Canine Model of Cardiopulmonary Bypass

2. Canine Model of
Cardiopulmonary Bypass Surgery

3. Canine Model of Cardiopulmonary
Bypass Surgery
Presented By-
Dr. Md Mossabbir Hossain
Department of Surgery and Obstetrics
Bangladesh Agricultural University, Mymensingh

4. • Introduction
• History
• Importance
• Principle
• CPB Team
• Physiology
• Steps
• Patients Monitors
• Systemic Complications
What will We Talk

5. • Definition:
CPB is a technique that temporarily
diverting blood from heart and lungs and
provides oxygenation and pump
functions in the presence of a still
bloodless heart.
• Uses:
CPB is used in heart surgery requiring
arrested heart either with or without
opening of cardiac chambers to support
the circulation during that period.
Cardiopulmonary Bypass (CPB)

6. • Dr.Gibbons, inventor of the
Heart & Lung machine Also
known as, cardio-pulmonary
bypass machine (CPB).
• 1935 –maintained a cat’s
circulation on CPB while
closing the pulmonary artery.
• 1953 –Cecelia Bavolek First
patient to undergo open
heart surgery using CPB to
repair an atrial septal defect
History of CPB

7. History of CPB
More than 40 years of Innovation,
Research, and Hard Work

8. Why CPB
• To facilitate a surgical intervention
• Provide a motionless field
• Provide a bloodless field

9. • Coronary Artery Disease (CAD)
• Valve Disease
• Congenital Heart Defects
• Dissections
• Transplants :- Heart, liver, lung, trachea
• Others: limb cancer, hypothermic rescue
In Which Cases

10. • Deoxygenated blood (Venous Return)
taken away from the body to the CPB
machine.
• Then pumped and oxygenated to
returned back to the body (Arterial
system)
Principle of CPB

11. • Venous and arterial cannulas
• Venous Reservoir
• Centrifugal pump
• Oxygenator, heat exchanger , venous
reservoir
• Microfilter bubble trap on the arterial side
• Suction system for cardiotomy reservoir and
filter returns to venous reservoir
• Field blood washed in a cell saver system
returned as packed RBCs.
• Partial and occluding clamps to direct and
regulate flow
• Various ports in the system to obtain blood
samples.
• Cardioplegic system, LV Vent.
Components of CPB

12. • Surgeon: Determines the planned
operation, target perfusion
temperatures, methods of cardioplegia,
cannulations.
• Perfusionist: Setting up and priming
the CPB machine, safety checks,
monitoring anticoagulation, adding
prescribed drugs, maintaining records.
• Anesthetist: “Troubleshooter” of
complex procedures
The CPB Team Role

13. • Hemodilution
• Anticoagulation
• Hypothermia.
• Flow rate & Blood Pressure.
• Blood gas control
CPB Physiology

14. Mainly there are Seven
steps of CPB
Steps for CPB

15. • Heparin
Step 1 for CPB

16. • Exposure of the heart & Check Aorta.
• Pericardial cradle/sutures.
Step 2 for CPB

17. Step 3 for CPB
• Check ACT
• Aortic Cannulation
• Remove arterial clamp.

18. • Atrial (venous) Cannulation
• Remove venous clamp
• Command “On bypass”
• Turn lungs ventilation off.
Step 4 for CPB

19. • Place cardioplegia cannula
• Reduce pump flow/Clamp
aorta.
• Resume full flow/check line
pressure.
• Start cardioplegia.
Step 5 for CPB

20. • Release cross-clamp after warm
cardioplegia.
• Remove all air from heart.
• Begin respirations (start lungs)
• Check Good contractility & Stable
heart rhythm.
• No bleeding.
• Desired patient temp.
Step 6 for CPB

21. • Wean slowly from CPB.
• Begin Protamine assessing BP, CVP.
• When stable: Clamp venous line and
remove.
• Remove vent/cardioplegia.
• Be alert for hemodynamic reactions.
• Remove arterial cannula after all
protamine in.
• Keep lines clamped and ready for any
emergency.
Step 7 for CPB

22. • Radial/brachial/femoral arterial
catheter.
• CVP via jugular venous catheter.
• Urine output.
• Temperature – Nasopharyngeal or
tympanic membrane temp used more
commonly.
• Arterial line temp. correlates best with
jugular venous bulb temp
Patient Monitors

23. • Cardiac
 Post-op cardiac dysfunction
 Subject to emboli, cytotoxins
 Myocardial “stunning ”reperfusion injury.
• Lung
• Pulmonary edema (complement activation )
• CPB reduces effect of natural surfactant .
• ARDS
• Kidney
 Hemodilution, microemboli,
catecholamines, diuretics, hypothermia,
aprotinin all impair renal function.
Systemic Complications

24. GI
 Peptic ulcers (surgical stress).
 Pancreatitis and mild jaundice.
 Gastroenteritis (increase inflammatory
response).
Brain
 Most sensitive organ exposed to injury by
CPB.
 Difficult to assess with difficult outcomes
as stroke, delirium & coma
 Risk increases with age (>60)M
 Protection strategies Mild hypothermia,
cerebral perfusion, off-pump.
Systemic Complications