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Cardiopulmonary Bypass ThirdEdition P blih d li b C bid i i P P blih d li b C bid i i P Cardiopulmonary Bypass Edited by Florian Falter RoyalPapworthHospital,Cambridge Albert C Perrino YaleUniversityMedicalCenter,NewHaven,CT Robert A. Baker FlindersMedicalCentreandFlindersUniversity,Adelaide TheeditorsareverygratefultoDrGhosh,whostartedthisprojectandledthefirsttwoeditions fromideatoprintedbook P blih d li b C bid i i P ShaftesburyRoad,CambridgeCB28BS,UnitedKingdom OneLibertyPlaza,20thFloor,NewYork,NY10006,USA 477WilliamstownRoad,PortMelbourne,VIC3207,Australia 314–321,3rdFloor,Plot3,SplendorForum,JasolaDistrictCentre, NewDelhi–110025,India 103PenangRoad,#05–06/07,VisioncrestCommercial,Singapore238467 CambridgeUniversityPressispartofCambridgeUniversityPress&Assessment, adepartmentoftheUniversityofCambridge. WesharetheUniversity’smissiontocontributetosocietythroughthepursuitof education,learningandresearchatthehighestinternationallevelsofexcellence. www.cambridge.org Informationonthistitle:www.cambridge.org/9781009009621 DOI:10.1017/9781009008143 ©CambridgeUniversityPress&Assessment2022 Thispublicationisincopyright.Subjecttostatutoryexceptionandtotheprovisions ofrelevantcollectivelicensingagreements,noreproductionofanypartmaytake placewithoutthewrittenpermissionofCambridgeUniversityPress&Assessment. Firstpublished2009 Secondedition2015 Thirdedition2022 PrintedintheUnitedKingdombyTJBooksLimited,PadstowCornwall AcataloguerecordforthispublicationisavailablefromtheBritishLibrary. LibraryofCongressCataloging-in-PublicationData Names:Falter,Florian,editor.|Perrino,AlbertC.,Jr.editor.|Baker,RobertA, 1960-editor. Title:Cardiopulmonarybypass/editedbyFlorianFalter,AlbertC.Perrino, RobertA.Baker. Othertitles:Cardiopulmonarybypass(Ghosh) Description:Thirdedition.|Cambridge,UnitedKingdom;NewYork,NY: CambridgeUniversityPress,[2022]|PrecededbyCardiopulmonary bypass/editedbySunitGhosh,FlorianFalter,AlbertC.Perrino,Jr. Secondedition.2015|Includesbibliographicalreferencesandindex. Identifiers:LCCN2022010263(print)|LCCN2022010264(ebook)| ISBN9781009009621(paperback)|ISBN9781009008143(epub) Subjects:MESH:CardiopulmonaryBypass–methods|CardiacSurgical Procedures–methods Classification:LCCRD598(print)|LCCRD598(ebook)|NLMWG168.5| DDC617.4/120592–dc23/eng/20220511 LCrecordavailableathttps://lccn.loc.gov/2022010263 LCebookrecordavailableathttps://lccn.loc.gov/2022010264 ISBN978-1-009-00962-1Paperback CambridgeUniversityPress&Assessmenthasnoresponsibilityforthe persistenceoraccuracyofURLsforexternalorthird-partyinternetwebsites referredtointhispublicationanddoesnotguaranteethatanycontenton suchwebsitesis,orwillremain,accurateorappropriate. .................................................................. Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to- dateinformationthatisinaccordwithacceptedstandardsandpracticeatthetime ofpublication.Althoughcasehistoriesaredrawnfromactualcases,everyefforthas beenmadetodisguisetheidentitiesoftheindividualsinvolved.Nevertheless,the authors,editors,andpublisherscanmakenowarrantiesthattheinformation containedhereinistotallyfreefromerror,notleastbecauseclinicalstandardsare constantlychangingthroughresearchandregulation.Theauthors,editors,and publishersthereforedisclaimallliabilityfordirectorconsequentialdamages resultingfromtheuseofmaterialcontainedinthisbook.Readersarestrongly advisedtopaycarefulattentiontoinformationprovidedbythemanufacturerof anydrugsorequipmentthattheyplantouse. P blih d li b C bid i i P Contents List of Contributors vi Foreword ix Alan Merry 11 Myocardial Preservation during Cardiopulmonary Bypass 102 Gudrun Kunst, Luc PuisandTom Gilbey 1 Human FactorsandTeamwork in 12 Weaning from Cardiopulmonary Bypass 112 Cardiac Surgery 1 Joanne F Irons, KennethGShann LindsayWetzel,David