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use of CPB, 192
bivalrudin, 45
in the operating room,
acute respiratory distress
bleeding after CPB
47“8
syndrome (ARDS)
patient management, 51“2
pharmacological strategies,
post-CPB, 150“1
bleeding prevention
42“5
acute respiratory failure
µ-aminocaproic acid, 50“1
point of care (POC) testing,
use of CPB, 192
47“8 antifibrinolytic agents, 50“1
acute tubular necrosis (ATN),
transfusion algorithms, 52 aprotinin, 51
170
anticoagulation reversal, 45“7 desmopressin, 51
adrenaline (epinephrine), 103
weaning from CPB, 94, 101“2 heparin dosing, 51
alarm systems
199
Index



bleeding prevention (cont.) integrated method of single and double lung
non-pharmacological administration, 87“9 transplantation, 192“3
strategies, 51 modifications for particular thoracic aortic aneurysms,
protamine dosing, 51 situations, 89“90 189“90
monitoring distribution by
tranexamic acid, 50“1 thoracic aortic dissection,
temperature, 86
blood-based priming solutions, 187“8
myocardial damage during
37 thoracic aortic surgery,
CPB, 80
blood cardioplegia. See 187“90
optimum cardioplegia trauma care, 194“5
cardioplegia
technique, 87“9 tumor resection, 193“4
blood flow, cessation. See deep
prevention of septal cardiopulmonary bypass
hypothermic circulatory
dysfunction, 89 machine
arrest (DHCA)
retrograde delivery, 84“5 basic circuit, 1
blood gas management
routes of cardioplegia cardiopulmonary bypass
DHCA, 132“3
delivery, 84“6 procedure, 54“67
during CPB, 75“6
temperature of the adequate tissue perfusion,
blunt thoracic aortic injury,
cardioplegia solution, 86 62“4
190“1
cardioplegia delivery systems, arterial cannulation, 54“7
brain injury. See cerebral
15“7, 23, 84 cardiotomy suction, 59
morbidity in adult cardiac
cardioprotective strategies. See central venous pressure
surgery
cardioplegia (CVP), 64
bubble traps and filters,
cardiopulmonary bypass (CPB) electrocardiogram (ECG), 64
13“4
definition, 1 general management, 61“6
buffer systems, 74
history of development, 1 hemodilution, 63
modifications for DHCA, hypothermic CPB, 65
C
129“30 laboratory investigations, 66
CABG (coronary artery bypass rates of patient injury or left atrial (LA) pressure, 64
graft), 6, 58 death, 28 mean arterial pressure
comparison of CPB and versus OPCAB, 148 (MAP), 63“4
OPCAB, 151 cardiopulmonary bypass circuit multidisciplinary approach,
See also OPCAB. reducing priming volume, 70 54
calcium cardiopulmonary bypass circuit planning, 54
Ca2+ electrolyte, 76 assembly, 23“8 pulmonary artery (PA)
in cardioplegia solutions, 82 approaches to the setup pressure, 64
carbon dioxide level in the procedure, 23“5 recommended flow rates for
patient™s blood, 75“6 disposable items, 23 CPB, 62“3
cardiac function assessment pre-bypass checklist, 25 systemic oxygen delivery
weaning from CPB, 95 (DO2), 62“3
priming solutions, 36“40
cardiac surgery systemic oxygen demand
review of patient™s notes, 25
de-airing the heart, 97 (VO2), 62“3
safety issues, 23, 25, 28
cardioplegia, 80“90 temperature, 65
cardiopulmonary bypass circuit
acute ischemia, 89 termination of CPB, 66“7
primes. See priming solutions
acute MI/arrest cardioplegia, transition of patient onto
for CPB circuits
89 CPB, 61“2
cardiopulmonary bypass in
alternatives to, 86“7 transesophageal
non-cardiac procedures,
antegrade delivery, 84“5 echocardiography (TOE),
187“96
aortic root replacement, 65“6
blunt thoracic aortic injury,
89“90 urine volume, 65
190
blood cardioplegia, 82“4 venous cannulation and
emergency cardiopulmonary
