heparin Neutralization

Heparin Induced Thrombocytopenia

Alternative Anticoagulants and Other Techniques in HIT

The Future of Anticoagulation for CPB

Suggested Further Reading

Chapter 7 Conduct of Cardiopulmonary Bypass

Arterial Cannulation

Connecting the Patient

Complications of Aortic Root Cannulation

Peripheral Arterial Cannulation

Venous Cannulation

Connection to the Patient

Peripheral Venous Cannulation

General Sequence of Events for the Conduct of CPB

Connecting the Patient to the CPB Circuit

Initiating CPB

The Rewarming Phase

Monitoring during CPB

Pressure Management

Maintaining a Bloodless Surgical Field

Cardiotomy Suction

Adverse Effects of Cardiotomy Suction

Keeping the Heart Relaxed

Detection of LV Distension

Venting the Heart

Suggested Further Reading

Chapter 8 Minimal Invasive Extracorporeal Circulation

The Evolution of Minimal Invasive Extracorporeal Circulation

Classification of MiECC systems

The Team Approach to MiECC

Surgeon's perspective

Anesthesiologist's perspective

Perfusionist's perspective

Advantages of a Modular Design

Training

The Quest for ''Physiologic'' Perfusion

Evidenced-Based Clinical Advantages of MiECC

Incorporating the Lessons Learned from MiECC into Practice

Suggested Further Reading

Chapter 9 Considerations for Operations Involving Deep Hypothermic Circulatory Arrest

Indications

Pathophysiology

Preoperative Considerations

Preoperative Assessment

Monitoring Considerations

Surgical Considerations

Arterial Cannulation

Venous Cannulation

Descending Thoracic Aortic Surgery

Perfusion Considerations

Extracorporeal Circulation

Hemodilution

Temperature Management

Acid-Base Management

Glucose Management

Blood Conservation

Neuroprotection during DHCA

Hypothermia Alone

Pharmacological Neuroprotection

Cerebral Perfusion Strategies

Intermittent Cerebral Perfusion

Selective Antegrade Cerebral Perfusion (SACP)

Retrograde Cerebral Perfusion (RCP)

Neurologic Monitoring

Spinal Cord Protection

Cerebrospinal Fluid Drainage

Neurophysiologic Monitoring

Pulmonary (Thrombo)endarterectomy (PTE)

Suggested Further Reading

Chapter 10 Metabolic Management during Cardiopulmonary Bypass

Cardiopulmonary Bypass and the Challenges of Metabolic Management

Effective Bypass and Circuit Design

Metabolic Markers during CPB

CPB Blood Flow

Mean Arterial Pressure (MAP) during CPB

Blood Gas Parameters

Continuous In-line Blood Gas Monitoring

Acid-Base Balance

Hematocrit on CPB

Mixed Venous Oxygen Saturation (SVO2)

Urine Output

Blood Lactate

Goal-Directed Perfusion Parameters in Metabolic Monitoring during CPB

Oxygen Delivery

CO2-derived Parameters

O2 and CO2 Ratios in Metabolic Monitoring during CPB

Electrolytes

Potassium

Magnesium

Calcium

Phosphate

Chloride

Glucose

Drug Metabolism

Temperature Management

Hypothermic Bypass ABG Management: Alpha versus pH Stat

Rewarming from Hypothermic Bypass

Suggested Further Reading

Chapter 11 Myocardial Preservation during Cardiopulmonary Bypass

History of Myocardial Protection

Ischemia/Reperfusion Injury and Key Intracellular Modulators of Cell Survival

Myocardial Ischemia

Ischemia/Reperfusion

Mitochondrial Based Protection

Cardioplegia Techniques

Physiology of Cardioplegia

Cardioplegia Solutions

Additives

Delivery of Cardioplegia

Antegrade Delivery

Retrograde Delivery

Delivery through Vein Grafts

Cardioplegia Techniques for Minimal Access Surgery

Temperature Management and Cardioplegia

Non-Cardioplegic Methods of Myocardial Protection

Intermittent Cross Clamping/Fibrillation

Off Pump Surgery (OPCABG)

Ischemic Preconditioning

Remote Ischemic Preconditioning

Sodium Hydrogen Exchanger Isoform-1 (NHE-1)

Cyclosporine

Volatile Anesthetic Agents

Suggested Further Reading

Chapter 12 Weaning from Cardiopulmonary Bypass

Communication and Teamwork

Weaning Checklist

Temperature

De-airing

Reperfusion

Rate/Rhythm/Contractility

Pacing

Inotropes

Anesthesia

Alarms

Ventilation

Electrolytes and Acid-Base

Levels

Predicting Difficulty

Mechanics of Separation from CPB

Assessment of Cardiac Function and Inotropic Support

Assessment of Afterload

TEE in Weaning from CPB

Reversal of Anticoagulation

Residual Blood Management

Failure to Wean from CPB

Reinstitution of CPB

Pharmacological Choices in Weaning from CPB

Pharmacological Side Effects

Mechanical Support in Weaning from CPB

Suggested Further Reading

Chapter 13 Intraoperative Mechanical Circulatory Support and Other Uses of Cardiopulmonary Bypass