Fitzgerald, Thoralf M and MichaelPoullis Sundt and James HAbernathy III 13 Intraoperative Mechanical Circulatory 2 Equipment for Cardiopulmonary Bypass 9 Supportand Other Uses of Simon Anderson andAmandaCrosby Cardiopulmonary Bypass 123 Mark Bucklandand JessicaUnderwood 3 Monitoring during Cardiopulmonary Bypass 25 14 Mechanical Circulatory Support 138 RichardFNewland and Pascal Starinieri Jason MAli,Ayyaz Aliand Yasir Abu-Omar 4 Cardiopulmonary Bypass Circuit Setup and 15 Cardiopulmonary Bypass for Pediatric Safety Checks 34 Cardiac Surgery 150 VictoriaMolyneux and Shahna Helmick Joseph JSistino andTimothy J Jones 5 Priming Solutions forCardiopulmonary 16 Coagulopathy andHematologicalDisorders BypassCircuits 42 Associated with Filip De Somer and Robert Young Cardiopulmonary Bypass 156 Bruce DSpiess and Erik Ortmann 6 Anticoagulation for Cardiopulmonary Bypass 49 17 Inflammation andOrgan Damageduring Martin Besserand Linda Shore-Lesserson Cardiopulmonary Bypass 166 R Clive Landis and Sherif Assaad 7 Conduct of Cardiopulmonary Bypass 57 Christiana Burt, Timothy A Dickinson, Narain 18 Neuromonitoring and CerebralMorbidity Moorjani and Caitlin Blau Associated with Cardiopulmonary Bypass 175 8 MinimalInvasive EtienneJ Couture, Stéphanie Jarry and André Extracorporeal Circulation 71 Y Denault Kyriakos Anastasiadis, Polychronis Antonitsis, Helena Argiriadou andApostolos 19 Renal Morbidity Associated with Deliopoulos Cardiopulmonary Bypass 184 Juan Pablo Domecqand Robert C Albright 9 ConsiderationsforOperationsInvolvingDeep HypothermicCirculatory Arrest 80 20 Common andUncommon Disasters during Pingping SongandJoseph E Arrowsmith Cardiopulmonary Bypass 194 GregoryMJanelle,JaneOttensandMichaelFranklin 10 Metabolic Management during Cardiopulmonary Bypass 92 Jonathan Brand and Edward M Darling Index 205 v P blih d li b C bid i i P Contributors James H.Abernathy III Helena Argiriadou Associate Professor, Interim Executive Vice Chair, Cardiac Anesthesiologist, Assistant Professor, ACCM Chief, Divisionof Cardiac Anesthesiology Aristotle University of Thessaloniki Core Faculty,Armstrong Instituteof PatientSafety, Joseph E. Arrowsmith Department of Anesthesiology & Critical Care Consultant Anaesthetist,Departmentof Anaesthesia Medicine,Johns Hopkins University &IntensiveCareMedicine, Royal Papworth Yasir Abu-Omar Hospital Director, Cardiothoracic Transplantation and Sherif Assaad MechanicalCirculatorySupport,UniversityHospitals Associate Professor, Cleveland Clinic LernerCollege Cleveland Medical Center ofMedicine | Case Western Reserve University,and Robert C. Albright Jr StaffAnesthesiologist, Departmentof Cardiothoracic Consultant,Division of Nephrology and HTN Mayo Anesthesiology | Anesthesiology Institute, Cleveland Clinic Rochester;Professorof Medicine, Division of Clinic Nephrologyand HTN, Mayo Clinic College of Martin Besser Medicine,Mayo Clinic, Rochester;RegionalVice Consultant Haematologist, Royal Papworth President, Mayo Clinic Health System Southeast; Hospital Professor of Medicine;Consultant, Division of Nephrologyand Hypertension Caitlin Blau Ayyaz Ali Perfusion Supervisor, Mayo Clinic Vice Chairman of CardiacSurgeryand Surgical Jonathan Brand Director of Heart Transplantation and Mechanical Clinical Directorand Consultant in Cardiothoracic CirculatorySupport, Hartford Hospital AnaesthesiaandCriticalCare,JamesCookUniversity Jason M. Ali Hospital, Middlesbrough Locum Consultant in Cardiothoracic andTransplant Mark Buckland Surgery, RoyalPapworth Hospital Deputy Director, Head of Cardiothoracic Kyriakos Anastasiadis Anaesthesia, Departmentof Anaesthesiology & Perioperative Medicine, Alfred Hospital and Monash Professor, Department ofCardiothoracic Surgery, University Aristotle University of Thessaloniki ChristianaBurt Simon Anderson Consultant Anaesthetist,Royal PapworthHospital