components of cardioplegia drainage, 57“8
support (ECPS), 195“6
solutions, 81“4 venting the heart, 60“1
liver transplantation, 193
definition, 80 weaning from CPB, 66“7
management of acute
delivery systems, 84 cardiothoracic surgery
pulmonary embolism, 192
evolving myocardial optimal surgical field, 1
management of acute
infarction, 89 cardiotomy reservoir, 8“9
respiratory failure, 192
goals and principles of cardiotomy suction, 59
rewarming from severe
adverse effects, 59
myocardial protection, 81“2 hypothermia, 190“2
200
Index



CPB modifications, 129“30
cavitation in roller pumps, 8 Clot Signature Analyzer, 48
duration of circulatory arrest,
cavitation in venous drainage, clotting and platelet function
129
57 assessment
extracorporeal circulation,
cavo-atrial cannulation, 58 weaning from CPB, 94
129“30
central venous pressure (CVP) coagulation
glycemic control, 134
during CPB, 64 weaning from CPB, 94
hemodilution, 132
centrifugal pumps, 8 coagulation cascade, 41
hemostasis, 131
cerebral morbidity in adult activation of the extrinsic
history of development,
cardiac surgery, 153“66 pathway, 52
125“6
cerebral physiology during coagulation disorders after
hypothermia
CPB, 153“6 CPB, 49“52
neuroprotection,
determinants of cerebral antifibrinolytic agents,
131“2
perfusion, 153“6 50“1
leukocyte depletion, 134
effects of glucose control, causes, 49“50
neurological function
157 effects of hypothermia, 50
monitoring, 136“7
effects of perfusion pressure, fibrinolysis, 50
neurological monitoring,
156 heparin rebound, 50
135“7
effects of temperature, 156“7 management of the bleeding
neuroprotection strategies,
intraoperative ischemia and patient, 51“2
131“7
physiological management, platelet abnormalities, 49“50
outcome, 137“8
156“7 prevention of bleeding, 50“1
pathophysiology of
neurocognitive outcomes, SIRS, 50
hypothermia, 126
163“6 Cobe Duo membrane
pH-stat blood gas
neurological complications, oxygenator, 13
management, 132“3
153 colloid-based priming
pharmacological
OPCAB and stroke, 159 solutions, 39“40
neuroprotection, 135
perioperative stoke, 157“8 complement system
postoperative care, 137
risk factors for perioperative role in organ damage during
practical considerations,
stroke, 161“3 CPB, 143
126“31
stroke and OPCAB, 159 contact activation, 142“4
preoperative assessment, 126
stroke risk in the general coronary artery bypass graft.
preservation of organ
population, 161“3 See CABG
function, 125
timing of cardiac surgery- CPB. See cardiopulmonary
retrograde cerebral perfusion
related stroke, 159“60 bypass
(RCP), 133
cerebral perfusion during CPB, CPD in cardioplegia solutions,
re-warming, 130
153“6 82, 87
safe duration of DHCA,
cerebral physiology during cross-circulation technique, 1
129“30
CPB, 153“6 crystalloid priming solutions,
selective antegrade cerebral
cerebral substrate delivery 37“9
perfusion (SACP), 133“4
monitoring, 135“6
spinal cord protection, 135
chest splinting, 105 D
surgical considerations, 128
children
danaparoid, 44“5 temperature monitoring,
priming solutions for CPB
deep hypothermic circulatory 127“8
circuits, 36
arrest (DHCA), 55, 73“4, desmopressin, 52
chloride ions in cardioplegia
125“38 bleeding prevention, 51
solutions, 82
acid“base management, dextrans, 39
chronic kidney disease (CKD),
132“3 direct thrombin inhibitors, 45
167, 169, 171
alpha-stat blood gas disseminated intravascular
management of dialysis-
management, 132“3 coagulation (DIC), 41
dependent patients, 172
anesthesia, 126“8 DO2. See systemic oxygen
management of non-dialysis-
