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

Engelman, Richard M.; Baker, Robert A.; Likosky, Donald S.; Grigore, Alina M.; Dickinson, Timothy A.; Shore‐Lesserson, Linda; Hammon, John W.

doi:10.1053/j.jvca.2015.07.011

Cited by 67 publications

(81 citation statements)

References 54 publications

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“…Factors previously associated with postoperative blood loss correlated with ΔHCT, but the only measure of temperature associated with increased ΔHCT 12 was a higher rewarming rate measured by blood temperature. This suggests caution in allowing a rate of rewarming above the generally recommended 0.2°C/min, although the mechanism for the association is unclear [21]. CT output is another commonly used measure of postoperative bleeding.…”

Section: Discussionmentioning

confidence: 99%

Too Cold to Clot? Does Intraoperative Hypothermia Contribute to Bleeding Following Aortic Surgery?

Stein¹,

Rubinfeld²,

Balsam³

et al. 2017

aorta

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Background: We determined the impact of intraoperative hypothermia on postoperative bleeding after thoracic aortic surgery. Methods: We retrospectively analyzed 98 consecutive patients who underwent aortic surgery with deep hypothermic circulatory arrest between 2010 and 2014. We evaluated lowest temperature, absolute decrease in temperature, and rewarming rate. Univariate and multivariate regression were used to determine relationships between temperature, clinical characteristics, and measures of postoperative bleeding. Results: The mean age of patients was 60.5 ± 15.1 years, with 64.3% male and 60% Caucasian. The lowest temperatures recorded were 13.5 ± 4.6°C at the bypass circuit. Change in hematocrit was associated with ethnicity, preoperative hematocrit, and rewarming rate. Chest tube output was associated with body mass index, preoperative platelet count, prior cardiac surgery, cardiopulmonary bypass (CPB) duration, intraoperative blood product transfusion, lowest surface temperature, and change in surface temperature. Postoperative packed red blood cell transfusion was associated with ejection fraction, chronic obstructive pulmonary disease (COPD), platelet count, partial thromboplastin time, CPB duration, and lowest blood temperature. Fresh frozen plasma transfusion correlated with COPD, CPB duration, and final blood temperature. Platelet transfusion correlated with body mass index and preoperative platelet count. Unplanned reoperation for bleeding was associated with final temperature and change in temperature. Conclusion: We found no consistent associations between intraoperative temperature and indicators of bleeding. Intraoperative cooling strategies should be based on optimal end-organ protection rather than fear of postoperative bleeding; rewarming strategies may ameliorate the risk of coagulopathy.

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Section: Discussionmentioning

confidence: 99%

Too Cold to Clot? Does Intraoperative Hypothermia Contribute to Bleeding Following Aortic Surgery?

Stein¹,

Rubinfeld²,

Balsam³

et al. 2017

aorta

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“…Following the recommendations of The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of Extracorporeal Technology (38) cooling should be performed gradually by maintaining a temperature gradient between the arterial outlet and the oxygenator venous inlet <10 ℃ to avoid the generation of gaseous embolism. Also during the rewarming, a gradient of T <10 ℃ must be maintained until the out-flow temperature reaches 30 ℃ where it should be lowered to <4 ℃.…”

Section: Temperature Managementmentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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Abstract:The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 ℃) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

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“…Хотя температурные стратегии часто упоминаются в литературе, обоснования для той или иной практики часто недостаточно описы-ваются или вовсе отсутствуют. Группа авторов по поручению Society of Thoracic Surgeons, Society of Cardiovascular Anesthesiology и American Society of ExtraCorporeal Technology недавно выполнила обзор имеющейся на данный момент литературы для улучшения доказательной базы температурного режима во время ИК [30]. Авторы отмечают суще-ственные различия на сегодняшний день как в уров-не температуры во время ИК, так и даже в способах мониторинга и достижения желаемой температуры.…”

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“…В другом исследовании температура на выходе артериальной крови выше 37°C являлась независимым предикто-ром острого повреждения почек [79]. Многие авто-ры предлагают медленное согревание по множеству причин: исключение гетерогенности в температуре головного мозга, избежание избыточной экстракции кислорода в головном мозге и десатурации крови в яремной вене, лучшее соотношение церебрального кровотока и церебрального потребления кислорода, увеличенное время для лучшего перераспределения тепла, вероятность предотвращения гипертермии [2,25,30,55,58,59,75,96]. В то же время данных об оптимальной скорости согревания и ее влиянии на результаты недостаточно -лишь 4 из 15 ран-домизированных исследований, сравнивающих гипотермический ИК с нормотермическим, имеют информацию о скорости согревания [42].…”

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Physiological Parameters of Artificial Blood Circulation From the Position of the Evidence Based Medicine (Part 2)

Kornilov¹,

Пономарев²,

Shmyrev³

et al. 2016

MAaR

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1ФГБУ «Новосибирский НИИ патологии кровообращения им. акад. Е. Н. Мешалкина» МЗ РФ, г. Новосибирск 2 ГБУЗ «НИИ -краевая клиническая больница № 1 им. проф. С. В. Очаповского», г. Краснодар 3 ФГБУ «Федеральный центр сердечно-сосудистой хирургии», г. Пермь В обзоре продолжено рассмотрение аспектов управления основными физиологическими параметрами во время искусственного крово-обращения у взрослых пациентов с позиции доказательной медицины, начатое в предыдущем номере журнала. Данная часть посвящена управлению температурой, доставкой кислорода и пульсацией. Делается заключение, что в настоящее время большинство рекомендаций по проведению искусственного кровообращения не имеют серьезной доказательной базы. Для достижения наилучших клинических результатов предложено отслеживать публикуемые данные и соотносить их с собственным опытом с учетом соотношения польза/риск. Показано, что в основе большинства осложнений, связанных с искусственным кровообращением, лежат разные причины, и это диктует необходимость мультидисциплинарного подхода к их предотвращению. This review continues to investigate the management aspects of main physiological parameters during artificial blood circulation in the adult patients from the position of the evidence based medicine, and the first part of this review was published in the previous issue. This part is devoted to management of temperature, oxygen delivery and pulsation. The authors conclude that currently the majority of recommendations for artificial blood circulation are not based on the relevant evidences. In order to achieve best clinical results it has been offered to review the published data and relate them with the personal experience evaluating benefits and risks. It has been shown that the majority of complications related to artificial blood circulation have various causes and it demands the multi-disciplinary approach to their prevention.

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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

Cited by 67 publications

References 54 publications

Too Cold to Clot? Does Intraoperative Hypothermia Contribute to Bleeding Following Aortic Surgery?

Too Cold to Clot? Does Intraoperative Hypothermia Contribute to Bleeding Following Aortic Surgery?

Intraoperative care for aortic surgery using circulatory arrest

Physiological Parameters of Artificial Blood Circulation From the Position of the Evidence Based Medicine (Part 2)

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