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Cardiopulmonary Bypass
Third Edition
Cardiopulmonary Bypass
Edited by
Florian Falter
Royal Papworth Hospital, Cambridge
Albert C Perrino
Yale University Medical Center, New Haven, CT
Robert A. Baker
Flinders Medical Centre and Flinders University, Adelaide
The editors are very grateful to Dr Ghosh, who started this project and led the first two editions
from idea to printed book
Shaftesbury Road, Cambridge CB2 8BS, United Kingdom
One Liberty Plaza, 20th Floor, New York, NY 10006, USA
477 Williamstown Road, Port Melbourne, VIC 3207, Australia
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Cambridge University Press is partof Cambridge University Press & Assessment,
adepartmentoftheUniversityofCambridge.
We share the University’smission to contributeto society through the pursuitof
education,learning and research at the highest international levels of excellence.
www.cambridge.org
Information on this title: www.cambridge.org/9781009009621
DOI: 10.1017/9781009008143
© Cambridge University Press & Assessment 2022
This publication is in copyright. Subject to statutory exception and to the provisions
of relevant collective licensing agreements, no reproduction of any part may take
place without the written permission of Cambridge University Press & Assessment.
First published 2009
Second edition 2015
Third edition 2022
Printed in the United Kingdom by TJ Books Limited, Padstow Cornwall
A catalogue record for this publication is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Names: Falter, Florian, editor. | Perrino, Albert C., Jr. editor. | Baker, Robert A,
1960- editor.
Title: Cardiopulmonary bypass / edited by Florian Falter, Albert C. Perrino,
Robert A. Baker.
Other titles: Cardiopulmonary bypass (Ghosh)
Description: Third edition. | Cambridge, United Kingdom ; New York, NY :
Cambridge University Press, [2022] | Preceded by Cardiopulmonary
bypass / edited by Sunit Ghosh, Florian Falter, Albert C. Perrino, Jr.
Second edition. 2015 | Includes bibliographical references and index.
Identifiers: LCCN 2022010263 (print) | LCCN 2022010264 (ebook) |
ISBN 9781009009621 (paperback) | ISBN 9781009008143 (epub)
Subjects: MESH: Cardiopulmonary Bypass–methods | Cardiac Surgical
Procedures–methods
Classification: LCC RD598 (print) | LCC RD598 (ebook) | NLM WG 168.5 |
DDC 617.4/120592– dc23/eng/20220511
LC record available at https://lccn.loc.gov/2022010263
LC ebook record available at https://lccn.loc.gov/2022010264
ISBN 978-1-009- 00962-1 Paperback
Cambridge University Press & Assessment has no responsibility for the
persistence or accuracy of URLs for external or third-party internet websites
referred to in this publication and does not guarantee that any content on
such websites is, or will remain, accurate or appropriate.
..................................................................
Every effort has been made in preparing this book to provide accurate and up-to-
date information that is in accord with accepted standards and practice at the time
of publication. Although case histories are drawn from actual cases, every effort has
been made to disguise the identities of the individuals involved. Nevertheless, the
authors, editors, and publishers can make no warranties that the information
contained herein is totally free from error, not least because clinical standards are
constantly changing through research and regulation. The authors, editors, and
publishers therefore disclaim all liability for direct or consequential damages
resulting from the use of material contained in this book. Readers are strongly
advised to pay careful attention to information provided by the manufacturer of
any drugs or equipment that they plan to use.
