Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

Abstract

A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB) as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.

Epoetin administrated after cardiac surgery: effects on renal function and inflammation in a randomized controlled study

“…For this reason, although all patients admitted in the ICU were first supposedly eligible for enrollment, finally only patients having “elective” cardiac surgery could be asked for consent prior to randomization and were included in this study. During surgery, patients were managed according to a published protocol [21]. The study was approved by the ethical committee from Geneva University Hospital and registered at ClinicalTrial.gov (NCT00676234).…”

Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography

“…The small size and simplicity of the hTEE probe make it ideal for ECMO weaning because the entire weaning process may take several hours to observe hemodynamics after each adjustment of ECMO flow, volume status, and inotropic support. Motivated by TEE-guided weaning of cardiopulmonary bypass in the operating room, 11 timely and accurate clinical decisions can be made by the intensivist for weaning ECMO and subsequent treatment without additional personnel. We reviewed our experience using hTEE in patients on ECMO to assess the functional status of the LV and RV in weaning ECMO before proceeding to the next level of care.…”

Calcium Administration During Weaning From Cardiopulmonary Bypass: A Narrative Literature Review

“…According to the available literature, 10% to 45% of patients face difficulties during weaning from CPB. 1 The choice of inotropic and vasopressor agents for weaning from CPB depends on each patient's cardiac pathology and hemodynamic status. Based on existing data regarding the beneficial effects of calcium administration on cardiac index and blood pressure in cardiac patients, some anesthesiologists believe that this drug may offer additional benefit.…”