A basic instructional video outlining the technique i use for aortic cannulation using actual case footage. Cpb takes over the functions of the heart and lungs and maintains blood oxygenation and circulation to the body whilst the. Pdf to text batch convert multiple files software please purchase personal license. Cannulation of the axillary artery for cardiopulmonary bypass. Pdf cardiopulmonary bypass via common carotid artery.
Oct, 2015 femoral cannulation first alternative to aortic cannulation indicated for initiating cpb quickly in cardiac arrest, acute, dissections, limited access complications retrograde arterial dissection 0. This was following four years of experiments with dogs. The objective of cannulation is to facilitate removal and subsequent return of the entire circulating blood volume, a process that is repeated about every 30 seconds. Crashing onto bypass is shortlived, however, as the cpb machines reservoir is quickly depleted, thus the central veins need to cannulated quickly and venous return to the pump established as soon as possible. Accidental hyperperfusion of the left carotid artery during cpb letter. Open and closed chest extrathoracic cannulation for. Femoral artery perfusion for cardiopulmonary bypass in.
We report a case where we established safe cardiopulmonary bypass with common carotid artery cannulation in an adult patient. Aortoatriocaval cannulation for cardiopulmonary bypass. Cpb takes over the functions of the heart and lungs and maintains blood oxygenation and circulation to the body whilst the heart and lungs are stopped during surgery. Cardiopulmonary bypass cannula sizes once the flow rate is calculated the choice of arterial and venous cannula size is made. The cardioplegia cannula is inserted proximally while the aortic cannula is. Peripheral cannulation is the historical route for connecting the pumpoxygenator to the vasculature of the patient in order to establish partial or complete cardiopulmonary bypass. Typically, blood is gravity drained from the heart and lungs to a reservoir via venous cannulation and tubing, and returned. Aortic cannulation and cardiopulmonary bypass independently. Strategies for optimisation of paediatric cardiopulmonary bypass. Dec 04, 2018 minimally invasive mitral surgery requires unique considerations for safe conduct of cardiopulmonary bypass. Nahush mokadam, has structured the publication in a very logical format, with chapters describing the circuit components, technical aspects of cardiopulmonary. Ecmo is frequently instituted using only cervical cannulation, which can.
At our institution, we favor a femoral platform for most minimally invasive cardiac procedures. How to cannulate the aorta for cardiopulmonary bypass. Percutaneous and open cannulation for peripheral cardiopulmonary. During the first operation, an attempt was made to expose the right axillary artery but the artery was not accessible.
For this isolation to be effective, the cpb circuit must be able to perform the functions of the intact cardiopulmonary system for a finite period. Postbypass monitors right ventricular function and left heart decompression. Principles of cardiopulmonary bypass bja education oxford. As compared to standard venous cannulae, data on file. Prebypass aortic valve and pfo during bypass assess inflow cannula placement.
Cannulation and the two methods of ecmo bypass the most striking initial difference between ecmo and bypass for cardiac surgery is that cannulation for ecmo is performed extrathoracically and at the bedside in an intensive care unit. We describe several techniques, highlighting both percutaneous and direct femoral cannulation, with accompanying video illustrations, while addressing relevant pearls and pitfalls of each. What is the difference between ecmo and cardiopulmonary bypass. Pdf open and closed chest extrathoracic cannulation for. Examples of such situations include initiating bypass before opening the chest, emergent situations, for aortic surgery, for minimal access surgery, and for. Physiology of cardiopulmonary bypass james ramsay, md. The arterial cannula is usually the narrowest part of the cpb circuit with resultant high resistance, pressure gradients, high velocity jets, and. This is achieved by introducing one or two venous cannulas in the venae cavae that direct venous return of the patient, by means of plastic tubing, into a reservoir. Cardiopulmonary bypass cpb provides a bloodless field for cardiac surgery. Cardiopulmonary bypass tsda boot camp july 2528, 20 chapel hill, nc. Introduction cardiopulmonary bypass cpb is a form of extracorporeal circulation in which the patients blood is diverted from the heart and lungs and rerouted outside of the body.