applications, 125 delivery
dependent patients, 172
blood gas management, dobutamine, 103
circulating volume
132“3 drainage
weaning from CPB, 94
cerebral substrate delivery venous, 57
citrate phosphate dextrose
monitoring, 135“6 drug dilution and loss during
(CPD) in cardioplegia
cooling, 129 CPB, 78
solutions, 82, 87
201
Index



effects on neurological
E veno-arterial (VA) ECMO
outcome, 157
cannulation, 183
ECMO. See extracorporeal weaning from CPB, 77
veno-arterial (VA)
membrane oxygenation glycemic control during DHCA,
ECMO weaning and
electrocardiogram (ECG) 134
decannulation, 185“6
recording during CPB, 64 veno-venous (VV) ECMO,
electrolytes, 76“8 176“7
H
monitoring, 78“9 veno-venous (VV) ECMO
weaning from CPB, 66 cannulation, 183 Hartmann™s solution, 38
emergency cardiopulmonary veno-venous (VV) heart-lung transplant, 58
support (ECPS), 195“6 ECMO weaning and heart transplant, 58
endothelium decannulation, 185 hematocrit (HCT)
functions during CPB, 144 extracorporeal membrane effects of hemodilution,
endotoxins oxygenation (ECMO) circuit, 70“1
and acute kidney injury, 171 181, 179“83 hematocrit monitors, 18“9
produced during CPB, 146 anticoagulation, 183 hemoconcentrators, 17“8
enoxinone, 103 bridge, 182 hemodilution, 63
epicardial pacing, 98“9 cannulae, 179“81 during DHCA, 132
equipment heat exchanger, 182 metabolic management
alarm systems, 20 monitoring, 182 during CPB, 70“1
arterial and venous saturation oxygenators, 182 hemofilters, 17“8
monitors, 18“9 pump, 181“2 hemofiltration, 77“8, 146
arterial cannulae, 3“5 safety devices, 182 hemoglobin
arterial line filters, 13“4, 23 buffering of hydrogen ions, 74
cardioplegia delivery systems, hemoglobin concentration
F
15“7, 23 weaning from CPB, 94
centrifugal pumps, 8 femoral veins Hemochron, 47
filters and bubble traps, cannulation, 6 hemophilia, 51“2
13“4 fibrillatory arrest with HemoTec ACT, 47
gas supply system, 13 hypothermia heparin, 42“4
hemofilters, 17“8 myocardial protection heparin (unfractionated, UFH)
history of development, 1 method, 86“7 ACT monitoring, 43
in-line blood gas analyzers, fibrinolysis dosing, 43
18“9 after CPB, 52 heparin-induced
oxygenators, 10“3, 23 in the CPB circuit, 50 thrombocytopenia (HIT),
pumps, 6“8 fibrinolytic pathway, 144 43“4
reservoirs, 8“9, 23 fibrinolytics, 45 heparin resistance, 43
roller pumps, 7“8 Fick equation, 62 mechanism of anticoagulant
suckers and vents, 14“5 Fick™s Law of Diffusion, 10 action, 42“3
tubing, 1“3, 23 filters and bubble traps, monitoring, 43
venous cannulae, 6 structure, 42
13“4
extracorporeal membrane use as CPB anticoagulant,
flow rates during CPB, 72
oxygenation (ECMO), 42“4
functional mitral regurgitation,
176“86 heparin-bonded circuitry, 146
104
cannulation, 183 heparin dosing
cardiac ECMO in adults, 179 bleeding prevention, 51
G
differences to CPB, 176 heparin-induced platelet
history of development, 176 gas-exchange mechanisms activation assay (HIPPA), 44
indications, 176“9 oxygenators, 10“3 heparin-induced
inflammatory response to, gas supply system, 13 thrombocytopenia, 43“4
183 gastrointestinal complications Heparin Management Test
of CPB, 148
patient management, 183“5 (HMT) Cascade analyzer, 47
gelofusine, 39
respiratory ECMO in adults, heparin neutralization, 45“7
Gibbon, John, 1, 187
177“9 heparinase, 47
glucose
types of ECMO, 176 hexadimethrine, 46
serum glucose levels, 77 methylene blue, 46“7
veno-arterial (VA) ECMO,
omit neutralization, 47
glucose control
176“7
202
Index



platelet factor 4 (PF4), 46 mechanical circulatory support,
