Acid-base Management in Cardiopulmonary Bypass

2021 ◽  
Vol 13 (2) ◽  
pp. 134-143
Author(s):  
Sonny Lesmana Surya ◽  
Yudi Hadinata
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Selective Cerebral Perfusion ◽  
Acid Base ◽  
Cerebral Dysfunction ◽  
Base Management ◽  
Ph Stat

Cardiopulmonary bypass (CPB) merupakan alat penunjang fungsi sirkulasi dan pernapasan pasien yang biasa digunakan ketika menjalani pembedahan jantung atau pembuluh darah besar. Selama prosedur CPB, kondisi hipotermia dipertahankan untuk menurunkan kebutuhan oksigen dan laju metabolisme. Kondisi hipotermia akan mempengaruhi keseimbangan asam-basa pada tubuh. Manajemen asam-basa selama prosedur CPB dicapai dengan menggunakan metode a-stat atau pH-stat. Pada metode a-stat, manajemen asam-basa dilakukan dengan menjaga pHa 7.4 dan PaCO2 40 mmHg pada suhu 37oC tanpa penambahan CO2 oksigen untuk menjaga total CO2 tetap konstan. Sedangkan, pada metode pH-stat, diberikan CO2 oksigen untuk menjaga PaCO2 40 mmHg dan pHa 7.4 secara in vivo. Masih banyak perdebatan terkait waktu penerapan masing-masing metode. Pada level mikrosirkulasi, manajemen a-stat terbukti memberikan keuntungan pada otak dan mengurangi insidensi postoperative cerebral dysfunction. Sedangkan, metode pH-stat dilaporkan meningkatkan risiko emboli otak, sehingga tidak disarankan untuk pasien yang memiliki risiko tinggi gangguan aliran darah otak. Namun, terdapat pula laporan yang menyatakan pH-stat bermanfaat pada operasi bedah jantung anak. Berdasarkan hal itu, usia pasien dapat menentukan waktu penggunaan metode a-stat dan pH-stat. Satu indikasi primer penggunaan pH-stat adalah selama proses pendinginan saat deep hypothermic circulatory arrest (DHCA), sedangkan metode a-stat lebih baik digunakan selama selective cerebral perfusion (SCP) dan rewarming.

scholarly journals Effects of circulatory arrest and cardiopulmonary bypass on cerebral autoregulation in neonatal swine

2021 ◽  
Author(s):  
Jonah A. Padawer-Curry ◽  
Lindsay E. Volk ◽  
Constantine D. Mavroudis ◽  
Tiffany S. Ko ◽  
Vincent C. Morano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cerebral Autoregulation ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Swine Model ◽  
Selective Cerebral Perfusion ◽  
Neurologic Injury

Abstract Background Cerebral autoregulation mechanisms help maintain adequate cerebral blood flow (CBF) despite changes in cerebral perfusion pressure. Impairment of cerebral autoregulation, during and after cardiopulmonary bypass (CPB), may increase risk of neurologic injury in neonates undergoing surgery. In this study, alterations of cerebral autoregulation were assessed in a neonatal swine model probing four perfusion strategies. Methods Neonatal swine (n = 25) were randomized to continuous deep hypothermic cardiopulmonary bypass (DH-CPB, n = 7), deep hypothermic circulatory arrest (DHCA, n = 7), selective cerebral perfusion (SCP, n = 7) at deep hypothermia, or normothermic cardiopulmonary bypass (control, n = 4). The correlation coefficient (LDx) between laser Doppler measurements of CBF and mean arterial blood pressure was computed at initiation and conclusion of CPB. Alterations in cerebral autoregulation were assessed by the change between initial and final LDx measurements. Results Cerebral autoregulation became more impaired (LDx increased) in piglets that underwent DH-CPB (initial LDx: median 0.15, IQR [0.03, 0.26]; final: 0.45, [0.27, 0.74]; p = 0.02). LDx was not altered in those undergoing DHCA (p > 0.99) or SCP (p = 0.13). These differences were not explained by other risk factors. Conclusions In a validated swine model of cardiac surgery, DH-CPB had a significant effect on cerebral autoregulation, whereas DHCA and SCP did not. Impact Approximately half of the patients who survive neonatal heart surgery with cardiopulmonary bypass (CPB) experience neurodevelopmental delays. This preclinical investigation takes steps to elucidate and isolate potential perioperative risk factors of neurologic injury, such as impairment of cerebral autoregulation, associated with cardiac surgical procedures involving CPB. We demonstrate a method to characterize cerebral autoregulation during CPB pump flow changes in a neonatal swine model of cardiac surgery. Cerebral autoregulation was not altered in piglets that underwent deep hypothermic circulatory arrest (DHCA) or selective cerebral perfusion (SCP), but it was altered in piglets that underwent deep hypothermic CBP.