Contents
List of Contributors vi
Foreword ix
Alan Merry
1 Human Factors and Teamwork in
Cardiac Surgery 1
Lindsay Wetzel, David Fitzgerald, Thoralf M
Sundt and James H Abernathy III
2 Equipment for Cardiopulmonary Bypass 9
Simon Anderson and Amanda Crosby
3 Monitoring during
Cardiopulmonary Bypass 25
Richard F Newland and Pascal Starinieri
4 Cardiopulmonary Bypass Circuit Setup and
Safety Checks 34
Victoria Molyneux and Shahna Helmick
5 Priming Solutions for Cardiopulmonary
Bypass Circuits 42
Filip De Somer and Robert Young
6 Anticoagulation for
Cardiopulmonary Bypass 49
Martin Besser and Linda Shore-Lesserson
7 Conduct of Cardiopulmonary Bypass 57
Christiana Burt, Timothy A Dickinson, Narain
Moorjani and Caitlin Blau
8 Minimal Invasive
Extracorporeal Circulation 71
Kyriakos Anastasiadis, Polychronis Antonitsis,
Helena Argiriadou and Apostolos
Deliopoulos
9 Considerations for Operations Involving Deep
Hypothermic Circulatory Arrest 80
Pingping Song and Joseph E Arrowsmith
10 Metabolic Management during
Cardiopulmonary Bypass 92
Jonathan Brand and Edward M Darling
11 Myocardial Preservation during
Cardiopulmonary Bypass 102
Gudrun Kunst, Luc Puis and Tom Gilbey
12 Weaning from Cardiopulmonary Bypass 112
Joanne F Irons, Kenneth G Shann
and Michael Pou llis
13 Intraoperative Mechanical Circulatory
Support and Other Uses of
Cardiopulmonary Bypass 123
Mark Buckland and Jessica Underwood
14 Mechanical Circulatory Support 138
Jason M Ali, Ayyaz Ali and Yasir Abu-Omar
15 Cardiopulmonary Bypass for Pediatric
Cardiac Surgery 150
Joseph J Sistino and Timothy J Jones
16 Coagulopathy and Hematological Disorders
Associated with
Cardiopulmonary Bypass 156
Bruce D Spiess and Erik Ortmann
17 Inflammation and Organ Damage during
Cardiopulmonary Bypass 166
R Clive Landis and Sherif Assaad
18 Neuromonitoring and Cerebral Morbidity
Associated with
Cardiopulmonary Bypass 175
Etienne J Couture, Stéphanie Jarry and André
Y Denault
19 Renal Morbidity Associated with
Cardiopulmonary Bypass 184
Juan Pablo Domecq and Robert C Albright
20 Common and Uncommon Disasters during
Cardiopulmonary Bypass 194
Gregory M Janelle, Jane Ottens and Michael Franklin
Index 205
v
Contributors
James H. Abernathy III
Associate Professor, Interim Executive Vice Chair,
ACCM Chief, Division of Cardiac Anesthesiology
Core Faculty, Armstrong Institute of Patient Safety,
Department of Anesthesiology & Critical Care
Medicine, Johns Hopkins University
Yasir Abu-Omar
Director, Cardiothoracic Transplantation and
Mechanical Circulatory Support, University Hospitals
Cleveland Medical Center
Robert C. Albright Jr
Consultant, Division of Nephrology and HTN Mayo
Clinic Rochester; Professor of Medicine, Division of
Nephrology and HTN, Mayo Clinic College of
Medicine, Mayo Clinic, Rochester; Region al Vice
President, Mayo Clinic Health System Southeast;
Professor of Medicine; Consultant, Division of
Nephrology and Hypertension
Ayyaz Ali
Vice Chairman of Cardiac Surgery and Surgical
Director of Heart Transplantation and Mechanical
Circulatory Support, Hartford Hospital
Jason M. Ali
Locum Consultant in Cardiothoracic and Transplant
Surgery, Royal Papworth Hospital
Kyriakos Anastasiadis
Professor, Department of Cardiothoracic Surgery,
Aristotle University of Thessaloniki
Simon Anderson
Clinical Perfusion Team Leader, Cambridge
Perfusion Services, Royal Papworth Hospital
Polychronis Antonitsis
Associate Professor, Department of Cardiothoracic
Surgery, Aristotle University of Thessaloniki
Helena Argiriadou
Cardiac Anesthesiologist, Assistant Professor,
Aristotle University of Thessaloniki
Joseph E. Arrowsmith
Consultant Anaesthetist, Department of Anaesthesia
& Intensive Care Medicine, Royal Papworth
Hospital
Sherif Assaad
Associate Professor, Cleveland Clinic Lerner College
of Medicine | Case Western Reserve University, and
Staff Anesthesiologist, Department of Cardiothoracic
Anesthesiology | Anesthesiology Institute, Cleveland
Clinic
Martin Besser
Consultant Haematologist, Royal Papworth
Hospital
Caitlin Blau
Perfusion Supervisor, Mayo Clinic
Jonathan Brand
Clinical Director and Consultant in Cardiothoracic
Anaesthesia and Critical Care, James Cook University
Hospital, Middlesbrough
Mark Buckland
Deputy Director, Head of Cardiothoracic
Anaesthesia, Department of Anaesthesiology &
Perioperative Medicine, Alfred Hospital and Monash