It takes over the cardiac and respiratory function temporarily during cardiac surgery, in order to making a silent heart for cardiac surgeon to perform complicating procedures. What is the difference between ecmo and cardiopulmonary. Initiation of cardiopulmonary bypass openanesthesia. Cardiopulmonary bypass critical care obstetrics wiley. Abstract a patient with type i aortic dissection, ascending aortic aneurysm, and infrarenal aortic occlusion was managed by inserting an infrarenal. Conduct of cardiopulmonary bypass for cardiac surgery. At times, venous cannulation for cardiopulmonary bypass can be done peripherally, by cannulation. Crashing onto bypass is shortlived, however, as the cpb machines reservoir is quickly. The primary function of cardiopulmonary bypass cpb is to divert blood away from the heart and lungs and return it to the systemic arterial system, thereby allowing cardiac surgery. Cardiopulmonary bypass cpb is a form of extracorporeal circulation that diverts the patients blood from the heart and lungs, rerouting it, and assuming control of the normal physiological functions of the heart and lungs, including maintaining whole body blood perfusion pressure, oxygenation, and co 2 elimination during cardiovascular and thoracic surgery.
Valve repair procedures coronary artery bypass grafting uteroplacental perfusion and cpb physiology anesthesia ventilation patient positioning cannula. The chest is opened via medium sternotomy and the pericardium lifted to make the heart accessible for cannulation. Conduct of cardiopulmonary bypass chapter 5 cardiopulmonary. To do otherwise is to risk a potentially fatal thrombotic event. Technology supporting the implementation of cardiopulmonary bypass cpb has advanced beyond recognition since its introduction by gibbon in 1953. Principles and practice, 3rd edition, does an outstanding job of explaining both the mechanical and physiologic process of cpb. Typically, blood is gravity drained from the heart and lungs to a reservoir via venous cannulation and tubing, and returned oxy. Jun 23, 20 cannulation or cardiopulmonary bypass md.
Whether cardiopulmonary bypass alone or together with the manipulation of the aorta produce neurological complication remains controversial. Extrathoracic cannulation to establish cardiopulmonary bypass has been widely applied in recent years and includes. The patient underwent aortic valve replacement for severe aortic regurgitation 8. Jun 07, 2005 extrathoracic cannulation to establish cardiopulmonary bypass has been widely applied in recent years and includes. Basics of cardiopulmonary bypass article pdf available in indian journal of anaesthesia 619. By interfacing with the cardiovascular system, total cpb completely replaces the function of the heart and lungs for a short time.
Ecmo is frequently instituted using only cervical cannulation, which can be performed under local anesthesia. Management of unusual problems encountered in initiating and maintaining cardiopulmonary bypass. Using a domestic pig model of cardiopulmonary bypass, we investigated the immediate effects of aortic cannulation and cardiopulmonary bypass on neuronal injury in different brain regions. In the more than 300,000 operations requiring cardiopulmonary bypass cpb performed yearly in the united states, aortoatriocaval cannulation is the most frequently used standard method for venous drainage and arterial perfusion. September 26, 1996 essentials and guidelines for perfusion practice of the american society of extracorporeal circulation essential i. The author provides a very simplified introduction to cannulation, with animation and intraoperative footage. In most cases, the machine is used to perform serious procedures that require the heart to be stopped. The cardiopulmonary bypass is a form of extracoporeal circulation. Unique benefits of this approach include a lack of systemic heparinization and arterial cannulation that mitigate the inherent risks of traditional cpb and vaecmo techniques, as well as percutaneous. The purpose of venous cannulation is to drain systemic deoxygenated blood into a cardiopulmonary bypass machine.
