Cardiopulmonary Bypass: Principles and Practice PDF
Preview Cardiopulmonary Bypass: Principles and Practice
Cardiopulmonary Bypass Cardiopulmonary Bypass Principles and Practice Third Edition GLENN P. GRAVLEE, MD Professor,DepartmentofAnesthesiology UniversityofColoradoatDenverandHealthSciencesCenter Denver,Colorado RICHARD F. DAVIS, MD, MBA Professor DepartmentofAnesthesiologyandPerioperativeMedicine OregonHealthandScienceUniversity Portland,Oregon ALFRED H. STAMMERS, MSA, CCP DirectorofPerfusionServices DivisionofCardiothoracicandVascularSurgery GeisingerHealthSystem Danville,Pennsylvania ROSS M. UNGERLEIDER, MD, MBA ProfessorandChief,CardiothoracicSurgery ProgramDirector,CardiothoracicSurgeryResidencyTrainingProgram OregonHealthandScienceUniversity JohnC.HurshChair,PediatricCardiacSurgery DoernbecherChildren’sHospital Portland,Oregon AcquisitionsEditor:BrianBrown ManagingEditor:NicoleT.Dernoski ProjectManager:RosanneHallowell ManufacturingManager:KathleenBrown MarketingManager:AngelaPanetta DesignCoordinator:DougSmock CoverDesigner:ScottRattray ProductionServices:LaserwordsPrivateLimited,Chennai,India 2008byLIPPINCOTTWILLIAMS&WILKINS,aWoltersKluwerbusiness 2000byLIPPINCOTTWILLIAMS&WILKINS 530WalnutStreet Philadelphia,PA19106USA LWW.com Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproducedinanyformorbyany means,includingphotocopying,orutilizedbyanyinformationstorageandretrievalsystemwithoutwrittenpermissionfrom thecopyrightowner,exceptforbriefquotationsembodiedincriticalarticlesandreviews.Materialsappearinginthisbook preparedbyindividualsaspartoftheirofficialdutiesasU.S.governmentemployeesarenotcoveredbytheabove-mentioned copyright. PrintedintheUSA LibraryofCongressCataloging-in-PublicationData Cardiopulmonarybypass:principlesandpractices/[editedby]GlennP.Gravlee...[etal.].—3rded. p.;cm. Includesbibliographicalreferencesandindex. ISBN978-0-7817-6815-3 1.Cardiopulmonarybypass.I.Gravlee,GlennP. [DNLM:1.CardiopulmonaryBypass.WG168C26622008] RD598.C35442008 617.4’12059—dc22 2007024060 Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentedandtodescribegenerallyacceptedpractices. However,theauthors,editors,andpublisherarenotresponsibleforerrorsoromissionsorforanyconsequencesfrom applicationoftheinformationinthisbookandmakenowarranty,expressedorimplied,withrespecttothecurrency, completeness,oraccuracyofthecontentsofthepublication.Applicationofthisinformationinaparticularsituationremains theprofessionalresponsibilityofthepractitioner. Theauthors,editors,andpublisherhaveexertedeveryefforttoensurethatdrugselectionanddosagesetforthinthistext areinaccordancewithcurrentrecommendationsandpracticeatthetimeofpublication.However,inviewofongoing research,changesingovernmentregulations,andtheconstantflowofinformationrelatingtodrugtherapyanddrug reactions,thereaderisurgedtocheckthepackageinsertforeachdrugforanychangeinindicationsanddosageandfor addedwarningsandprecautions.Thisisparticularlyimportantwhentherecommendedagentisaneworinfrequently employeddrug. SomedrugsandmedicaldevicespresentedinthispublicationhaveFoodandDrugAdministration(FDA)clearancefor limiteduseinrestrictedresearchsettings.ItistheresponsibilityofthehealthcareprovidertoascertaintheFDAstatusof eachdrugordeviceplannedforuseintheirclinicalpractice. Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartmentat(800)638-3030orfaxordersto (301)223-2320.Internationalcustomersshouldcall(301)223-2300. VisitLippincottWilliams&WilkinsontheInternet:atLWW.com.LippincottWilliams&Wilkinscustomerservice representativesareavailablefrom8:30amto6pm,EST. 10 9 8 7 6 5 4 3 2 1 We dedicatethis third editiontoourpreviouscoeditorfor the firstandsecond editions,thelateJoeR.Utley,MD.Dr.Utley’slongandaccomplishedcareerin cardiac surgerywasmarkedbyinspirationalinnovationsin the scienceand clinical practice ofcardiopulmonarybypass.We believethat Joederivedhis greatestprofessionalsatisfaction fromeducationaladvancements, innovationssuch asan annualmultidisciplinarymeetingabout cardiopulmonarybypass,andthedevelopmentandpublicationofthefirstand secondeditionsof Cardiopulmonary Bypass:Principles andPractice.We misshis leadership,creativity, andfriendship.We sincerelyhopethat he wouldhave agreed that thethird editionhas remainedtrueto theprinciples and trajectorywe establishedin the firsttwoeditions.Thankyou, Joe. C O N T E N T S Contributors viii 10 MyocardialProtection 172 Preface xiii MatthewS.Slater,ChristopherB.Komanapalli, PrefacetotheFirstEdition xiv andHowardSong Acknowledgments xv 11 ChangesinthePharmacokineticsand PharmacodynamicsofDrugsAdministered DuringCardiopulmonaryBypass 190 SECTION I: HISTORY 1 RichardI.HallandBlaineKent 12 EmbolicEvents 261 1 HistoricalDevelopmentofCardiopulmonary RobertA.BakerandDavidA.Stump BypassinMinnesota 3 C.WaltonLillehei 13 Endocrine,Metabolic,andElectrolyte Responses 282 2 TheBirthofanIdeaandtheDevelopment ScottG.WalkerandJohnF.Butterworth ofCardiopulmonaryBypass 21 HarrisB.Shumacker 14 CardiopulmonaryBypassandtheLung 311 VivekK.MoitraandRobertN.Sladen 15 ImmuneSystemandInflammatoryResponses SECTION II: EQUIPMENT 33 toCardiopulmonaryBypass 321 MustafaZakkar,KennethTaylor,andPhilipI.Hornick 3 BloodPumpsinCardiopulmonaryBypass 35 16 KidneyFunctionandCardiopulmonary FilipM.J.J.DeSomerandGuidoVanNooten Bypass 338 4 PrinciplesofOxygenatorFunction:Gas DavidM.Rothenberg Exchange,HeatTransfer,andOperation 47 17 SplanchnicVisceral,Metabolic,and AlfredH.StammersandCodyC.Trowbridge GlucoregulatoryEffectsofCardiopulmonary 5 CircuitryandCannulationTechniques 63 Bypass 352 EugeneA.HesselII VeronicaChristineSwansonandRobertE.Shangraw 6 UltrafiltrationandDialysis 114 18 NeurologicEffectsofCardiopulmonary RobinG.SuttonandDavidM.Rothenberg Bypass 376 7 MechanicalCirculatorySupportDevices 128 DavidJ.Cook RichardG.SmithandJackG.Copeland 8 CardiopulmonaryBypassforMinimally SECTION IV: HEMATOLOGY 409 InvasiveCardiacSurgery 140 MatthewL.Kolz,JohnM.Toomasian,andChristina 19 HemodilutionandPrimingSolutions 411 T.MoraMangano JohnR.Cooper,Jr.andN.MartinGiesecke 20 TheBlood–SurfaceInterface 423 SECTION III: PHYSIOLOGY AND L.HenryEdmunds,Jr. PATHOLOGY 153 21 HematologicEffectsandCoagulopathy 439 