Metabolic Management during Cardiopulmonary Bypass

doi:10.1017/9781009008143.010

Chapter 10 - Metabolic Management during Cardiopulmonary Bypass

Published online by Cambridge University Press: 24 October 2022

Jonathan Brand and

Edward M Darling

Edited by

Florian Falter ,

Albert C. Perrino, Jr and

Robert A. Baker

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Florian Falter: Affiliation:
Royal Papworth Hospital, Cambridge
Albert C. Perrino, Jr: Affiliation:
Yale University Medical Center, Connecticut
Robert A. Baker: Affiliation:
Flinders Medical Centre, Adelaide

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Summary

The metabolic management of patients on cardiopulmonary bypass (CPB) is a complex process, involving several key biochemical and physiological parameters essential to maintaining homeostasis and reducing morbidity and mortality associated with CPB and cardiac surgery.There is movement toward goal directed perfusion (GDP), using indexed parameters such as carbon dioxide production, oxygen delivery and oxygen consumption to individualize perfusion strategies. This chapter provides an overview of the fundamental principles surrounding the metabolic management of the patient on CPB.

Keywords

Metabolic Management Metabolic Markes Arterial Blood Gas Acid-Base Balance Mixed Venous Oxygen Saturation Lactate Goal Directed Perfusion Electrolytes Drug Metabolsism Alpha stat pH Stat Temperature Management

Type: Chapter
Information: Cardiopulmonary Bypass , pp. 92 - 101

DOI: https://doi.org/10.1017/9781009008143.010 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2022

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References

Suggested Further Reading

Murphy, GS. Hessel, EA 2nd, Groom, RC. Optimal perfusion during CPB: an evidence-based approach. Anesth Analg 2009; 108:1394.Google Scholar

Baker, RA, Nikolic, A, Onorati, F et al. 2019 EACTS/EACTA/EBCP guidelines on CPB in adult cardiac surgery: a tool to better clinical practice. Eur J Cardiothorac Surg 2020; 57: 207– 209.Google Scholar

Reves, JG. Toward understanding cerebral blood flow during CPB: implications for the central nervous system. Anesthesiology 2019; 130: 609–613.CrossRef Google Scholar PubMed

American Society of ExtraCorporeal Technology Standards and Guidelines For Perfusion Practice. 2017. Available from www.amsect.org/d/do/1370 Google Scholar

Svenmarker, S, Hannuksela, M, Haney, M. A retrospective analysis of the mixed venous oxygen saturation as the target for systemic blood flow control during CPB. Perfusion 2018; 33: 453–462.Google Scholar

Engelman, R. Baker, RA, Likosky, DS et al. The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of ExtraCorporeal Technology: Clinical practice guidelines for CPB temperature management during CPB. J Cardiothorac Vasc Anesth 2015; 29: 1104–1111CrossRef Google Scholar

Govender, P, Tosh, W, Burt, C et al. Evaluation of increase in intraoperative lactate level as a predictor of outcome in adults after cardiac surgery. J Cardiothorac Vasc Anesth. 2020 Apr;34(4): 877–884.Google Scholar

Ranucci, M, Carboni, G, Cotza, M et al. Carbon dioxide production during CPB: pathophysiology, measure and clinical relevance. Perfusion 2017; 32: 4–12.Google Scholar

Society of Thoracic Surgeons Blood Conservation Guideline Task Force. Ferraris, VA, Brown, JR, Despotis, GJ et al. Update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011; 91: 944–982.CrossRef Google Scholar

Kunst, G, Milojevic, M, Boer, C et al. 2019 EACTS/EACTA/EBCP guidelines on CPB in adult cardiac surgery. BJA 2019; 123: 713–757.CrossRef Google Scholar