Cardioplegia and MUF Flashcards Preview

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Flashcards in Cardioplegia and MUF Deck (67):
1

CHOOSING A CARDIOPLEGIA SYSTEM
What we want in pediatrics:

Small prime
Good heat exchange
Air handling capabilities
A versatile system

2

air detector used

for shutting down system when air is detected

3

csc actually has _____ cc of prime

28cc instead of 14 cc

4

csc 14 put a 4 way stop cock to

allow for recirculation prime

5

retro cardioplegia cannula sizes DLP neonatal

6 fr

6

retro cardioplegia cannula sizes DLP ped.

10 fr

7

retro cardioplegia cannula sizes DLP small adult

13 fr

8

retro cardioplegia cannula sizes adult

15 fr

9

hard tip coronary ostium come in what sizes

10,12,14

10

soft tip coronary ostium tip size

universal

11

aortic root cardioplegia cannula 0-7 kg

dlp 18 gauge

12

aortic root cardioplegia cannula 7-20kg

dlp 16 gauge

13

aortic root cardioplegia cannula 20-35 kg

dlp 14 gauge

14

aortic root cardioplegia cannula >35 kg

dlp 12 gauge

15

dlp vents malleable tip

10 fr on surgeons request

16

dlp vent curved lv <14 kg

10 fr

17

dlp curved lv vent 14-30 kg

13 fr

18

dlp adult lv vent 30-50 kg

16 fr

19

dlp adult lv vent >50 kg

20 fr

20

ANTEGRADE DELIVERY equals

30 mL/kg in pediatric patients.

21

antegrade line pressure depends

pressure drop across the cardioplegia system (the goal is to maintain root pressure approximately 70 mmHg).
Look at your pre-op pressures
Flow is variable depending on patient size

22

Retrograde cardioplegia is given into the coronary sinus A balloon is inflated or self inflated and provides two functions:

Prevents backflow Holds cannula in place

23

RETROGRADE DELIVERY Flow should be titrated to maintain

a coronary sinus pressure of 30-40 mmHg. DO NOT EXCEED 40 mmHg on kidlets

24

percentage of blood based cp

86%

25

percentage of crystalloid based cp

14%

26

del nido solution what type and percentage

blood based 1:4 38%

27

Customized solutions blood

32%

28

St. Thomas, Plegisol, or Baxter what type and percentage

blood based 11%

29

Microplegia what type and percentage

blood based 5%

30

custodial what type and percentage

crystalloid 7%

31

St. Thomas, Plegisol, or Baxter crystalloid

5%

32

customized crystalloid solutions

2%

33

percentage that uses cold cardioplegia under 10 degrees

93%

34

percentage that uses hot shots

21%

35

most common type of hypothermia in neonates an infants

moderate 28 to 31 degrees

36

most common route of administration in neonates and infants is_______ and the percentage is _____

antegrade 89%

37

Longer intervals between cardioplegia doses were associated with surgeons using

del Nido and Custodiol solutions
(these solutions were commonly administered with a single dose regardless of aortic cross-clamp time

38

del nido solution lies betwee

hyper polarizing and depolarizing solutions

39

del nido osolarity

340 mOsm/L

40

dosing to get arrest with del nido

20 ml/kg

41

del nido doing for maintenance

10 mL/kg

42

del nido delivery rate

90-180 mL min

43

custodial description

intracellular low na solution

44

custodial single administration lasts

up to 2 hours

45

each component of histidine tryptophan ketoglutarate are used for what

histidine:buffer against acidosis during XC. tryptophan: cell membrane stabilizer. ketoglutarate: improves atp production during reperfusion

46

The addition of magnesium may provide

a protective effect on the hypoxic-ischemic immature heart.

47

protective effect of mag. due to

antiarrhythmic effect of magnesium, inhibited entry of calcium into the myocytes, and decreased uptake of sodium by myocytes during ischemia.

48

during reperfusion mag is exchanged for

calcium

49

MUF is huge advance because

allow recovery of the pump blood for the patient, while allowing the patient to be in a hemodynamic state to accept the volume is the a significant advance for pediatric perfusionists

50

MUF developed by

Mr. Martin Elliott (Great Ormand Street/Hospital for Sick Children London UK) in 1985

51

What’s really happening at the hemoconcentrator level 7 things

A. Raising Hct
B. Extravascular fluid crosses ( rapid, large increase in COP and OSMO)
C. Removes inflammatory mediators
D. C-Reactive Proteins cross
E.Protein reactive cytokines cross
F.Complement activation factors cross (C3a, sC56-9, C3 bound)
G. Pulmonary effects > Systemic effects with IL-6, IL-8, and TNF

52

The principal finding of multiple studies is that :
MUF after CPB in infants did result

in immediate improvements in both static and dynamic pulmonary compliance, but the effect was not sustained after admission to the PICU or 24 hours after the operation.

53

MUF
WHY ARE THESE IMPROVEMENTS NOT SUSTAINED?

A possible reason is that pulmonary compliance is affected both by excess fluid from the hemodilutional effect of bypass,
(As well as by the systemic inflammatory response)

54

MUF
WHY ARE THESE IMPROVEMENTS NOT SUSTAINED? 2

Ultrafiltration after bypass decreases total body water and removes inflammatory cytokines. However, the initiation of the systemic inflammatory response most likely occurs during rewarming.
(MUF starts after the inflammatory cascade has been activated)

55

MUF
WHY ARE THESE IMPROVEMENTS NOT SUSTAINED? 3

It may be that the salutary effects of hemoconcentration and removal of water after bypass by MUF are unable to overcome the ongoing effects of capillary leak possibly caused by an activated ongoing inflammatory response.

56

The technique of MUF is performed after

CPB is complete and allows filtration of both the patient and remaining contents of the CPB circuit, including the venous reservoir.

57

Using the MUF technique, an ultrafilter is interposed in the CPB circuit between

the aortic arterial line and the venous After weaning from CPB, the blood is removed from the patient via the aortic canula and fed through the ultrafilter. The outlet of the ultrafilter is fed to the right atrium of the patient.

58

Blood flow through the ultrafilter approximates

20mL/kg/min max.

59

during MUF suction is applied to the_____ which can result in a filtration rate of ______

filter port of the ultrafilter, 100 to 150 mL per minute.

60

Ultrafiltration is carried out with the end point being either

ime (10–20 minutes) or the achievement of a hematocrit value of approximately 40-50.

61

Beneficial effects of MUF (5):

total body water is reduced as a direct result of removing the ultrafiltrate.
Reduced edema
Reduced hospital stay
Reduced ventilation times
Reduced incidence of pleural and pericardial effusions.

62

Arguments against MUF(6):

Possible air embolism Remember that air would be entering
venous side
Circuit complexity and cost
Prolonged exposure to foreign surface
“Patient can be concentrated before coming of CPB”
What are your endpoints?

63

Endpoints of hemofiltration vary

mong institutions and can be defined by time, volume, or hematocrit.

64

In the postoperative period, patients receiving MUF have smaller increases in

total-body weight

65

In addition to decreasing edema, hemofiltration increases

the hematocrit, which translates into increased oxygen-carrying capacity.

66

Removed fluids also contain

inflammatory mediators and vasoactive substances.

67

CLINICAL STUDIES HAVE DEMONSTRATED THAT MUF IS ASSOCIATED WITH

Improved cerebral blood flow (CBF), cerebral metabolic
activity, cerebral oxygen delivery Pulmonary function, decreased postoperative ventilation
Decreased postoperative bleeding, chest-tube drainage, pleural effusions
They equal short hospital stays.