ChristineS.Rinder 9 TemperatureManagementinCardiacSurgery 155 22 CoagulationTesting 459 LaurieK.Davies JayC.HorrowandJosefNileMueksch vi Contents vii 23 AnticoagulationforCardiopulmonaryBypass 32 PerfusionforThoracicAorticSurgery 647 472 JosephHuh,ScottA.LeMaire,JohnBozinovski, LindaShore-LessersonandGlennP.Gravlee andJosephS.Coselli 24 HeparinNeutralization 502 33 NoncardiacSurgicalApplications DharmenderChandokandMarkE.Comunale ofCardiopulmonaryBypass 662 DavidJ.Cook,StephenAniskevich,andMichael 25 PharmacologicProphylaxisfor J.Murray Post–CardiopulmonaryBypassBleeding 522 GlennP.GravleeandBruceSpiess SECTION VI: NEONATES, INFANTS, AND CHILDREN 683 SECTION V: CLINICAL APPLICATIONS 541 34 PediatricCardiopulmonaryBypassOverview: StateoftheArtandFuture 685 26 ConductofCardiopulmonaryBypass 543 CarmenGiacomuzzi,BrianMejak,andIrvingShen RichardF.Davis,MarkKurusz,andVincentR.Conti 35 MyocardialProtectionandPreservation 27 Teamwork:ASystems-BasedPractice 572 forNeonatesandInfants 700 JamieDickeyandRossM.Ungerleider PaulJ.Chai 28 PrimumNonNocere:PatientSafety 36 BrainInjuryFollowingInfantCardiac inCardiopulmonaryBypass 589 SurgeryandNeuroprotectiveStrategies 710 ValerieSera EdwardJ.Hickey,TaraKaramlou, andRossM.Ungerleider 29 UnusualProblemsinCardiopulmonary Bypass 608 37 ECMOforInfantsandChildren 735 LudwigK.vonSegesser D.MichaelMcMullan,MartinJ.Elliot, andGordonA.Cohen 30 TerminationofCardiopulmonaryBypass 614 RogerL.Royster,StephenJ.Thomas, 38 CirculatoryAssistDevicesforInfants andRichardF.Davis andChildren 756 ChitraRavishankarandJ.WilliamGaynor 31 ECMOforRespiratorySupportinAdults 632 ScottK.Aberegg,StephenKirkby,andMarkCrowley Index 767 C O N T R I B U T O R S ScottK.Aberegg,MD,MPH GordonA.Cohen,MD,PhD AssistantProfessorofClinicalMedicine Chief,PediatricCardiacSurgery TheOhioStateUniversityCollegeofMedicine Children’sHospitalandRegionalMedicalCenter DivisionofPulmonary,CriticalCare,andSleepMedicine UniversityofWashingtonSchoolofMedicine Columbus,Ohio Seattle,Washington StephenAniskevichIII,MD SeniorAssociateConsultant MarkE.Comunale,MD DepartmentofAnesthesiology ProfessorandChairman MayoClinicCollegeofMedicine DepartmentofAnesthesiologyandCriticalCareMedicine Jacksonville,Florida SaintLouisUniversitySchoolofMedicine; DepartmentofAnesthesiologyandCriticalCareMedicine RobertA.Baker,PhD,DipPerf,CCP(Aust) SaintLouisUniversityHospital SeniorLecturer SaintLouis,Missouri DepartmentofMedicine FlindersUniversity; VincentR.Conti,MD Director,CardiacSurgeryResearchandPerfusion Professor DepartmentofCardiacandThoracicSurgery DepartmentofSurgery FlindersMedicalCentre Chief,DivisionofCardiothoracicSurgery Adelaide,Australia UniversityofTexasMedicalBranch Galveston,Texas JohnBozinovski,MD,MSc,FRCSC AttendingCardiacSurgeon DepartmentofSurgery DavidJ.Cook,MD RoyalJubileeHospital Professor Victoria,Canada DepartmentofAnesthesiology MayoClinicofMedicine; JohnF.Butterworth,MD StaffConsultant RobertK.StoeltingProfessorandChair DepartmentofAnesthesiology DepartmentofAnesthesia SaintMary’sHospital IndianaUniversitySchoolofMedicine; Rochester,Minnesota