University
Christiana Burt
Consultant Anaesthetist, Royal Papworth Hospital
Etienne J. Couture
Anesthesiologist & Intensivist, Institut universitaire
de cardiologie et de pneumologie de Québec –
Université Laval (IUCPQ-UL)
vi
Amanda Crosby
Staff Perfusionist, University of Tennessee Medical
Center
Edward M. Darli ng
Associate Professor, College of Health Professions,
Department of Cardiovascular Perfusion, SUNY
Upstate Medical University; Faculty/Clinical
Coordinator
Filip De Somer
Professor in Perfusion Technology, University Ghent,
Chief Perfusionist, University Hospital Ghent
Apostolos Deliopoulo
Perfusionist, Cardiothoracic Department, Aristotle
University of Thessaloniki
André Y. Denault
Professor, and Anesthesiologist & Intensivist,
Montreal Heart Institute, Université de Montréal
Timothy A. Dickinson
Assistant Professor of Surgery, CCP, Mayo Clinic;
Director, Perfusion Services
Juan Pablo Domecq
Senior Associate Consultant, Division of Nephrology,
Hypertension and Critical Care Medicine, Mayo Clinic,
Rochester, and Mayo Clinic, Mankato; Assistant
Professor of Medicine, Mayo Clinic College of Medicine
David Fitzgerald
Assistant Professor, Division Director, CVP Program,
Medical University of South Carolina
Michael Franklin
Clinical Assistant Professor – Cardiothoracic
Anesthesiology, University of Florida
Tom Gilbey
Anaesthetic Registrar and NIHR Academic Clinical
Fellow, Department of Anaesthetics and Pain
Medicine, King’s College Hospital NHS Foundation
Trust
Shahna Helmick
Program Director of Perfusion Education, University
of Iowa Hospitals and Clinics
Joanne F. Irons
Senior Lecturer, University of Sydney; Staff Specialist
Anaesthetist, Royal Prince Alfred Hospital
Gregory M. Janelle
Professor of AnesthesiologyandSurgeryandAssociate
Chair for Clinical Affairs, Department of Anesthesiology,
University of Florida College of Medicine
Stéphanie Jarry
PhD candidate, Department of Anesthesiology,
Montreal Heart Institute, Université de Montréal
Timothy J. Jones
Consultant Congenital Cardiac Surgeon, Birmingham
Women’s and Children’s Hospital, University
Hospitals Birmingham; Honorary Senior Lecturer,
Institute of Cardiovascular Science, University of
Birmingham
Gudrun Kunst
Professor of Cardiovascular Anaesthesia, Department
of Anaesthetics and Pain Medicine, King’s College
Hospital NHS Foundation Trust & School of
Cardiovascular Medicine and Sciences, King’s Co llege
London; Consultant Anaesthetist and Professor of
Cardiovascular Anaesthesia, British Heart
Foundation Centre of Research Excellence
R. Clive Landis
Professor of Cardiovascular Research, and Pro Vice
Chancellor and Principal, The University of the West
Indies, Cave Hill Campus
Victoria Molyneux
Senior Clinical Perfusionist, Great Ormond Street
Hospital for Children NHS Foundation Trust
Narain Moorjani
Consultant Cardiac Surgeon & Clinical Lead for
Cardiac Surgery, Royal Papworth Hospital; Affiliated
Assistant Professor, University of Cambridge;
President, Society for Cardiothoracic Surgery in Great
Britain & Ireland
Richard F. New land
Senior Perfusionist & Clinical Lead for Perfusion,
Flinders Medical Centre and Lecturer, Flinders
University
List of Contributors
vii
Erik Ortmann
Chair, Department of Anaesthesiology,
Schüchtermann-Heart-Centre
Jane Ottens
Chief Perfusionist, Ashford Hospital
Michael Poullis
Senior Fellow Cardiothoracic Surgery, Manchester
Royal Infirmary
Luc Puis
Senior Perfusionist, University Hospital Brussels,
Center for Heart and Vascular Diseases
Kenneth G. Shann
Director, Perfusion Services, Massachusetts General
Hospital
Linda Shore-Lesserson
Professor of Anesthesiology, Zucker School of
Medicine at Hofstra Northwell; Vice Chair Academic
Affairs; Director, Cardiovascular Anesthesiology
Joseph J. Sistino
Professor Emeritus, Medical University of South
Carolina College of Health Professions
Pingping Song
Assistant Professor, Departmen t of Anesthesiology &
Pain Medicine, University of Washington Medical
Center; Medical Director, Cardiothoracic Intensive
Care Unit
Bruce D. Spiess
Professor and Associate Chair (Research), University
of Florida College of Medicine
Pascal Starinieri
Clinical Perfusionist, JESSA Hospital
Thoralf M. Sundt
Chief, Division of Cardiac Surgery, Director of
Cardiac Surgery Clinical Service, and Edward D.
