Chapter 5 - Conduct of cardiopulmonary bypass

Summary

The management of cardiopulmonary bypass (CPB) involves a multi-disciplinary approach with coordinated actions and precise communication being crucial for a safe, and effective outcome. Before each case the conduct of CPB should be planned. All members of the team need to be aware of the intended method for cannulation, the systemic and myocardial temperatures required during surgery, the technique of myocardial protection to be used, whether deep hypothermic circulatory arrest (DHCA) will be required and the most appropriate sites for monitoring during CPB. The arterial cannula is the narrowest part of the CPB circuit with resultant high resistance, pressure gradients, high velocity jets and turbulence. Venous blood inflow to the CPB circuit is usually achieved by gravity drainage, using the siphon effect, but earlier CPB circuits used suction to aid venous drainage; in pediatric cases, drainage is often aided by applying suction to the venous lines.