Anaes SAQs · Cardiac anaesthesia
Cardiopulmonary bypass circuit: components, physiology, and anaesthetic priorities
Final-examination SAQ for cpb-circuit-physiology.
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ANZCAFRCAEDAICABAFCAI
Prompt
Describe the CPB circuit in order, anticoagulation and ACT targets, full-flow physiology, and your approach to inability to wean from bypass.
Model answer
Circuit (4). Venous cannula → reservoir → pump → oxygenator/heat exchanger → arterial filter → arterial cannula (taught order); list vents and cardioplegia.[1]
Anticoagulation (4). Heparin 300 IU/kg fixed method (mean ACT 487 s in a 107-patient randomised comparison), ACT 400 or 480 s per surveyed thresholds, protamine 1:1 surveyed commonest ratio slow.[1][2][3]
Weaning (7). RRRAC optimisation, TOE-guided, inotropes/vasopressors, mechanical support if refractory (taught sequence).[1]
References3ShowHide
- [1]Shore-Lesserson L, Baker RA, Ferraris V, et al. STS/SCA/AmSECT Clinical Practice Guidelines: Anticoagulation during Cardiopulmonary Bypass. J Extra Corpor Technol, 2018.PMID 29559750
- [2]Clark TD, Ecklund JM, McCall MM, et al. Comparison of three methods to estimate heparin loading dose for cardiopulmonary bypass. J Extra Corpor Technol, 1996.PMID 10160446
- [3]Mattox KL, Guinn GA, Rubio PA, Beall AC Jr Use of the activated coagulation time in intraoperative heparin reversal for cardiopulmonary operations. Ann Thorac Surg, 1975.PMID 1079715