Anaes · Cardiac anaesthesia
Cardiopulmonary bypass circuit: components, physiology, and anaesthetic priorities
Also known as CPB circuit · Cardiopulmonary bypass anaesthesia · Heart-lung machine
Ordered CPB circuit components, heparin and ACT targets, indexed flows and MAP, alpha-stat versus pH-stat, weaning with rate-rhythm-preload-afterload-contractility, protamine reactions, air embolism, and TRICS III transfusion context for ANZCA Final.
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10 MCQs with explanations
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Meet the patient
A 68-year-old for elective CABG is heparinised, the ACT is confirmed, and the surgeon calls for bypass. Your job for the next hour is to manage the physiology of the machine that has just replaced the patient's heart and lungs — non-pulsatile flow, haemodilution, hypothermia, and the inflammatory response — and to bring him off it in one piece.[1]
The two questions every CPB case turns on: is the circuit primed, the ACT therapeutic, and the cannulae placed correctly? and can the heart separate from the pump when the time comes? Say the circuit order first, confirm the ACT second, and wean with structure third — that order mirrors safe conduct and safe viva conduct.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Anaesthesia fellowship atlas.
References2Show ledgerHide ledger
- [1]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery (TRICS III). New England Journal of Medicine, 2017.PMID 29130845
- [2]Levy JH, Ghadimi K, Kizhakkedathu JN, Iba T What's fishy about protamine? Clinical use, adverse reactions, and potential alternatives. Journal of Thrombosis and Haemostasis, 2023.PMID 37062523