intra-aortic balloon pump
protamine, 45“6 106“24
(IABP), 105
heparin rebound, 50 history of development, 106
description, 106
heparin resistance, 43, 61 intra-aortic balloon
placement, 106
heparinase, 47 counterpulsation, 106“8
intraoperative ischemia and
hepatic dysfunction caused by range of options, 106
physiological management,
CPB, 148“9 ventricular assist devices
156“7
Hepcon HMS® analyzer, 47 (VADs), 108“24
ischemia“reperfusion injury
hexadimethrine mechanical ventilation
(IRI), 144“5
weaning from CPB, 96
heparin neutralization, 46
metabolic acidosis, 38“9, 72,
High-Dose Thrombin Time J
74“5
(HiTT), 47
Jehovah™s Witness patients, 35, weaning from CPB, 94, 97
hydroxyethyl starch, 39
71 metabolic alkalosis, 74“5
hyperkalemia, 93
metabolic management during
therapy for AKI, 173
K CPB, 70“8
hypernatremia
acid-base status, 74“5
therapy for AKI, 173 Kay, Philip, 23
alpha-stat management of
hypokalemia, 93 kinin“kallikrein pathway, 143“4
blood gas, 75
hyponatremia
autologous priming of the
therapy for AKI, 173 L
CPB circuit, 71
hypoperfusion during CPB, 72
laboratory investigations, 66 blood gas managment, 75
hypothermia, 70
lactate causes of metabolic
blood gas management, 75
serum lactate levels, 77, 94 derangement, 70
DHCA, 73“4
lactated Ringer™s solution, 38 DHCA, 73“4
during CPB, 65, 72“3
latex tubing in the CPB circuit, 3 drug dilution and loss, 78
effects on hemostasis, 50
Lee-White clotting time. See electrolytes, 76“8
pathophysiology, 126
activated clotting time flow rates, 72
hypothermia (accidental)
left atrial (LA) pressure during hemodilution, 70“1
re-warming from severe
CPB, 64 hemofiltration, 77“8
hypothermia, 190“2
left ventricular assist device hypoperfusion, 72
hypoxia and renal damage, 170
(LVAD), 109 hypothermia, 72“4
lepirudin, 45 metabolic effects of CPB
I
leukocyte depletion, 146“7 primes, 70“1
in-line blood gas analysis, 18“9, during DHCA, 134 monitoring of patient
78“9 levosimendan, 103 parameters, 78“9
inferior vena cava liver transplantation pH, 74“5
cannulation, 6 use of extracorporeal pH-stat management of
inflammatory response to circulation, 193 blood gas, 75
ECMO, 183 principles, 70
low-molecular-weight heparin
inorganic phosphate buffers, 74 temperature effects, 72“4
(LMWH), 44
inotropic drugs, 94“5 methylene blue
lung transplantation
inotropic support heparin neutralization, 46“7
use of CPB, 192“3
weaning from CPB, 99“100 milrinone, 103
102“3 mini-bypass, 20“2
M
integrated method of monitoring during CPB, 18“20
magnesium
cardioplegia administration, Munsch, Christopher, 23
in cardioplegia solutions,
87“9 myocardial damage
82, 87
intra-aortic balloon causes during CPB, 80
Mg+ electrolyte, 77
counterpulsation, 106“8 postoperative detection
magnesium level
complications, 108 methods, 80
weaning from CPB, 93, 97
description of the IABP, 106 myocardial dysfunction
mannitol
effects on cardiovascular associated with CPB, 151
in cardioplegia solutions, 87
physiology, 106 myocardial infarction during
use in CPB primes, 39“40
IABP placement, 106 CPB, 89
mean arterial pressure (MAP),
management of the IABP myocardial protection during
63“4
patient, 106“8 CPB, 80“90
203
Index



neuromuscular blockade
myocardial protection during oxygen demand. See systemic
weaning from CPB, 95
CPB (cont.) oxygen demand (VO2)
neuroprotection strategies
acute ischemia, 89 oxygen-hemoglobin
during DHCA, 131“7
acute MI/arrest cardioplegia, dissociation curve, 73
non-bicarbonate buffers, 74
89 oxygenators, 10“3, 23
non-pulsatile (laminar) flow
