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Management of Challenging Cardiopulmonary Bypass Separation
- Source :
- Journal of cardiothoracic and vascular anesthesia. 34(6)
- Publication Year :
- 2019
-
Abstract
- SEPARATION from cardiopulmonary bypass (CPB) after cardiac surgery is a progressive transition from full mechanical circulatory and respiratory support to spontaneous mechanical activity of the lungs and heart. During the separation phase, measurements of cardiac performance with transesophageal echocardiography (TEE) provide the rationale behind the diagnostic and therapeutic decision-making process. In many cases, it is possible to predict a complex separation from CPB, such as when there is known preoperative left or right ventricular dysfunction, bleeding, hypovolemia, vasoplegia, pulmonary hypertension, or owing to technical complications related to the surgery. Prompt diagnosis and therapeutic decisions regarding mechanical or pharmacologic support have to be made within a few minutes. In fact, a complex separation from CPB if not adequately treated leads to a poor outcome in the vast majority of cases. Unfortunately, no specific criteria defining complex separation from CPB and no management guidelines for these patients currently exist. Taking into account the above considerations, the aim of the present review is to describe the most common scenarios associated with a complex CPB separation and to suggest strategies, pharmacologic agents, and para-corporeal mechanical devices that can be adopted to manage patients with complex separation from CPB. The routine management strategies of complex CPB separation of 17 large cardiac centers from 14 countries in 5 continents will also be described.
- Subjects :
- Inotrope
medicine.medical_specialty
separation
Ventricular Dysfunction, Right
Separation (statistics)
inotropes
030204 cardiovascular system & hematology
anesthesia
law.invention
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
law
Hypovolemia
Intensive care
Vasoplegia
medicine
Cardiopulmonary bypass
Humans
Cardiac Surgical Procedures
Intensive care medicine
intensive care
Cardiopulmonary Bypass
business.industry
weaning
Thoracic Surgery
ventricular dysfunction
medicine.disease
Pulmonary hypertension
Cardiac surgery
surgical procedures, operative
Anesthesiology and Pain Medicine
medicine.symptom
Cardiology and Cardiovascular Medicine
business
cardiopulmonary bypass
Echocardiography, Transesophageal
discontinuation
Subjects
Details
- ISSN :
- 15328422
- Volume :
- 34
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of cardiothoracic and vascular anesthesia
- Accession number :
- edsair.doi.dedup.....9d01d7a244a580a903150d8a79bb3dc2