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562 - Perfusion Technology II > Exam 5 - Cardioplegia > Flashcards

Exam 5 - Cardioplegia Flashcards

1
Q

Myocardium O2 consumption

A

70-75%

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2
Q

Arrested heart O2 consumption

A

2 ml O2 / 100 g tissue

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3
Q

Resting heart O2 consumption

A

8 ml O2/min/100 g

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4
Q

Heavy exercise O2 consumption

A

70 ml O2/min/100g

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5
Q

Other O2 consumption

A

Brain: 3
Kidney: 5
Skin: 0.2
Resting/Active muscle: 1/50

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6
Q

Coronary perfusion pressure equation

A

DBP - LVEDP or LA

  • Gradient of 15 needed for survival
  • Hard to get that low
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7
Q

W/O cardioplegia

A
  • 20 min before permanent damage
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8
Q

W/ cardioplegia

A

4-5 hours without permanent damage

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9
Q

Phase 0

A

Na influx

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10
Q

Phase 1

A

Transient K efflux

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11
Q

Phase 2

A

Ca influx

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12
Q

Phase 3

A

K efflux

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13
Q

Phase 4

A

Na/K pump

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14
Q

K arrest

A
  • knocks out phase 3
  • K efflux stage
  • no repolarization
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15
Q

Low K arrest (custodial)

A
  • knocks out phase 0
  • Na influx
  • No depolarization
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16
Q

Del Nido arrest (Low Ca)

A
  • knocks out phase 2
  • Ca influx stage
  • No contraction phase
17
Q

Antegrade

A

Pros: simple / like normal flow / quick arrest
Cons: need good aortic valve / interrupt surgery / bad for CAD

  • 10-15 ml/kg initial dose (30 in peds)
  • 4:1
  • more doses are less K and less volume
  • Line pressure: 125-150 / root pressure: 50-100
  • Flow is 250-400 ml/min
18
Q

Retrograde

A

Pros: avoids bad AI / CAD / No interruption / helps de-air
Cons: hard to place catheter / can blow sinus / poor R heart coverage

VENT ON

  • balloon stops backflow AND holds in place
  • flow is 200 ml/min
  • Sinus pressure of 30-40 mmHG
19
Q

Integrated

A

Pros: uniform distribution of cpg
Cons: complex / need to monitor pressures

20
Q

Ostial delivery

A
  • used in AVR / aneurysm / dissection
  • 250-300 mmHg circuit pressure (tiny cannula orifice)
  • 150-250 ml/min
  • 5-8% of CO
21
Q

Graft delivery

A
  • can check anastomosis / flow
  • flow 50-100 ml/min
  • can’t do it in every case
22
Q

Pressure and cpg

A
  • NEED a pressure to prevent sinus/root blow up
  • need to know pressure drop across system
  • high flow -> larger pressure drop
23
Q

Goal of perfusionist with cpg

A
  • uniform delivery
  • effective delivery
  • look at EKG and temp
24
Q

Crystalloid benefits

A
  • simple
  • cheap
  • better visibility
  • better distal perfusion
  • low Ca
25
Q

Crystalloid cons

A
  • minimal buffering
  • low O2 capacity
  • hemodilution
  • must be cold
26
Q

Blood cpg benefits

A
  • better metabolic environment
  • can be warm
  • smaller crystalloid volume (but watch reservoir)
27
Q

Blood cpg cons

A
  • shifts oxy curve left
  • increase viscosity
  • complex
  • cost
28
Q

Blood vs crystalloid

A
  • blood better
  • better systolic function and diastolic function
  • better protection and recovery
29
Q

Quest

A
  • all blood
  • small volume cpg
  • controllable
  • expensive and complex
30
Q

Standard temp

A

10 C

Target is 10-15
- but better recovery with warm cpg

31
Q

Intermittent delivery

A
  • improved exposure
  • lower volume
  • BUT more acidosis
32
Q

Continuous delivery

A
  • normal perfusion
  • better LV function
  • less inotropic help
  • BUT wet field / complex for perfusionist and surgeon
33
Q

Common additives

A
  • KCl: maintain diastolic arrest
  • THAM: buffer
  • Mannitol: Osmolarity AND radical scavenger
  • Aspartate: gentle Cardioplegia BUT expensive
  • CPD: citrate / lowers free Ca / prevent stone heart
  • MgCl2: less Ca
  • Glucose: metabolic substrate
  • Blood: oxygen carrying capacity
34
Q

Typical cpg solution

A 
KCl
THAM
MgSO4
Dex
CPD
35
Q

St Thomas solution

A 
Na
K
Ca
Mg
Cl
Na Bicarb
320 Osmolarity
36
Q

Custodial HTK

A

Histadine
Tryptophan
Ketogluterate
Intracellular ion mixture

  • One dose for 60 min
37
Q

Del Nido

A 
-1:4....one dose needed
Plasmalyte base similar to ECF
Mannitol
MgSO4
Bicarb
Lidocaine
38
Q

3 phases of cpg

A
  • induction
  • Maintenance (every 15-20 min)
    • keep temp down / check grafts / wash out / maintain
  • reperfusion

562 - Perfusion Technology II (9 decks)

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