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Chapter 85. Basics of CPB

Jennie Ngai, MD

  • Bypass blood circulation of the heart and lungs while still perfusing other organs
  • Diversion of blood flow through a circuit located outside of the body, yet in continuity with it
  • Primarily used for cardiac surgery, but also for major vascular surgery, neurosurgery, and transplant surgery

See Figure 85-1.

  • Venous cannula to remove blood from the patient
  • Venous reservoir
  • Pump to return blood
  • Oxygenator to add oxygen (and remove CO2)
  • Heat exchanger to warm or cool blood
  • Filter to remove debris and air
  • Arterial cannula to return blood to the patient

Figure 85-1. Basic Diagram of CPB Machine
image
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Reproduced with permission from Hessel EA II, Edmunds LH Jr. Extracorporeal Circulation: Perfusion Systems. In: Cohn LH, Edmunds LH Jr, eds. Cardiac Surgery in the Adult. New York: McGraw-Hill, 2003:317-338. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.

  • Pulse oximetry—monitor for peripheral oxygen saturation
  • EKG—monitor for dysrhythmias, ST segment changes
  • Arterial line—necessary for cardiac surgery as noninvasive cuff measurement will not work during CPB (nonpulsatile flow)
  • Central line—monitor for volume status, rhythm disturbances, superior vena cava (SVC) syndrome, and adequate venous drainage during CPB. Used for rapid volume resuscitation and medication administration
  • Pulmonary artery (PA) catheter—should be placed in patients having off pump CABG, pulmonary hypertension, low EF. May not be routinely placed; depends on preference of surgical team for postoperative care
  • Transesophageal echo (TEE)—if available, should be placed in every cardiac case. If limited availability, should be used preferentially for valve procedures. Monitor for contractility, volume status, valve competence, and presence of air prior to CPB separation. This is now becoming a standard of care
  • Processed EEG monitor—level of anesthetic depth
  • Cerebral oximetry—monitor for cerebral oxygenation and perfusion

Arterial Line Placement

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Arterial Line Location According to the Location of the Arterial Cannula
Location of arterial cannulaPossible arterial line locations for monitoring
Ascending aortaRight or left radial artery; right or left femoral artery
Axillary/innominate arteryLeft radial artery; right or left femoral artery
Femoral arteryRight or left radial artery
Balloon endoclamp in ascending aortaTwo arterial lines, right and left radial artery
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Arterial Line Location According to the Type of Surgery
Type of surgeryPossible arterial line locations for monitoring
Coronary artery bypass surgeryRight or left radial artery, unless using radial artery graft; right or left femoral artery
Valve surgeryRight or left radial artery; right or left femoral artery
Ascending aorta surgeryRight or left radial artery; right or left femoral artery
Aortic arch surgeryPossibly need two arterial lines, discuss with surgeon about location

Central Line Placement

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Central Line Locations
Location of central venous ...

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