CARDIO PULMONARY BYPASS

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CARDIO PULMONARY BYPASS

• MODERATORDR.POONAM MALHOTHRA
• PRESENTORSDR.SENTHIL
• DR.PRABHU

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Cardiopulmonary Bypass
provide a non beating bloodless heart with
flow temporarily diverted to an extra-corporeal
circuit that functionally replaces heart and lung
boldest and most decisive feats of mans
mind
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DEVELOPMENT OF HEART LUNG MACHINE
GIBBON ERA
1930 October 3 Gibbon watches over a patient
die of pulmonary embolism Birth of the idea Work
at Thomas Jefferson Hospital, Philadelphia 1939
use of heparin 1939 CPB in cats and dogs W W -
II interruption
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1945 GIBBON RESUMES WORK
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BULL FINCH LAB MGH
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JOHN GIBBON JR
Coupling extra corporeal circulation, oxygenation
and cardiac surgery 1952 first ASD closure
died autopsy PDA 1953 May 6 2nd patient
Cecelia Bavelok ,16/f ASD closure
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JOHN GIBBON
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CPB EQUIPMENT
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• FUNCTION OF CPB
• Oxygenation and elimination ofco2
• Circulation of blood
• Systemic cooling and re-warming
• Diversion of blood from the heart

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CPB CIRCUIT
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CPB CIRCIUT
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CPB CIRCUIT
Venous canula reservoir pump heat
exchanger oxygenator arterial filter aortic canula
Vent cardiotomy suction gas
blender saftey devices monitoring devices
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OXYGENATORS
Vertical screen Gibbon Rotating disc
Kay Cross Stationary film
Kirklin Bubble De
Wall Lillehei Membrane
Kolff, Neville
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BUBBLE OXYGENATOR
Blood drains into chamber Oxygen diffuses through
diffusion plate -produce bubbles Small bubbles
enhance O2 exchange Large bubbles enhance CO2
removal Easy to prime Inexpensive RISKS Air
embolism gt 2 hours protein denaturation platelet
, complement activation Defoaming
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MEMBRANE OXYGENATOR

• Imitates natural lung
• Gas exchange across thin membrane
• 2 Types
• Microporous
• Nonporous

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Membrane oxygenator
MICROPOROUS Polypropelene Small pores impervious
to blood 2 Types 1. Hollow Fiber 2. Parallel
Plate/ Pleated Sheet
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Membrane oxygenator
Non Porous Methyl Silicone Rubber Increased
priming volume ECMO
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Membrane Oxygenator
PCO2 controlled by gas flow PO2
controlled by fio2 Safer Less particulate and
gaseous emboli Less reactive
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BLOOD PUMPS
Ideal Pump Flow Rate 7 Lts/ Min Pressure 500 Mm
Hg Non Damaging No Turbulence Disposable Exact
Calibration Manually Operable
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BLOOD PUMPS

• 4 Types
• Roller Pump
• Centrifugal Pump
• Pulsatile Pump
• Non Occlusive Roller Pump

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ROLLER PUMP
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Roller pump
Since 1956 Positive Displacement Pump Most
commonly used length of tubing inside curved
raceway Predictable pump flow Preload/ Afterload
independent Simple Can be used as vent
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Roller pump

• PROBLEMS
• Mal occlusion
• Tubing Fracture
• Runaway pump
• Spallation
• Air Pumping
• Cavitation

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CENTRIFUGAL PUMPS
Since 1976 Rotates and generates a
vortex Magnetically coupled another magnet in
pump head Non Occlusive Pre After load Dependent
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CENTRIFUGAL PUMPS
Less blood trauma Do not over pressurize
disrupt No tubing wear No spallation No
cavitation Decreased risk of air embolism
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CENTRIFUGAL PUMPS
DIS ADVANTAGES Lacks versatility in placement No
vent / suction Adds to complexity Adds to
cost Non Pulsatile Retrograde flow
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VENOUS CANULATION and DRAINAGE
CANULA chosen by Size and AGE WEIGHT 1 STAGE 10
- 46 F 2 STAGE 36- 51 F Flow 1/3 SVC 2/3
IVC CANULATION Bicaval
Cavo atrial Single Atrial Peripheral

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VENOUS DRAINAGE
Gravity Siphon Assisted Vacuum Assisted ( VAVD)
Regulated vacuum to closed hard shell
reservoir Kinetic Assisted ( KAVD) centrifugal
pump in venous line Roller pump between
canula and reservoir
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Advantages of AVD

• Improved venous return
• Lowering the priming volume.
• Alternative venous cannulation sites
• Almost impossible to have an air-lock in the
  venous line.

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VAVD
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ARTERIAL CANULAE
Narrowest part of circuit High flow jet Pressure
gradient gt 100 mm hemolysis Choose smallest
canula that will provide calculated flow rate
with a gradient lt 100 mm Hg COANDA EFFECT Jet
stream adheres to boundary lower pressure on
opposite wall carotid hypoperfusion
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ARTERIAL CANULATION

• Femoral Canulation
• Redo Surgery
• Aortic Surgery
• Minimal Access Surgery
• Severe Atherosclerosis of Asc Aorta

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TUBING

• Transparent
• Resilient
• Flexible
• Non-kinking
• Hardness

• Toughness
• Inertness
• Smooth
• Non-wettable
• Heat Tolerance
• Blood compatibility

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TUBING
Size of tube Art- 3/8 th inch, Venous-1/2 inch,
Suction-1/4th inch Latex
Rubber Hemolysis PVC Stiffens Silicone
Rubber Spallation

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Heparin Bonded Circuits
Increase hemocompatibility Reduced complement
activation Decreased heparin requirement Lower
blood loss Less transfusion requirement
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TCM
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Warm and cool patient temp range 4 - 42
c Nonsterile water in manifolds of tubing Water
circulates in opposite direction to that of
blood Heat exchangers _at_
venous reservoir, cardioplegia
delivery

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Venous Reservoir
Hard shell
Hard shell open to atmosphere risk of air
embolism VAVD possible
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Venous Reservoir
Soft shell collapses on itself decreased risk of
air embolism VAVD not possible
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VENOUS RESERVOIR WITH INTEGRATED OXYGENATOR AND
HEAT EXCHANGER
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FILTERS
Screen Filters Woven polyester or nylon Defined
pore size Filter by interception Harder to deair
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FILTERS
Depth Filters Packed fibre/foam No defined pore
size Filter by impaction and absorption Concern
hemolysis,thrombocytopenia
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MONITORING
Inline blood gas monitoring HCT Line
pressure Arterial flow meter Temperature
monitoring Expired gas monitoring
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