All patients were successfully cannulated and axilloaxillary cardiopulmonary bypass was possible without the need for additional cannulas. It incorporates an extracorporeal circuit to provide physiological support. Chow, md max kanevsky, md goals and mechanics of cardiopulmonary bypass the cardiopulmonary bypass cpb circuit is designed to perform four major functions. The normal physiologic functions of the heart and lungs, including circulation of blood, oxygenation, and ventilation, are temporarily taken over by the cpb machine. In summary, our strategy of rv bypass with membrane oxygenation can provide adequate and safe cardiopulmonary support during lung transplantation. Bypass of the heart and lungs for example, during openheart surgery. Coronary revascularization without cardiopulmonary bypass. The science and practice of cardiopulmonary bypass. Cardiopulmonary bypass and the anesthesiologist christina moramangano, md john l. Cardiac surgery has made significant progress since the advent of cardiopulmonary bypass. Central venous cannulation for cardiopulmonary bypass is usually accomplished by cannulation of the right atrial appendage, the lateral wall of the right atrium, the superior vena cava, or the inferior vena cava.
The use of cardiopulmonary bypass cpb technology allows cardiac surgical procedures to be performed in a motionless, bloodless surgical field. The technique allows the surgical team to oxygenate and circulate the patients blood, thus allowing the surgeon to operate on the heart. Perfusion can be accomplished by two forms of bypass. Special report the society of thoracic surgeons, the society of cardiovascular anesthesiologists, and the american society of extracorporeal technology. The cpb circuit is a unique device designed to divert a patients circulation around the area that requires surgical repair so that surgeons can operate. Favorable experience at our institution and elsewhere using axillary artery cannulation in treating type a aortic dissections has caused us to broaden our indications for using this site for arterial cannulation for cardiopulmonary bypass. Thruport systems and edwards cardiac cannulae product guide. The overall choice of cannula size is done by the computer, using the charts below. Cardiopulmonary bypass cpb has developed into an invaluable tool for operations on the thoracic viscera. The endovent pulmonary catheter is indicated for use in patients undergoing cardiopulmonary bypass. Choosing an ideal cannulation site, employing peri and intraoperative imaging, selecting an appropriate cannula, and avoiding complications are vital to success.
Blood pumps, circuitry, and cannulation techniques in. Society of thoracic surgeons blood conservation guideline task force, ferraris va, brown jr, et al. There are certain situations in redo cardiac surgery in adults where it may not be possible to use alternate arterial cannulation sites like the common femoral artery and axillary artery. Further, to provide myocardial protection, ischemic preconditioning was used.
As a general concept, cardiopulmonary bypass will temporarily bypass heart and lungs. Structurally, the book is of the quality one would expect for a reference text. Anesthetic management during cardiopulmonary bypass. Peripheral cannulation, using the femoral or other veins and arteries, is occasionally used electively for cardiac surgery when central cannulation is not technically possible.
Percutaneous femoral cannulation for cpb represents the least invasive approach, and is safe in. Cardiopulmonary bypass is a technique which allows performing open heart surgical procedures in a bloodless and motionless field. Arterial cannulation for bypass is a cornerstone to most cardiac procedures. Open and closed chest extrathoracic cannulation for cardiopulmonary bypass and extracorporeal life support. A primer was published by the cardiac surgery team at the university of washington, using the ibook electronic format. Cardiopulmonary bypass via common carotid artery cannulation. Cardiopulmonary bypass is a surgical technique that temporarily supports or replaces the function of the heart and lungs during various cardiothoracic surgical procedures, such as coronary artery bypass surgery, cardiac valve surgery, thoracic aorta surgery, and thoracic organ transplantation.
The senior authors technique will be highlighted and illustrated through an accompanying video, with discussion of helpful methods to avoid common pitfalls. In many operations, such as coronary artery bypass grafting cabg, the heart is arrested i. Extrathoracic cannulation to establish cpb has been widely applied in recent years and includes. Cardiopulmonary bypass cpb is a form of extracorporeal circulation in which the patients blood is diverted from the heart and lungs and rerouted outside of the body. Tears, late stenosis, thrombosis, bleeding, lymph fistula, infection in groin, cerebral or coronary. The cardiopulmonary bypass cpb circuit is designed to perform four major functions. Cardiopulmonary bypass complicated by inadvertent carotid cannulation. Blood returning to the heart is diverted through a heartlung machine a pumpoxygenator before it is returned to the arterial circulation. Clinical practice guidelines for cardiopulmonary bypass temperature management during cardiopulmonary bypass richard engelman, md, robert a. Systemic heparinization prior to initiation of cpb is mandatory, even in emergency situations. Introduction to cardiopulmonary bypass tsda boot camp july 2528, 20 chapel hill, nc. Pdf cardiopulmonary bypass cpb provides a bloodless field for cardiac surgery.
