KAHER INSTITUTE OF NURSING

SCIENCES
CARDIOPULMONARY BY
PASS

Presented by :
Arya Gaunker
1st Year M.S.c
N
 History of CPB
The Austrian-German physiologist Maximilian von Frey

 constructed an early prototype of a heart-lung machine in

1885 at Carl Ludwig’s Physiological Institute of the 
University of Leipzig.
The first successful open heart procedure on a human

utilizing the heart lung machine was performed by 

John Gibbon and Frank F. Allbritten, Jr. on May 6, 1953
at Thomas Jefferson University Hospital in Philadelphia.
A heart lung machine used in London's Middlesex Hospital in
1958. Science Museum, London (2008)
Cardiopulmonary bypass machine used at the
University of Michigan in the 1960s.
DEFINITION
(CPB) is a technique in which a machine temporarily

takes over the function of the heart and lungs during 

surgery, maintaining the circulation of blood and the
oxygen content of the patient's body.
USES
coronary artery bypass grafting 

mitral valve repair or replacement,

induction of total body hypothermia

SURGICAL PROCEDURES IN WHICH CARDIOPULMONARY
BYPASS IS USED
Coronary artery bypass surgery
Cardiac valve repair and/or replacement (
aortic valve, mitral valve, tricuspid valve, pulmonic
valve)
Repair of large septal defects (atrial septal defect, 
ventricular septal defect, atrioventricular septal
defect)
Repair and/or palliation of congenital heart defects
 (Tetralogy of Fallot, 
transposition of the great vessels)
Transplantation (heart transplantation, 
lung transplantation, heart–lung transplantation, 
liver transplantation)
Repair of some large aneurysms (aortic aneurysms, 
cerebral aneurysms)
Pulmonary thromboendarterectomy
Pulmonary thrombectomy
Isolated Limb perfusion
CONTRAINDICATIONS
Heparin-induced thrombocytopenia

antithrombin III deficiency,

 persistent left superior vena cava 

TYPES OF CANNULATION
Venous cannulation

A cannula may be placed in the right atrium , superior

vena-cava , inferior vena-cava or femoral vein to drain

the blood from the body.
Arterial cannulation

A cannula may be placed in ascending aorta,arch of aorta of

femoral artery for returning of oxygenated blood from the

heart-lung machine.
The left ventricular venting catheter has been inserted

adjacent to the right superior pulmonary vein (SPV).

The retrograde cardioplegia catheter is in the coronary sinus.

The antegrade cardioplegia catheter is in the ascending aorta

proximal to the aortic occluding clamp.

Cardiopulmonary Circuit
Components of cardiopulmonary bypass
circuit
Pumps: Pumps are used for circulation of blood at
constant speed.
Pumps may be roller or centrifugal.
Venous reservoir: It serves as a receiving chamber for
venous return .
During cardiopulmonary bypass 1-3 liters of blood
may be stored in the reservoir.
Oxygenated Membrane
Oxygenator :It is used for oxygenating the venous blood

The oxygenator may be membrane or bubble generator .

Heat exchanger: It is used for warming or cooling the blood.

Filter: It is used to prevent the air embolism.

Cardiotomy suction: It is the suctioning of blood from the

surgical wound during the surgery.

Cardiopulmonary reservoir : The blood suctioned from the

surgical wound is directed into the cardiotomy reservoir for

defoaming, filtering , storage and then the redirected to the
venous reservoir
Left ventricular venting : It is the process of removing
blood from the left ventricle to prevent left ventricular
distension during aortic cross clamp.
During cardiopulmonary bypass left ventricle may be
distended due to :
Blood escaping from the atrial or venous cannula.
Blood from the coronary sinus and besian veins pass into
pulmonary circulation.
Blood from aortic regurgitation
Bronchial arterial and venous blood
PDA
Cardioplegia delivery system:
It is used for delivering the cardioplegia solution into the
coronary arteries .
This is a separate perfusion system from the main
perfusion it includes reservoir , heat exchanger ,roller
pump , bubble trapper , filter.
During the procedure the patient receives the heparin dose
of 3 mg/kg , after the termination of cardiopulmonary
bypass protamine sulfate is administered to reserve the
effects of heparin.
COMPLICATIONS
Arrythmias

Air embolism

Dislogement of cannula

Acidosis

Pulmonary edema

Oliguria

Delirium

gastroenteritis
Bleeding

Aortic dissection

Clotting within the circuit during perfusion

Myocardial reperfusion injury

Acute respiratory distress syndrome

Stroke

Peptic ulcer