alternatives to cardioplegia, oxyhemoglobin
during CPB, 8
86“7 buffering of hydrogen ions,
Normal Saline solution, 38
antegrade delivery of 74
Normosol solution, 38
cardioplegia, 84“5
NovoSeven (recombinant factor
aortic root replacement, P
VIIa), 52
89“90
pancreatitis related to CPB,
cardioplegia delivery systems,
149“50
84
O paradoxical intracellular
cardioplegia technique
acidosis
oliguria therapy for AKI, 173
modifications, 89“90
weaning from CPB, 97
OPCAB (off-pump CABG), 47,
causes of myocardial damage,
patient injury or death rates for
55, 140
80
CPB, 28
and stroke, 159
components of cardioplegia
patient management
comparison with CPB, 148,
solutions, 81“4
bleeding after CPB, 51“2
151
definition of cardioplegia,
patient™s notes
organ damage during CPB,
80
review prior to CPB circuit
140“51
evolving myocardial
assembly, 25
activation of plasma protease
infarction, 89
perfusion during CPB
pathways, 142“4
fibrillatory arrest with
pulsatile versus non-pulsatile
alterations in organ
hypothermia, 86“7
(laminar) flow, 8
perfusion, 148
goals and principles, 80“1
perfusion pressure
comparison with OPCAB,
integrated method
effects on neurological
151
of cardioplegia
outcome, 156
complement activation, 143
administration, 87“9
perioperative stroke, 157“8
contact activation, 142“4
monitoring cardioplegia
pH
CPB versus OPCAB, 148
distribution by
bicarbonate buffer system, 74
endotoxins, 146
temperature, 86
buffer systems, 74
fibrinolytic pathway, 144
optimum cardioplegia
during CPB, 74“5
gastrointestinal
technique, 87“9
non-bicarbonate buffers, 74
complications, 148
postoperative detection of
normal pH of arterial blood,
hepatic dysfunction, 148“9
myocardial damage, 80
74
ischemia“reperfusion injury
prevention of septal
pH-stat management of blood
(IRI), 144“5
dysfunction, 89
gas, 75,132“3
myocardial dysfunction,
retrograde delivery of
pharmacology
151
cardioplegia, 84“6
anticoagulation strategies,
pancreatitis, 149“50
routes of cardioplegia
42“45
post-CPB ARDS, 150“1
delivery, 84“6
interventions for SIRS, 146
pulmonary dysfunction,
surgical septum, 89
neuroprotection during
150“1
temperature of the
DHCA, 135
quality of life after cardiac
cardioplegia solution, 86
phosphate electrolyte, 77
surgery, 151
physiological alarms
role of the endothelium, 144
N CPB monitoring, 20
role of the kinin“kallikrein
re-enabling before weaning
neurocognitive outcomes in pathway, 143“4
from CPB, 96
cardiac surgery, 163“6 SIRS, 146“7
Plasma-Lyte solution, 38
neurological complications in therapeutic strategies, 146“7
plasma protease pathways
adult cardiac surgery, 153 triggers of organ damage, 140
activation, 142“4
neurological function See also acute kidney injury
plasma proteins
monitoring during DHCA, (AKI); cerebral morbidity
buffering capacity, 74
in adult cardiac surgery
136“7
effects of hemodilution, 71
oxygen delivery. See systemic
neurological monitoring during
platelet factor 4 (PF4)
oxygen delivery (DO2)
DHCA, 135“7
204
Index



heparin neutralization, selective antegrade cerebral
types of priming solution,
46 perfusion (SACP)
37“40
platelet function DHCA, 133“4
Procaine in cardioplegia
abnormalities after CPB, septal dysfunction after cardiac
solutions, 82
49“50, 52 surgery, 89
protamine
point of care (POC) tests, 48 serotonin release assay (SRA),
heparin neutralization, 45“6
Platelet Function Analyzer, 44
protamine dosing
PFA-100, 48 silicone rubber tubing in the
bleeding prevention, 51
platelet-rich plasma (PRP) CPB circuit, 3
pulmonary artery (PA) pressure