Cardiopulmonary bypass in the pediatric patient johns. The development of cardiopulmonary bypass cpb has enabled operative treatment for countless numbers of patients with a multitude of acquired and congenital cardiac and vascular anomalies. Cardiac surgery simulation curriculum simulationbased training in surgical skills and decision making richard h. We report a case where we established safe cardiopulmonary. Femoral artery perfusion for cardiopulmonary bypass i patients with aortoiliac artery obstruction n joseph s. The differences between ecmo and cardiopulmonary bypass are as follows. In addition, the success and relative ease of peripheral cannulation, among other technological advances, has permitted the. The cardiopulmonary bypass cpb circuit is intended to isolate the cardiopulmonary system so that optimal surgical exposure can be obtained for operations on the heart, lungs and great vessels. The ascending aorta is the customary site for arterial cannulation for cardiopulmonary bypass. Cardiopulmonary bypass cpb is a key component of these highly invasive surgical procedures, many of which are complex. Pdf aortoatriocaval cannulation for cardiopulmonary bypass. Various routes for cannulation for cardiopulmonary bypass cpb were discussed due to previous sternotomy and the xray finding of close proximity of the repaired ascending aorta to the sternum.
Femoral cannulation for cardiopulmonary bypass was utilized in 2,400 cases 90. Complications associated with femoral cannulation during. A correctable complication of cardiopulmonary bypass. A novel strategy for cardiopulmonary support during lung. This reservoir replaces the compliance of the veins. It is available as a free download from the apple ibook store. These, along with the steps to arterial cannulation, are discussed. At the end of the session, residents completed a written examination. Armed with ramphals specification documents, coore set about designing and building. Femoral cannulation during cardiopulmonary bypass has become a common approach for many cardiac procedures and serves as an important access option, especially during minimally invasive cardiac.
In general, one should wait 35 minutes after heparinization before initiating cpb. Cardiopulmonary bypass simulation at the boot camp. Pdf arterial cannulation after heparin has been administered, the adventitia within the purse string is incised. Repair andor palliation of congenital heart defects. Post bypass monitors right ventricular function and left heart decompression. Because of the lack of suitable cannulation sites for cardiopulmonary bypass, the decision was made to perform the coronary revascularization without cardiopulmonary bypass.
Boot camp cardiac faculty john alexander, md brian bethea, md. Surgical procedures in which cardiopulmonary bypass is used coronary artery bypass surgery. An accurate perfusion record must be maintained according to an established protocol. It is a device that does the work of providing blood and oxygen to the body when the heart is stopped for a surgical procedure. Pre bypass aortic valve and pfo during bypass assess inflow cannula placement. Nahush mokadam, has structured the publication in a very logical format, with chapters describing the circuit components, technical aspects of cardiopulmonary support, myocardial protection, nursing principles, anesthesia management, troubleshooting, and finally a brief summary of the history of cardiopulmonary bypass. The aortic cannula is always placed prior to the venous cannulas and removed last, because in the event of an emergency, the perfusionist can temporarily initiate cardiopulmonary bypass via a single aortic cannula i. Different types of cannulation techniques are available for minimally invasive cardiac surgery. In the case of venous cannulation, the choice as to single right atrial or double svc and ivc cannulation is made. Residents rated the sessions on cannulation skills, cardiopulmonary bypass knowledge, and cardiopulmonary bypass emergency and crisis scenarios on a 5point scale 5 very helpful to 1 not helpful.
A cardiopulmonary bypass machine cbm is commonly known as a heartlung bypass machine. Cannulation for cbp is typically performed centrally with an inflow cannula in the ascending aorta and outflow cannulas. History the first operation performed using cardiopulmonary bypass and open cardiotomy was on april 5, 1951 by dr. Pdf arterial and venous cannulation in cpb researchgate.