Codirector DepartmentofAnesthesiaService ClarianHealthPartners JohnR.Cooper,Jr.,MD Indianapolis,Indiana Professor DepartmentofAnesthesiology PaulJ.Chai,MD DivisionofCardiovascularAnesthesiology AttendingPediatricCardiacSurgeon BaylorCollegeofMedicine; TheCongenitalHeartInstituteofFlorida(CHIF) InterimChief SaintJoseph’sChildren’sHospitalofTampa DepartmentofCardiovascularAnesthesia AllChildren’sHospital TexasHeartInstituteatSt.Luke’sEpiscopalHospital Tampa,Florida Houston,Texas DharmenderChandok,MD AssistantProfessorofAnesthesiology JackG.Copeland,MD DepartmentofAnesthesiologyandCriticalCare Professor SaintLouisUniversitySchoolofMedicine; DepartmentofSurgery DirectorofCardiacAnesthesiaandPerioperative UniversityofArizona; Echocardiography Chief DepartmentofAnesthesiologyandCriticalCareMedicine SectionCardiothoracicSurgery SaintLouisUniversityHospital UniversityMedicalCenter SaintLouis,Missouri Tucson,Arizona viii Contributors ix JosephS.Coselli,MD CarmenGiacomuzzi,BSN,CCP ProfessorandCullenFoundationEndowedChair Instructor,PediatricPerfusion DivisionofCardiothoracicSurgery PediatricPerfusion/ECMOServices BaylorCollegeofMedicine; DoernbecherChildren’sHospital Chief OregonHealthandScienceUniversity AdultCardiacSurgerySection Portland,Oregon TheTexasHeartInstituteatSt.Luke’sEpiscopalHospital Houston,Texas N.MartinGiesecke,MD AssistantProfessor MarkCrowley,MD DepartmentofAnesthesiology AssociateProfessor DivisionofCardiovascularAnesthesiology DepartmentofPediatrics BaylorCollegeofMedicine; UniversityofNewMexicoSchoolofMedicine StaffAnesthesiologist Albuquerque,NewMexico DepartmentofCardiovascularAnesthesiology LaurieK.Davies,MD,MBA St.Luke’sEpiscopalHospital/TexasHeartInstitute AssociateProfessor Houston,Texas DepartmentofAnesthesiologyandSurgery UniversityofFlorida; GlennP.Gravlee,MD Chief Professor,DepartmentofAnesthesiology PediatricCardiothoracicAnesthesiology UniversityofColoradoDenverandHealthSciencesCenter UniversityofFlorida Denver,Colorado Gainesville,Florida RichardF.Davis,MD,MBA RichardI.Hall,MD,FRCPC,FCCP Professor Professor DepartmentofAnesthesiologyandPerioperativeMedicine DepartmentofAnesthesia,Medicine&Pharmacology OregonHealthandScienceUniversity AssociateProfessorofSurgery Portland,Oregon DalhousieUniversity; CardiacAnesthesiologist,Intensivist FilipM.J.J.DeSomer,ECCP,PhD DepartmentofAnesthesia ChiefPerfusionist QueenElizabethIIHealthSciencesCentre DepartmentofHeartCentre5IE-K12 Halifax,NovaScotia,Canada UniversityHospitalGent Gent,Belgium EugeneA.HesselII,MD,FACS Professor JamieDickey,PhD DepartmentofAnesthesiologyandSurgery AssistantProfessor UniversityofKentuckyCollegeofMedicine; DepartmentofPsychiatry AttendingAnesthesiologist DirectorofInterdisciplinaryEducationandExecutiveCoach DepartmentofAnesthesiology OregonHealthandScienceUniversity UniversityofKentuckyAlbertChandlerMedicalCenter Portland,Oregon Lexington,Kentucky L.HenryEdmunds,Jr.,MD JulianJohnsonProfessorofCardiothoracicSurgery EdwardJ.Hickey,MRCS,DM DepartmentofSurgery JohnKirklinFellow UniversityofPennsylvaniaSchoolofMedicine