Clinical Perfusion Team Leader,Cambridge Perfusion Services, Royal PapworthHospital Etienne J. Couture Polychronis Antonitsis Anesthesiologist &Intensivist,Institut universitaire decardiologie etde pneumologie de Québec – Associate Professor, Department of Cardiothoracic Université Laval (IUCPQ-UL) vi Surgery, Aristotle University of Thessaloniki P blih d li b C bid i i P ListofContributors AmandaCrosby Joanne F.Irons Staff Perfusionist, University of TennesseeMedical SeniorLecturer,UniversityofSydney;StaffSpecialist Center Anaesthetist, Royal Prince AlfredHospital Edward M. Darling Gregory M. Janelle Associate Professor,College of Health Professions, ProfessorofAnesthesiologyandSurgeryandAssociate Department of CardiovascularPerfusion,SUNY ChairforClinicalAffairs,DepartmentofAnesthesiology, UpstateMedical University;Faculty/Clinical UniversityofFloridaCollegeofMedicine Coordinator Stéphanie Jarry Filip DeSomer PhD candidate,Departmentof Anesthesiology, ProfessorinPerfusionTechnology,UniversityGhent, MontrealHeart Institute,Université deMontréal Chief Perfusionist, University Hospital Ghent Timothy J. Jones Apostolos Deliopoulo ConsultantCongenitalCardiacSurgeon,Birmingham Perfusionist, Cardiothoracic Department, Aristotle Women’sandChildren’s Hospital, University University of Thessaloniki HospitalsBirmingham; HonorarySenior Lecturer, Instituteof Cardiovascular Science,University of André Y. Denault Birmingham Professor, and Anesthesiologist &Intensivist, MontrealHeart Institute,Université deMontréal Gudrun Kunst ProfessorofCardiovascularAnaesthesia,Department Timothy A. Dickinson of Anaesthetics and Pain Medicine,King’s College AssistantProfessorof Surgery, CCP, Mayo Clinic; HospitalNHSFoundation Trust& School of Director,Perfusion Services CardiovascularMedicineandSciences,King’sCollege London;Consultant Anaesthetist and Professor of Juan Pablo Domecq CardiovascularAnaesthesia, British Heart SeniorAssociateConsultant,DivisionofNephrology, Foundation Centre of Research Excellence HypertensionandCriticalCareMedicine,MayoClinic, Rochester,andMayoClinic,Mankato;Assistant R. Clive Landis ProfessorofMedicine,MayoClinicCollegeofMedicine Professorof Cardiovascular Research, andPro Vice ChancellorandPrincipal,TheUniversityoftheWest David Fitzgerald Indies,Cave Hill Campus AssistantProfessor,DivisionDirector,CVPProgram, Medical University of South Carolina Victoria Molyneux SeniorClinical Perfusionist, Great Ormond Street MichaelFranklin ClinicalAssistant Professor –Cardiothoracic Hospitalfor Children NHS Foundation Trust Anesthesiology, University of Florida Narain Moorjani Consultant CardiacSurgeon &ClinicalLead for Tom Gilbey CardiacSurgery, Royal PapworthHospital; Affiliated Anaesthetic Registrar and NIHR Academic Clinical AssistantProfessor, University ofCambridge; Fellow, Department of Anaesthetics and Pain Medicine, King’s College HospitalNHSFoundation President,SocietyforCardiothoracicSurgeryinGreat Britain & Ireland Trust Richard F.Newland Shahna Helmick SeniorPerfusionist& Clinical Lead forPerfusion, ProgramDirectorofPerfusionEducation,University Flinders Medical Centre and Lecturer, Flinders of Iowa Hospitals andClinics University vii P blih d li b C bid i i P ListofContributors Erik Ortmann Center; Medical Director, Cardiothoracic Intensive Chair, Departmentof Anaesthesiology, Care Unit Schüchtermann-Heart-Centre Bruce D. Spiess Jane Ottens Professor and Associate Chair (Research), University Chief Perfusionist, AshfordHospital ofFlorida Collegeof Medicine Michael Poullis Pascal Starinieri Senior Fellow Cardiothoracic Surgery, Manchester Clinical Perfusionist, JESSAHospital Royal Infirmary Thoralf M. Sundt LucPuis Chief, Division of CardiacSurgery,Director of Senior Perfusionist, University Hospital Brussels, Cardiac Surgery Clinical Service,and Edward