32
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management during Cardiopulmonary Bypass

      brief-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract:

          To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation.

          Related collections

          Most cited references55

          • Record: found
          • Abstract: found
          • Article: not found

          Optimal perfusion during cardiopulmonary bypass: an evidence-based approach.

          In this review, we summarize the best available evidence to guide the conduct of adult cardiopulmonary bypass (CPB) to achieve "optimal" perfusion. At the present time, there is considerable controversy relating to appropriate management of physiologic variables during CPB. Low-risk patients tolerate mean arterial blood pressures of 50-60 mm Hg without apparent complications, although limited data suggest that higher-risk patients may benefit from mean arterial blood pressures >70 mm Hg. The optimal hematocrit on CPB has not been defined, with large data-based investigations demonstrating that both severe hemodilution and transfusion of packed red blood cells increase the risk of adverse postoperative outcomes. Oxygen delivery is determined by the pump flow rate and the arterial oxygen content and organ injury may be prevented during more severe hemodilutional anemia by increasing pump flow rates. Furthermore, the optimal temperature during CPB likely varies with physiologic goals, and recent data suggest that aggressive rewarming practices may contribute to neurologic injury. The design of components of the CPB circuit may also influence tissue perfusion and outcomes. Although there are theoretical advantages to centrifugal blood pumps over roller pumps, it has been difficult to demonstrate that the use of centrifugal pumps improves clinical outcomes. Heparin coating of the CPB circuit may attenuate inflammatory and coagulation pathways, but has not been clearly demonstrated to reduce major morbidity and mortality. Similarly, no distinct clinical benefits have been observed when open venous reservoirs have been compared to closed systems. In conclusion, there are currently limited data upon which to confidently make strong recommendations regarding how to conduct optimal CPB. There is a critical need for randomized trials assessing clinically significant outcomes, particularly in high-risk patients.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            An evidence-based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Postoperative hyperthermia is associated with cognitive dysfunction after coronary artery bypass graft surgery.

              Temperature is a well-known modulator of experimental cerebral injury. We hypothesized that hyperthermia would be associated with a worsened cognitive outcome after coronary artery bypass graft surgery (CABG). Three hundred consenting patients undergoing cardiopulmonary bypass for CABG had hourly postoperative temperatures recorded. The degree of postoperative hyperthermia was determined by using the maximum temperature within the first 24 hours as well as by calculating the area under the curve for temperatures >37 degrees C. Patients underwent a battery of cognitive testing both before surgery and 6 weeks after surgery. By use of factor analysis, 4 cognitive domains (scores) were identified, and the mean of the 4 scores was used to calculate the cognitive index (CI). Cognitive change was calculated as the 6-week CI minus the baseline CI. Multivariable linear regression (controlling for age, baseline cognitive function, and temperature during cardiopulmonary bypass) was used to compare postoperative hyperthermia with the postoperative cognitive change. The maximum temperature within the first 24 hours after CABG ranged from 37.2 degrees C to 39.3 degrees C. There was no relationship between area under the curve for temperatures >37 degrees C and cognitive dysfunction (P=0.45). However, the maximum postoperative temperature was associated with a greater amount of cognitive dysfunction at 6 weeks (P=0.05). This is the first report relating postoperative hyperthermia to cognitive dysfunction after cardiac surgery. Whether the hyperthermia caused the worsened outcome or whether processes that resulted in the worsened cognitive outcome also produced hyperthermia requires further investigation. In addition, interventions to avoid postoperative hyperthermia may be warranted to improve cerebral outcome after cardiac surgery.
                Bookmark

                Author and article information

                Journal
                J Extra Corpor Technol
                J Extra Corpor Technol
                JECT
                The Journal of Extra-corporeal Technology
                American Society of ExtraCorporeal Technology
                0022-1058
                2015
                2015
                : 47
                : 3
                : 145-154
                Affiliations
                Department of Surgery, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts; Cardiac Surgery Research and Perfusion, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Department of Anesthesiology, University of Nevada, Las Vegas, Nevada; Clinical Performance Improvement, SpecialtyCare, Nashville, Tennessee; Department of Anesthesiology, Hofstra Northshore-Long Island Jewish School of Medicine, New Hyde Park, New York; and Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
                Author notes
                Address correspondence to: Richard Engelman, MD, Department of Surgery, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199. E-mail: richard.engelman@ 123456baystatehealth.org

                This article is copublished in the Journal of ExtraCorporeal Technology, The Annals of Thoracic Surgery, and the Journal of Cardiothoracic and Vascular Anesthesia.

                Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Society of ExtraCorporeal Technology. Please contact the Journal of ExtraCorporeal Technology for permission at ject@ 123456mmc.org .

                Article
                ject.2015.47.3.145
                10.1016/j.athoracsur.2015.03.126
                4631211
                26279227
                91f62406-66f2-458d-a4fc-39e8e64f20a4
                © Copyright 2015 AMSECT

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Pages: 10
                Categories
                Special Report

                cardiopulmonary bypass,perfusion,temperature management,cardiopulmonary bypass neurologic morbidity

                Comments

                Comment on this article