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cardiopulmonary bypass; heart-lung machine; extracorporeal membrane oxygenation (ECMO)

Indications: - cardiac surgery - CABG - cardiac transplantation - congenital heart disease - transposition of the great vessels - ventricular septal defect - atrial septal defect - *valvular heart disease - lung transplantation - *vascular surgery involving the aortic root &/or ascending thoracic aorta - *heart failure Procedure: - surgical procedure bypassing the heart & the lungs using a device that pumps & oxygenates blood (extracorporeal membrane oxygenator) Laboratory: - activated clotting time before initiation & at regular intervals - matintain > 480 seconds [2] Complications: - high risk of postoperative stroke mostly due to atrial fibrillation [3] Management: - anticoagulation with heparin - bivalirudin is a reasonable option for patients with heparin-induced thrombocytopenia Notes: - 1/3 of heater-cooler devices used in bypass surgery may be contaminated with Mycobacterium chimaera [1]

Related

extracorporeal membrane oxygenator (ECMO)

Specific

prolonged extracorporeal circulation for cardiopulmonary insufficiency

General

extracorporeal circulation

References

  1. Association for Professionals in Infection Control & Epidemiology More than a third of heater-cooler devices used in open heart surgery may be contaminated with deadly bacteria. June 14, 2017 https://apic.org/For-Media/News-Releases/Article?id=cfa1fb1b-e399-46fa-82f4-9b18e71004f3
  2. Cardiopulmonary Bypass and Anticoagulation Society of Thoracic Surgeons, Society of Cardiovascular Anesthesiologists, and American Society of ExtraCorporeal Technology. In: Anello J, Feinberg B, Heinegg J et al New Clinical Practice Guidelines, February 2018. Medscape. February 07, 2018 https://reference.medscape.com/viewarticle/892328 - Shore-Lesserson L, Baker RA, Ferraris VA, et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines - Anticoagulation During Cardiopulmonary Bypass. Ann Thorac Surg. 2018 Feb;105(2):650-62. PMID: 29362176 http://www.annalsthoracicsurgery.org/article/S0003-4975(17)31478-9/fulltext
  3. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021