A cardiopulmonary bypass strategy to support a patient with vein of Galen malformation

Perfusion ◽  
2021 ◽  
pp. 026765912110015
Author(s):  
Alex Robertson ◽  
Nagarajan Muthialu ◽  
Mike Broadhead
Keyword(s):  
Cardiopulmonary Bypass ◽  
Surgical Repair ◽  
Circulatory Arrest ◽  
Ductus Arteriosus ◽  
Venous Drainage ◽  
Deep Hypothermic Circulatory Arrest ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Neurological Sequelae ◽  
Ph Stat

We present a dissection of the patent ductus arteriosus and pulmonary artery for surgical repair utilising cardiopulmonary bypass in the setting of vein of Galen malformation. Several strategies were employed to attenuate the cerebral shunt including pH-stat, high cardiac index, restrictive venous drainage, continuous ventilation and deep hypothermic circulatory arrest. The patient recovered from surgery with no apparent neurological sequelae.

scholarly journals Results of Proximal Arch Replacement Using Deep Hypothermia for Circulatory Arrest: Is Moderate Hypothermia Really Justifiable?

2011 ◽  
Vol 77 (11) ◽  
pp. 1438-1444 ◽  
Author(s):  
Brian Lima ◽  
Judson B. Williams ◽  
S. Dave Bhattacharya ◽  
Asad A. Shah ◽  
Nicholas Andersen ◽  
...  
Keyword(s):  
Renal Failure ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Deep Hypothermia ◽  
Aortic Root Replacement ◽  
Moderate Hypothermia ◽  
Selective Cerebral Perfusion ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement

The use of selective cerebral perfusion with warmer temperatures during circulatory arrest has been increasingly used for arch replacement over concerns regarding the safety of deep hypothermic circulatory arrest (DHCA). However, little data actually exist on outcomes after arch replacement and DHCA. This study examines modern results with DHCA for proximal arch replacement to provide a benchmark for comparison against outcomes with lesser degrees of hypothermia. Between July 2005 and June 2010, 245 proximal arch replacements (“hemiarch”) were performed using deep hypothermia; mean minimum core and nasopharyngeal temperatures were 18.0 ± 2.1°C and 14.1 ± 1.6°C, respectively. Adjunctive cerebral perfusion was used in all cases. Concomitant ascending aortic replacement was performed in 41 per cent, ascending plus aortic valve replacement in 23 per cent, and aortic root replacement in 32 per cent. Mean age was 58 ± 14 years; 36 per cent procedures were urgent/emergent. Mean duration of DHCA was 20.4 ± 6.2 minutes. Thirty-day/in-hospital mortality was 2.9 per cent. Rates of stroke, renal failure, and respiratory failure were 4.1 per cent (0.8% for elective cases), 1.2 per cent, and 0.4 per cent, respectively. Deep hypothermia with adjunctive cerebral perfusion for circulatory arrest during proximal arch replacement affords excellent neurologic as well as nonneurologic outcomes. Centers using lesser degrees of hypothermia for arch surgery, the safety of which remains unproven, should ensure comparable results.

Acid-Base Management Alters Cerebral Perfusion during Cardiopulmonary Bypass

1994 ◽  
Vol 81 (SUPPLEMENT) ◽  
pp. A1399
Author(s):  
F. A. Burrows ◽  
R. A. Jonas ◽  
P. R. Hickey
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Perfusion ◽  
Acid Base ◽  
Base Management
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