Cardiopulmonary Bypass Flashcards Preview

I&M for Anesthesia - Fall 2013 > Cardiopulmonary Bypass > Flashcards

Flashcards in Cardiopulmonary Bypass Deck (28):
0

Why bypass the heart and lungs? For _____ heart procedures, ________ that do not tolerate mechanical manipulation, ______, distal ___________.

Open heart procedures
Unstable hearts
Transplants
Distal airway reconstruction

1

How to bypass the heart and lungs?

1 drain venous blood
2 collect in reservoir
3 pump it through a device
4 oxygenate and filter
5 return via aorta

2

What are the components of CPB?

Biosurface
Reservoir
Roller pumps
Centrifugal pump
Oxygenators
Anticoagulation

3

What are two kinds of biosurface?

Terumo and Medtronic

4

Terumo is an X-coating (what does this mean?) which is ______ and ______. It ______ protein desaturation and platelet adhesion.

Amphiphilic and biopassive
Reduces

5

Three kinds of Medtronic biosurface?

Balance
Carmeda
Trillium

6

Which Medtronic biosurface is not heparin coated?

Balance

7

Which Medtronic biosurface are hydrophilic?

Balance
Trillium

8

Which Medtronic is negatively charged?

Trillium

9

Which Medtronic is nonleaching?

Carmeda

10

The hard shell reservoir has

Stable blood levels
High visibility scale

11

The Levelsens is a ______ reservoir with

Soft shell
Low level alarm

12

Review the centrifugal pump cause the pictures I printed are too small to read

Go do that

13

Oxygenators

Review the membrane lung vs natural lung chart

14

Oxygenators assembled

Fill this in later...

15

Anticoagulation is achieved through ______ at _____ units per kg. the activated clotting time (ACT) is

Unfractionated heparin (UFH)
300
>400 seconds

16

The HMS Medtronic Plus uses ______ heparin concentration based anticoagulation with heparin _______ and automated ______ titration

Patient specific
Heparin dose response
Automated protamine titration

17

What is monitored on CPB?

CO, SVO2, SVR
Arterial blood gases
Temperature
Urine output

18

What is the equation for SVR?

SVR = (MAP-CVP)/CO

19

Arterial blood gases on the CPB are monitored every

30-60 min

20

What factors contribute to myocardial protection?

Pre CPB stable hemodynamics
Anesthetic preconditioning
Adequate cardioplegia (intentional and temporary cessation of cardiac function)
Myocardial temperature

21

Weaning from CPB

Adequate repair
Confirmed by echocardiologist
Rewarm
De aired heart
Repercussion rhythm
Adequate hemodynamics
Appropriate ABG, gas exchange, electrolytes

22

What needs to be done post CPB?

Protamine to reverse UFH
ABGs
Follow up hematology studies

23

How does protamine reverse UFH?

Binds to it to form a stable ion pair that does not have anticoagulant properties

24

What are the follow up hematology studies?

ACT
TEG
PT/INR/PTT, fibrinogen, thrombin time

25

Complications of CPB?

Cardiovascular collapse - graft failure, thrombosis, coronary spasm, residual defects, L/R heart failure, dysrhythmias
Pulmonary complications
Coagulopathy
Metabolic disturbances

26

Bedside CPB

Rapid cardiopulmonary support (CPS)

27

Ventricular Assist Device

Kid holding up his shirt