aggregation assay, 44 SIRS (systemic inflammatory
during CPB, 64
platelet transfusion, 52 response syndrome), 50, 64,
pulmonary dysfunction
Plateletworks, 48 140“2, 146“7
associated with CPB,
point-of-care (POC) testing, and acute kidney injury, 171
150“1
47“8 sodium in cardioplegia
pulsatile flow during CPB, 8
and transfusion algorithms, solutions, 82
pumps used in extracorporeal
52 Sonoclot test, 48
circuits, 7“8
post-CPB ARDS, 150“1 spinal cord
PVC tubing, 1“3
potassium protection during DHCA,
in cardioplegia solutions, 135
Q
82, 87 reducing ischemia during
+
quality of life after cardiac
K electrolyte, 76 descending aneurysm
surgery, 151
potassium level surgery, 189
weaning from CPB, 93 St Thomas™ Hospital
pre-bypass checklist cardioplegia solution, 82
R
design and use of, 25 stroke
priming solutions for CPB and intraoperative
recombinant factor VIIa
circuits, 36“40 physiological management,
(rFVIIa), 52
acceptable hemodilution, 156“7
renal damage. See acute kidney
36“7 and OPCAB, 159
injury (AKI); chronic kidney
association with metabolic perioperative, 157“8
disease (CKD)
acidosis, 38“9 risk factors for perioperative
renal replacement therapy for
autologous priming, 37 stroke, 161“3
AKI, 173“4
avoiding allogenic blood stroke risk in the general
reservoirs, 23
transfusions, 37 population, 161“3
venous, 8“9
blood-based primes, 37 timing of cardiac surgery-
respiratory acidosis, 75
children, 36 related stroke, 159“60
respiratory alkalosis, 75
colloid-based primes, suckers and vents, 14“5
retrograde cerebral perfusion
39“40 superior vena cava
(RCP), 74
crystalloid primes, 37“9 cannulation, 6
DHCA, 133
experimental oxygen- surgical septum, 89
retrograde delivery of
SvO2 measurement, 78“9
carrying solutions, 40 cardioplegia, 84“6
systemic inflammatory
Hartmann™s solution, 38 right ventricular assist device
response syndrome (SIRS),
infants and neonates, 36 (RVAD), 109
50, 64, 140“2, 146“7
Lactated Ringer™s solution, Ringer™s solution, 38
and acute kidney injury, 171
38 roller pumps, 7“8
systemic oxygen delivery (DO2)
mannitol, 39“40
blood gas monitoring, 78“9
metabolic effects, 70“1 S
influence of temperature,
Normal Saline solution, 38
safety issues 72“3
Normosol solution, 38
before, during and after CPB, metabolic acidosis, 74“5
Plasma-Lyte solution, 38
25 systemic oxygen demand (VO2)
prime volume, 36“7
rates of patient injury or blood gas monitoring, 78“9
purpose of priming solution,
death, 28 influence of temperature,
36
salvaged blood, 9 72“3
Ringer™s solution, 38
suckers and vents, 14“5 metabolic acidosis, 74“5
target hematocrit, 36“7
weaning from CPB, 94 systemic vascular resistance
tonicity of the priming
See also cardiotomy suction. (SVR), 100“1
solution, 37“8
205
Index



long-term care of VAD
uninterruptible power supply
T
patients, 123“4
(UPS), 23
temperature outcomes for patients,
urine volume during CPB, 65
during CPB, 64“5, 72“3 110“1
effects on neurological patient management,
V
outcome, 156“7 120“3
influence on blood gas vasoactive drugs, 94“5, 102“3 perioperative patient
management, 75 vasodilators, 94“5 management, 120“2
weaning from CPB, 92“3 vasopressors, 94“5, 102“3 postoperative patient
Terumo CDI-500 in-line blood venous and arterial oxgyen management, 122“3
gas analyzser, 19 saturation monitors, 18“9
THAM in cardioplegia venous blood analysis, 78“9 preoperative patient
solutions, 82, 87 venous cannulae, 6 managment, 120
thoracic aorta, blunt injury, 190 venous cannulation and pulsatile devices (volume
thoracic aortic aneurysms, drainage, 57“8 displacement devices),