D. Center for Heart and Vascular Diseases ChurchillProfessor of Surgery, Harvard Medical School,Massachusetts General Kenneth G. Shann Hospital Director, Perfusion Services, MassachusettsGeneral Hospital Jessica Underwood Perfusionist, AlfredHospital; Director,Victorian Linda Shore-Lesserson Perfusion Specialists Professor of Anesthesiology,Zucker Schoolof MedicineatHofstraNorthwell;ViceChairAcademic Lindsay Wetzel Affairs; Director,Cardiovascular Anesthesiology Cardiac Anesthesiologist, TriHealth Heart Institute- Seven Hills Anesthesia Joseph J. Sistino Professor Emeritus,Medical University of South Robert Young Carolina College of Health Professions SpecialistCardiothoracicAnaesthetist,Departmentof Anaesthesia, Flinders Medical Centre Pingping Song AssistantProfessor,DepartmentofAnesthesiology& Pain Medicine, University of Washington Medical viii P blih d li b C bid i i P Foreword Sixyearsafterthepublicationofthesecondeditionof edition, the editors have achieved a consistency of Cardiopulmonary Bypass, Florian Falter, Robert style and message with a minimum of repetition. BakerandAlbertCPerrinohaveproducedasubstan- Thus, the book feels coherent and has a logical flow tial revision of this highly regarded text. Success in of ideas. As before, there is effective use of illustra- cardiac surgery requires each member of the team to tions and tables and a good bibliography of selected be expert in thetheory and capable inthe practice of referencesforeachchapter.Thebookwillcontinueto theirindividualdiscipline,butitalsorequiresthemto provide an outstanding introduction to this field of work together effectively as a team, often for long practice,bothforsurgeonsandanesthetists,whopri- hours under considerable stress.It isthus very pleas- marily need to understand and contribute to the ingtoseeastrongnewemphasisonteamwork,com- management of cardiopulmonary bypass or mechan- munication and human factors added to this already ical circulatory support, and for perfusionists who excellent book. This emphasis is reflected in the alsohavetosetupandruntheequipment.Forthose renewed authorship of each chapter, which (in most alreadyexpertinthisfield,itwillprovideatechnically cases) now includes all three of the disciplines key to up-to-date source for revision of the relevant topics the management of cardiopulmonary bypass – anes- from ahighly contemporary perspective. thesia, perfusion and surgery. The list of editors and The editors work in leading institutions in their authorsisa“Who’sWho”ofthisfieldandreflectsnot respective countries (England, Australia and the only deep expertise in the relevant topics but also United States). Each is known for leadership and established ability to disseminate knowledge through innovation within their discipline. The same can be lecturingandwriting.Theresult,asonemightexpect, saidforthechapterauthors.Itisunsurprisingthatthe is a scientifically sound, clearly written and highly bookcarriesatoneofauthoritythatwillleavereaders accessible text. It is a text that will (like the previous confidentinthereliabilityoftheinformationandthe edition) be an excellent source of practical hands-on soundness ofthe perspectives within it. advice on how to apply the underpinning principles I offer the editors and the authors my hearty to the everyday practice of cardiopulmonary bypass congratulations. within the dynamic context of cardiac surgery. Thenumber ofchapters hasincreased from 16to Alan Merry FANZCA, FFPMANZCA, FRSNZ 20, but new material has been incorporatedthrough- Professor of Anaesthesiology,University of out. The themes of teamwork, communication, Auckland, checklists and safety (both Safety-I and Safety-II) Specialistin Anaesthesia, Auckland City Hospital, run through the entire book. As with the previous New Zealand. ix P blih d li b C bid i i P