Churchill Professor of Surgery, Harvard
Medical School, Massachusetts General
Hospital
Jessica Underwood
Perfusionist, Alfred Hospital; Director, Victorian
Perfusion Specialists
Lindsay Wetzel
Cardiac Anesthesiologist, TriHealth Heart Institute -
Seven Hills Anesthesia
Robert Young
Specialist Cardiothoracic Anaesthetist, Department of
Anaesthesia, Flinders Medical Centre
List of Contributors
viii
Foreword
Six years after the publication of the second edition of
Cardiopulmonary Bypass, Florian Falter, Robert
Baker and Albert C Perrino have produced a substan-
tial revision of this highly regarded text. Success in
cardiac surgery requires each member of the team to
be expert in the theory and capable in the practice of
their individual discipline, but it also requires them to
work together effectively as a team, often for long
hours under considerable stress. It is thus very pleas-
ing to see a strong new emphasis on teamwork, com-
munication and human factors added to this already
excellent book. This emphasis is reflected in the
renewed authorship of each chapter, which (in most
cases) now includes all three of the disciplines key to
the management of cardiopulmonary bypass – anes-
thesia, perfusion and surgery. The list of editors and
authors is a “Who’sWho” of this field and reflects not
only deep expertise in the relevant topics but also
established ability to disseminate knowledge through
lecturing and writing. The result, as one might expect,
is a scientifically sound, clearly written and highly
accessible text. It is a text that will (like the previous
edition) be an excellent source of practical hands-on
advice on how to apply the underpinning principles
to the everyday practice of cardiopulmonary bypass
within the dynamic context of cardiac surgery.
The number of chapters has increased from 16 to
20, but new material has been incorporated through-
out. The themes of teamwork, co mmunication,
checklists and safety (both Safety-I and Safety-II)
run through the entire book. As with the previous
edition, the editors have achieved a consistency of
style and message with a minimum of repetition.
Thus, the book feels coherent and has a logical flow
of ideas. As before, there is effective use of illustra-
tions and tables and a good bibliography of selected
references for each chapter. The book will continue to
provide an outstanding introduction to this field of
practice, both for surgeons and anesthetists, who pri-
marily need to understand and contribute to the
management of cardiopulmonary bypass or mechan-
ical circulatory support, and for perfusionists who
also have to set up and run the equipment. For those
already expert in this field, it will provide a technically
up-to-date source for revision of the relevant topics
from a highly contemporary perspective.
The editors work in leading institutions in their
respective countries (England, Australia and the
United States). Each is known for leadership and
innovation within their discipline. The same can be
said for the chapter authors. It is unsurprising that the
book carries a tone of authority that will leave readers
confident in the reliability of the information and the
soundness of the perspectives within it.
I offer the editors and the authors my hearty
congratulations.
Alan Merry FANZCA, FFPMANZCA, FRSNZ
Professor of Anaesthesiology, University of
Auckland,
Specialist in Anaesthesia, Auckland City Hospital,
New Zealand.
ix
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