Historical Perspective of MCS in Cardiac and Respiratory Failure

MCS Equipment Selection

Thoracic Surgeries

Anterior Mediastinal Masses and Difficult Airways

Thoracic and Abdominal Tumor Surgery

Thoracic Aortic Surgery

Left Heart Bypass

Partial or Complete Cardiopulmonary Bypass

Selective Spinal and Reno-visceral Perfusion

Circulatory Support during Donor Organ Procurement

Organ Donation for Heart Transplantation

Organ Donation for Lung Transplantation

Circulatory Support during Organ Implant

Heart and Heart-Lung Transplantation

Lung Transplantation

Liver Transplantation

Emergent or Bail-out Applications of MCS

Perioperative

Outside the Operating Room

Organ Support during ECLS

Suggested Further Reading

Chapter 14 Mechanical Circulatory Support

Intra-aortic Balloon Pump

Management of the Patient with IABP

Complications of IABP Use

Extracorporeal Membrane Oxygenation (ECMO)

Circuit Design

Indications

Contraindications

Complications

Clinical Outcomes

Managing Patients on VA-ECMO

Weaning VA-ECMO

Ventricular Assist Devices

Indications for VAD

The VAD Decision-Making Process

Types of Ventricular Assist Devices

Percutaneous Temporary Ventricular Assist Devices

Central Ventricular Assist Devices

VAD Patient Management

Perioperative Management

Postoperative Management

Complications

Suggested Further Reading

Chapter 15 Cardiopulmonary Bypass for Pediatric Cardiac Surgery

Major Differences between the Pediatric and Adult Cardiac Patients

Specific Pathophysiology That Affects Cardiopulmonary Bypass

Myocardial Protection in the Immature Myocardium

Deep Hypothermia Circulatory Arrest and Regional Cerebral Perfusion

Conduct of Cardiopulmonary Bypass

Cannulation

Anticoagulation Management

Flow Rates and Oxygen Delivery

Monitoring

Blood Gas Management

Termination of CPB

Pathophysiology of Cardiopulmonary Bypass

Hemodilution and Low Prime Circuits

Retrograde Autologous Prime

Conventional and Modified Ultrafiltration

Suggested Further Reading

Chapter 16 Coagulopathy and Hematological Disorders Associated with Cardiopulmonary Bypass

Pathophysiology of Coagulopathy After Cardiopulmonary Bypass

Role of Preoperative Medication in Coagulopathy

Genetic Factors

Anti-platelet Agents

Vitamin K Antagonists

Novel Oral Anticoagulants

Assessment of Coagulopathy

Therapeutic Interventions and Management of Bleeding Patients

Blood Conservation Techniques

Antifibrinolytic Agents

Avoiding Hemodilution

Special Conditions

Jehovah's Witnesses

Sickle Cell Anemia

Cold Agglutinins

Suggested Further Reading

Chapter 17 Inflammation and Organ Damage during Cardiopulmonary Bypass

Systemic Inflammatory Response

From Teflon to Velcro: How Endothelial Lining Links the Systemic Inflammatory Response to Organ Inju

Dysfunction of Specific Organ Systems

Gastrointestinal Dysfunction

Pathogenesis of GI Complications

Specific GI Complications

Pulmonary Dysfunction

Myocardial Dysfunction

Therapeutic Strategies for Attenuating the Systemic Inflammatory Response

How to Measure Anti-inflammatory Interventions?

Anti-inflammatory Interventions

Pharmacological Strategies

Perfusion Strategies

Suggested Further Reading

Chapter 18 Neuromonitoring and Cerebral Morbidity Associated with Cardiopulmonary Bypass

Risk Factors

Blood Pressure Control

Blood Pressure Control and Stroke

Blood Pressure Control and Delirium

Cerebral Blood Flow

Cerebral Oxygen Saturation

Pharmacologic Options for Neuroprotection

Temperature Management and Cerebral Morbidity

Epiaortic Ultrasound Scanning of the Ascending Aorta

Suggested Further Reading

Chapter 19 Renal Morbidity Associated with Cardiopulmonary Bypass

Definitions

Epidemiology and Outcomes Associated with AKI

Pathophysiology

Risk Factors

Patient-Related Factors

Procedure-Related Factors

Perfusion-Related Risk Factors

Blood Flow and Oxygen Delivery to the Kidneys

Prevention of AKI

Non-pharmacological Interventions

Pharmacological Interventions

Management of Patients with Chronic Kidney Disease

RRT-dependent Patients

Patients with Non-RRT-dependent CKD

Suggested Further Reading

Chapter 20 Common and Uncommon Disasters during Cardiopulmonary Bypass

Incident Reporting and Safety Culture

Common and Uncommon Disasters

Oxygenator Failures

Blood Path Obstruction

Falling Cerebral Saturation

Equipment Failure

Circuit Disruption

Air in Circuit

Electrical Failure

Heater Cooler Failure

Clinical Events

Drug and Medication Error

Heparin Resistance

Cold Agglutination

Malignant Hyperthermia

Vasoplegic Shock

Aortic Dissection

Over-pressurization during Cardioplegia

Inadvertent Cannulation of Hepatic Vein during Bi-caval Venous Cannulation

Suggested Further Reading

Index

 

An aparitie	10 Nov. 2022
Autor	Florian Falter, Albert C. Perrino, Jr, Robert A. Baker
Dimensiuni	189 x 246 x 11 mm
Editura	Cambridge University Press
Format	Paperback
ISBN	9781009009621
Limba	Engleza
Nr pag	288