Need for Cardiopulmonary Bypass

Cardiopulmonary bypass is avoided if possible because it prolongs the procedure, and results in more perioperative blood loss and an increased need for platelets and coagulation factors after cardiopulmonary bypass. The decision to use cardiopulmonary bypass is based on the right ventricular function after clamping of the pulmonary artery of the lung that is excised. If cardiac output after clamping of the pulmonary artery decreases significantly and/or if worsening right ventricular dysfunction is observed on transesophageal echocardiography (TEE), it is very likely that cardiopulmonary bypass will be necessary. Most patients with pulmonary hypertension will require cardiopulmonary bypass because the right ventricle does not tolerate a further increase in afterload. Also, the patients with pulmonary hypertension who will need correction of cardiac anomalies (e.g., atrial septum defect, ventricular septum defect) will require cardiopulmonary bypass. Finally, cardiopulmonary bypass is used when there is intractable hypoxia during one-lung ventilation, despite appropriate interventions.

Use of femoral cannulas to establish partial cardiopulmonary bypass may be adequate treatment for right ventricular failure. However, there is still blood flow through the native lung and ejection by the left ventricle, and therefore oxygenation of arterial blood in the upper half of the body is sometimes inadequate. Therefore, determination of PaO2 from a blood sample from a radial artery has to be done to assure adequate oxygenation of blood perfusing the heart and brain. Measures should be instituted to improve oxygenation of blood flowing through the native lung. If necessary, ventricular fibrillation is induced during cardiopulmonary bypass in order to interrupt flow through the native lung.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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