J2 Cardiopulmonary bypass surgery April17

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It takes time to construct, but it does not take time to destruct… Goyal: It takes time to construct, but it does not take time to destruct… Goyal

BIOFLUID DYNAMICS OF THE CARDIOPULMONARY BYPASS SURGERY: BIOFLUID DYNAMICS OF THE CARDIOPULMONARY BYPASS SURGERY

Slide3: John Ramirez Karym Urdaneta Jesse Castillo Victor Delgado

Objectives: Objectives Early history of CPB Description of the CPB machine Components of the CPB circuit. Fluid balance during CPB usage. Conduct during CPB

History: History Early machines WWII Thomas Watson John H. Gibbons Jr. 1903-1973

History: History Success with dogs Human failures Success

CPB Machine: CPB Machine Allows heart surgery Heart is emptied and stopped Oxygenates and pumps the blood

CPB Machine: CPB Machine Blood pumps Heater/cooler device Gas exchanger Tubing Filter

CPB Machine: CPB Machine Personnel Fluids Circuit

CPB Machine: CPB Machine Gravlee, 2000, page 585

Equipment: Cannulas: Equipment: Cannulas Gravity siphonage Single or two stage Effective positioning Gravlee, 2000, page 72 & 73

Equipment: Equipment

Equipment: Tubing: Equipment: Tubing Low spallation Smooth curves and nonwettable Flexible, hard, tough…

Equipment: Tubing: Equipment: Tubing

Equipment: Reservoir: Equipment: Reservoir A buffer for fluctuations A gross bubble trap Provides time for action

Equipment: Pumps: Equipment: Pumps Ideal pump: No blood damage Easily monitored flow rate No turbulence or stagnation Manually operable

Types of Pumps: Types of Pumps Gravlee, 2000, page 42 Roller Pumps

Types of Pumps: Types of Pumps Gravlee, 2000, page 42 Centrifugal pumps

Types of Pumps: Types of Pumps

Equipment: Oxygenators: Equipment: Oxygenators (Bubble Oxygenator) Gravlee, 2000, page 55

Equipment: Oxygenators: Equipment: Oxygenators (Membrane Oxygenator) Gravlee, 2000, page 57

Equipment: Oxygenators: Equipment: Oxygenators Gravlee, 2000, page 50

Equipment: Other Components: Equipment: Other Components Filters Bubble traps Heat exchangers Hemoconcentrators Gravlee, 2000, page 86

CPB Circuit: CPB Circuit Gravlee, 2000, page 70

Fluid Balance: Fluid Balance Hematocrit Priming volume Fluid administration during CPB

Hypothermia: Hypothermia Reduced metabolic rate Less oxygen consumption Viscosity

Hypothermia: Hypothermia Gravlee, 2000, page562 Viscosity of human blood with varying temperature

Myocardial Protection: Myocardial Protection Cardiac arrest with cardioplegia Hypothermia Myocardial edema Buffering acidosis

Anticoagulation: Anticoagulation Blood contact with foreign surfaces Heparin & side effects Monitoring Protamine

Conduct: Conduct Teamwork Initiation Performance Monitoring

Monitoring: Monitoring Electrocardiograph Pressure Temperature Neurological Activity Coagulation Status

Conclusions: Conclusions Cardiovascular surgery Postperfusion syndrome Artificial blood

Acknowledgements: Acknowledgements BMEI staff Professor Megh Goyal

Thank You: Thank You

Slide35: Reach for the stars, even if you have to stand on a cactus… John Ramirez