Richard Ginther, CCP, FPP

Jim Reagor, CCP, FPP

Nischal Gautam, MD

CPB Workshop

Perfusion: What you might not know

Disclosures

None

Objectives

Demonstrate how the cardiopulmonary bypass machine works and be able to help trouble shoot problems

Explain some of the different techniques of cardiopulmonary bypass

Why CPB?

To facilitate surgical intervention

Circulatory Support

Oxygenation, CO2 removal

Provide a motionless field

Provide a bloodless field

Heart Lung Machines

Blood Flow Pathway

Cannulae

ARTERIAL VENOUS

Venous Line 8

Venous Line

Safety Devices: Temperature Probes

Venous Blood

Venous Reservoir

Venous Reservoir

Technique: VAVD Vacuum Assisted Venous Drainage Regulator

Actively augment venous drainage with vacuum

Typically 0 to -40 mmHg

Uses:

Increased flow through small cannula

Resolve venous airlock

Alternative: Kinetic Assisted Venous Drainage with pump

Safety Devices: Level Sensor

Safety Devices: Level Sensor

Safety Devices: Bubble Detector

Safety Devices: Bubble Detector

Arterial Pump Head

Arterial Pump Head

Roller

Centrifugal

Pediatric Perfusion Survey 2011

Oxygenator

Oxygenator – Heat Exchanger – Integrated Arterial Line Filter

Arterial Line

Arterial Line

Safety Devices: Temperature Probes

Arterial Blood

Safety Devices: Pressure Transducers

Safety Devices: Pressure Transducers

Vacuum Cardioplegia Arterial

Pump Suckers and Vent

Pump Suckers and Vent

•Return to ports @ top of veno

us reservoir

Hemoconcentrator

Techniques

CUF – conventional

Remove fluid, increase Hct

ZBUF – zero balance

Decrease K+, inflammatory mediators

MUF

Post CPB removal of fluid, circuit concentration, factor concentration

Removal inflammatory mediators

Discussion Topics

Basic Concepts

Retrograde Autologous Priming (RAP)

Modified Ultrafiltration (MUF)

NIRS & Troubleshooting

Perfusion Pressure on CPB

Advanced Techniques

Antegrade/Retrograde cerebral perfusion

Massive Air Embolism

Oxygenator Failure

Oxygenation Algorithm