This chapter describes the standard equipment and monitoring components of the cardiopulmonary bypass (CPB) machine and extracorporeal circuit as well as additional equipment such as the suckers used to scavenge blood from the operative field, cardioplegia delivery systems and hemofilters. The tubing in the CPB circuit interconnects all of the main components of the circuit. The arterial cannula is used to connect the arterial limb of the CPB circuit to the patient and so deliver oxygenated blood from the heart-lung machine directly into the patient's arterial system. Venous cannulation for CPB allows deoxygenated blood to be drained from the patient into the extracorporeal circuit. The Terumo CDI 500 in-line blood gas analyzer is an optical fluorescence and reflectance based in-line system that continuously monitors 11 critical blood gas parameters with laboratory quality accuracy. Non-invasive simultaneous arterial and venous saturation monitors are also available for use during CPB.

This chapter reviews the rationale for the use of cardioplegia, techniques of administration, components of different cardioplegia solutions and applications of cardioplegia in different surgical interventions. Myocardial damage can be detected by electrocardiography, echocardiography, radioactive imaging studies and cardiac magnetic resonance imaging. The clinical manifestations of myocardial damage may present as low cardiac output syndrome due to impaired myocardial contractility, dysrhythmias, decreased ventricular compliance or segmental myocardial wall motion abnormalities. The goal of myocardial protection with cardioplegia is to prevent myocardial injury during the periods of intentional ischemia that are required to perform cardiac operations. Cardioplegia delivery systems generally comprise an infusion system with in-line pressure monitors, a cardioplegic heat exchanger for cold and warm perfusion, and cannulae for antegrade and retrograde delivery. Crystalloid cardioplegia solutions are usually delivered at 4°C, cold blood solutions at 10-16°C and warm blood solutions at 37°C.