188“9 avoiding air entry into the 113
thoracic aortic dissection, system, 58 purpose of VADs, 108“9
187“8 cavitation phenomenon, 57 right ventricular assist device
thoracic aortic surgery, 187“90 cavo-atrial cannulation, 58 (RVAD), 109
thrombocytopenia connection to the patient, Thoratec PVAD and IVAD,
after CPB, 52 57“8 114“6
heparin-induced (HIT), 43“4 peripheral venous types of VAD, 120
thromboelastography (TEG), 48 cannulation, 58 types of VAD systems, 110
alpha angle, 48 right atrial cannulation, Ventracor VentrAssist, 120
clot lysis measurement, 48 57“8 weaning from CPB with VAD
K value, 48 single cannula approach, 57 support, 122
MA (maximum amplitude), types and sizes of cannulae, Verify Now monitoring system,
48 57 48
R value, 48 venous drainage, 57 VO2. See systemic oxygen
tissue plasminogen activator venous circulation and drainage demand
(tPA), 144 bicaval cannulation, 58 von Willebrand factor (VWF),
tonicity of a priming solution, venting the heart, 14“5, 51, 52
37“8 60“1
total artificial heart (TAH), 106 venting methods, 61 W
total circulatory arrest. See deep venting the left heart, 60
hypothermic circulatory weaning from CPB, 66“7,
venting the right heart,
arrest (DHCA) 92“105
60“1
tranexamic acid, 50“1, 131 adrenaline (epinephrine),
ventricular assist devices
transfusion algorithms, 52 103
(VADs), 105, 108“24
transesophageal analgesia, 95
bridge to recovery (BTR),
echocardiography (TOE) anesthesia, 95
110“1
arterial blood gases, 97
during CPB, 65“6 bridge to transplant (BTT),
assessment and adjustment of
role in weaning from CPB, 101 110“1
preload, 99
trauma care categories of potentially
assessment of afterload,
use of CPB, 194“5 suitable patients, 111“3
100“1
continuous flow devices, 113
tromethamine (tris-
assessment of clotting and
decision-making process,
hydroxymethyl
platelet function, 94
111“3
aminomethane). See THAM
assessment of contractility,
description, 109
tubing in the CPB circuit, 1“3,
99“100
destination therapy (DT),
23
calcium level, 93
110“1
tumor resection
cardiac function assessment,
factors affecting output,
use of CPB, 193“4
95
110
chest splinting, 105
HeartMate II, 116“8
U circulating volume, 94
left ventricular assist device
coagulation, 94
ultrafilters, 17“8 (LVAD), 109
de-airing the heart, 97
Levitronix CentriMag, 114
ultrafiltration, 77“8, 146
206
Index



re-institution of CPB, 92
inotropic support, 99“100,
dobutamine, 103
re-warming the patient,
102“3
dopamine, 103
92“3
intra-aortic balloon
electrolytes, 97
reversal of anticoagulation,
counterpulsation, 105
enabling physiological
94, 101“2
lactate levels, 94
alarms, 96
role of TOE, 101
levosimendan, 103
enoximone, 103
systemic vascular resistance
magnesium levels, 93, 97
epicardial pacing, 98“9
(SVR), 100“101
mechanical support, 104“5
events immediately prior
temperature of the patient,
mechanical ventilation, 96
to, 98
92“3
mechanics of separation from
failure to achieve satisfactory
use of salvaged blood, 94
CPB, 99“101
weaning, 102“5
vasoactive drugs, 94“5,
metabolic acidosis, 94, 97
functional mitral
102“3
milrinone, 103
regurgitation, 104
vasodilators, 94“5
neuromuscular blockade, 95
glucose control, 93
vasopressors, 94“6,
paradoxical intracellular
hemoglobin concentration,
102“3
acidosis, 97
94
ventricular assist devices
potassium level, 93
hyperkalemia, 93
(VADs), 105
predicting difficulty, 95“6
hypokalemia, 93
with VAD support, 122
preparation, 92“6
inotropic drugs, 94“5, 96




207

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