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2.  A procedure in which blood is taken
from a patient's circulation to have a
process applied to it before it is
returned to the circulation
 All of the apparatus carrying the blood
outside the body is termed
extracorporeal circuit

3.  Cardiopulmonary bypass during open
heart surgery
 Autotransfusion
 Hemodialysis
 Hemofiltration
 Apheresis
 Plasmapheresis
 Extracorporeal membrane
oxygenation (ECMO)

4.  Is a method that is used to achieve the
extracorporeal removal of waste
products such as creatinine, urea and
free water from the blood when
the kidneys are in a state of renal
failure.

7.  Is a similar treatment to hemodialysis, but it
makes use of a different principle
 Pressure gradient rather than conc. gradient
 Convection not diffusion

10.  Is a medical technology in which
the blood of a donor or patient is
passed through an apparatus that
separates out one particular
constituent and returns the remainder
to the circulation
Whole blood enters the centrifuge
(1) and separates into:
plasma (2)
leukocytes (3)
erythrocytes (4).

12.  Is the removal, treatment, and return of blood
plasma from blood circulation.
 It is used when a substance in the plasma,
such as immunoglobulin, is acutely toxic and
can be efficiently removed

13. Plasma exchange offers
the quickest short-term
treatment to removing
harmful auto-antibodies

15.  It provides both cardiac and
respiratory support to patients whose
heart and lungs are so severely
diseased or damaged

16.  Guidelines that describe the indications and
practice of ECMO are published by the
Extracorporeal Life Support Organization
(ELSO).
Criteria for the initiation of ECMO include
acute severe cardiac or pulmonary
failure that is potentially
reversible and unresponsive to
conventional management

17.  Performed under local anesthesia
 Used for long term support
ranges 3-10 days
 Aim:to allow time for intrinsic
recovery of the lungs and heart

19. I’m almost
done!

20.  Also known as autologous transfusion
 Defined as the collection and
reinfusion of patients own blood/
blood compartments.
 Safest form of blood transfusion

21. Advantages
 No acute or delayed hemolytic rxn dt
ABO incompetability.
 No allergic or febrile reactions
 No transfusion trasmitted infectious
diseases like HIV, HepB, HepC,
EBV,CMV and malaria

22.  Conservation of blood resources
 Patients with rare blood phenotypes
are benefited
 Availability – Instantly avialable and
requires no cross matching

23.  Clerical error
 Pre-operative anemia
 Costlier
 Unnecessary wastage of blood
 Risk of bacterial contamination
 Increased complexity of procedure
Disadvantages

24.  Pre-operative autologous blood
donation
 Acute normo-volemic hemodilution
 Intra operative and post operative
blood selvage

25.  Patient selectivity:
1. Hb not<11g/dl
2. Hct not<33%
Last transfusion 72 hrs before surgery
 Contraindication
1. Bacteriemia/septicemia
2. Unstable angina, CHF, MI within
previous 6 months

26.  It is collecting a patient’s blood
(2-4 units) into anticoagulant-
containing storage bags at the outset
of surgery, accompanied by
intravenous replacement with
crystalloids or colloids to maintain
normovolemia and later reinfusion of
blood.

27.  Is an effective method of
transfusion avoidance
 Shed blood is collected from the
operative field and mixed with an
anticoagulant.
 It is concentrated and washed or
filtered, then returned to the patient

28.  Collection from drains but is
rarely used
 To be used within 6 hrs
 Blood collection is diluted and
partially hemolysed.

31. Heart - Lung - Machine (HLM)/
cardiopulmonary bypass(CPB)
The innovation of the machine for extracorporeal
circulation (ECC) was in 1950. The first successful
application of this machine was made by Dr. John
Gibbon on the 20th May 1953, on a young patient
with ASD
With the help of the ECC the heart is
emptied, arrested (stopped), opened
at the needed chamber, and thus a
safe surgical intervention can be
made without any consequences to
the patient, allowing surgeons to
operate about 90 min
Price:10-45 thousand $

33.  To provide a stilled bloodless heart with
blood flow temporarily diverted to an extra
corporeal circuit that functionally replaces the
heart and lungs
 Respiration
◦ Ventilation
◦ Oxygenation
 Circulation
 Temperature regulation

34.  Surgical correction of congenital,
ischemic or valvular heart diseases
 Coronary artery bypass
 Valve replacement
 Correction of septal defects

35. Basic CPB Circuit

36. Venous Cannulas

37. Venous Reservoir

38. Pump

39. Heat Exchanger

40. Oxygenator

41. Filters

42. Filters

43. Filters

44. Aortic cannulas

45.  The rewarming should be gradual &
is done over a 30 minute period
 A gradient of I0°c is maintained
between patient & perfusate to
prevent formation of gas bubbles
due to their increased solubility as
blood gets warmed

46. Balanced electrolyte solution
Sometimes mannitol is added
to stimulate diuresis so to
prevent post-op renal
dysfunction
Addition of glucose/lactate is
avoided because it showed
neurological deficits

47.  As bypass circuits are
thrombogenic
 Heparin 2-3 mg/kg given into
the central vein / directly into the
right atrium
 Supplemental dose of heparin
given every hourly at the dose of
1/3 of initial dose

48.  The primary goal of this
period is to obtain-
 desired levels of hypothermia
maintain adequate systemic
perfusion
tissue oxygenation

49.  To maintain normal myocardial
cellular integrity and function during
CPB, the available high energy
phosphate compounds have to be
spared
 This is accomplished by
◦ Hypothermia
◦ Cardioplegia

50.  inserted into the aortic root
 It’s a solution of dextrose,
sodium, potassium and
chloride..
 It is administrated periodically
to inhibit myocardial
contraction

51. Increased extracellular potassium
↓
Decrease in transmembrane potential
↓
Impairment of Na+ transport
↓
Abolition of action potential generation
↓
Cardiac arrest in diastole
MOA:

52.  Reversal of anticoagulation done with
protamine
 Dose - 1 to 1.3ml (10mg/ml) for every 1000U
of heparin or dose is calculated based on the
heparin dose response curve
 Arterial cannulas remain in place for
continued transfusion of pump contents
 When this is completed & bleeding is
controlled, arterial cannula is removed &
chest is closed

53. Physiologic
 CNS –amnesia, Intracranial Haemorrhage
(14%),seizures
 Respiratory - Pulmonary oedema,
pulmonary haemorrhage
 Renal-Decreased tubular function, Renal
blood flow dt diminshed flow rate
 Hematologic - Anemia, leukopenia,
thrombocytopenia
 Infections

54. The absence of significant organ dysfunction
probably is the best indicator of successful
CPB.
Post-CPB organ dysfunction constitutes a
spectrum ranging from mild dysfunction in one
or more organ systems to death resulting from
multiorgan failure.
The probability of significant morbidity
increases with duration of CPB and decreasing
age of the patient within the pediatric age
group

55. The impact of preexisting organ
dysfunction on post-CPB morbidity is not
well defined, but it seems likely that poor
overall condition before CPB results in
greater morbidity after CPB.
 For unexplained reasons, women seem
to have greater morbidity and mortality
after cardiac surgery

56.  Mechanical
 Failure of pump
 Rupture of tubing
 Difficulties with cannulas