TheCongenitalHeartSurgeons’Society Philadelphia,Pennsylvania TheHospitalforSickChildren,Toronto Toronto,Ontario,Canada MartinJ.Elliot,MD,FRCS Chief,PediatricCardiacSurgery GreatOrmondStreetHospitalNHSTrust PhilipI.Hornick,BSc(Hons),PhD,MB,BChir,FRCS(Eng), London,UnitedKingdom FRCS(CTh),FESC SeniorLecturer J.WilliamGaynor,MD DepartmentofCardiothoracicSurgery AttendingSurgeonandAssociateProfessorofSurgery NationalHeartandLungInstitute DivisionofCardiothoracicSurgery ImperialCollegeLondon; DepartmentofSurgery HonoraryConsultant TheChildren’sHospitalofPhiladelphia DepartmentofCardiothoracicSurgery UniversityofPennsylvaniaSchoolofMedicine HammersmithHospital Philadelphia,Pennsylvania London,UnitedKingdom x Contributors JayC.Horrow,MD,MS ScottA.LeMaire,MD ProfessorandChair AssociateProfessorandDirectorofClinical DepartmentofAnesthesiology andTranslationalResearch DrexelUniversityCollegeofMedicine DivisionofCardiothoracicSurgery Philadelphia,Pennsylvania MichaelE.DeBakeyDepartmentofSurgery BaylorCollegeofMedicine; Staff JosephHuh,MD CardiovascularSurgeryService AssistantProfessor TexasHeartInstituteatSt.Luke’sEpiscopalHospital DivisionofCardiothoracicSurgery Houston,Texas MichaelE.DeBakeyDepartmentofSurgery BaylorCollegeofMedicine; ChiefofCardiothoracicSurgery C.WaltonLillehei,MD† DepartmentofCardiothoracicSurgery ClinicalProfessor MichelE.DeBakeyVeteran’sAffairsMedicalCenter DepartmentofSurgery Houston,Texas UniversityofMinnesota St.Paul,Minnesota; Formerly,LewisAtterburyStimson TaraKaramlou ProfessorandChairman GeneralSurgeryResident DepartmentofSurgery OregonHealthandScienceUniversity CornellUniversityMedicalCenter Portland,Oregon NewYork,NewYork ChristinaT.MoraMangano,MD BlaineKent,MD,FRCPC AssociateProfessor AssistantProfessor DepartmentofAnesthesia DepartmentofAnesthesia StanfordUniversity DalhousieUniversity; SanFrancisco,California Chief,DivisionofCardiacAnesthesia DepartmentofAnesthesia CapitalDistrictHealthAuthority D.MichaelMcMullan,MD Halifax,NovaScotia,Canada AttendingPediatricCardiacSurgeon Children’sNationalMedicalCenter Washington,DC StephenKirkby,MD Fellow,ClinicalInstructor DepartmentofPulmonary,CriticalCareandSleepMedicine BrianMejak,BS,CCP OhioStateUniversityMedicalCenter Perfusionist Columbus,Ohio DepartmentofPediatricPerfusion DoernbecherChildren’sHospital Portland,Oregon MatthewL.Kolz,PhD,MD Fellow,CardiacAnesthesia VivekK.Moitra,MD DepartmentofAnesthesia AssistantProfessor StanfordUniversityMedicalCenter DepartmentofAnesthesiology Stanford,California ColumbiaUniversityCollegeofPhysiciansandSurgeons NewYork,NewYork ChristopherB.Komanapalli,MD GeneralSurgeryResident JosefNileMueksch,MD,MBA OregonHealthandScienceUniversity AssistantProfessor Portland,Oregon DepartmentofAnesthesiology DrexelUniversityCollegeofMedicine; Anesthesiologist MarkKurusz,CCP DepartmentofAnesthesiology ChiefPerfusionist HahnemannHospital DivisionofCardiothoracicSurgery; Philadelphia,Pennsylvania AssistantProfessor DepartmentofSurgery UniversityofTexasMedicalBranch Galveston,Texas †Deceased.
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