Techniques in extracorporeal circulation This page intentionally left blank Techniques in extracorporeal circulation FOURTH EDITION Edited by PHILIP H KAY MA DM FRCS Consultant Cardiothoracic Surgeon, Yorkshire Heart Centre, The General Infirmary, Leeds, UK and CHRISTOPHER M MUNSCH ChM FRCS (C/Th) Consultant Cardiothoracic Surgeon, Yorkshire Heart Centre, The General Infirmary, Leeds, UK A member ofthe Hodder Headline Group LONDON First published in 1976 by Butterworth-Heinemann Ltd, Linacre House, Jordan Hill, Oxford, OX2 8DP. This edition published in Great Britain in 2004 by Arnold, a member of the Hodder Headline Group, 338 Euston Road, London NW1 3BH http://www.arnoldpublishers.com First published 1976 Second edition 1981 Reprinted 1982 Third edition 1992 Reprinted 1993 Fourth edition 2004 Distributed in the United States of America by Oxford University Press Inc., 198 Madison Avenue, New York, NY10016 Oxford is a registered trademark of Oxford University Press ©2004 Arnold All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronically or mechanically, including photocopying, recording or any information storage or retrieval system, without either prior permission in writing from the publisher or a licence permitting restricted copying. In the United Kingdom such licences are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London W1T 4LP. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however, it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN 0 340 80723 7 1 2 3 4 5 6 7 8 9 10 Commissioning Editor: Joanna Koster Development Editor: Sarah Burrows Project Editor: Zelah Pengilley Production Controller: Deborah Smith Cover Design: Lee-May Lim Indexer: Laurence Errington Typeset in 10/12 pt Minion by Charon Tec Pvt Ltd, Chennai, India Printed and bound in Great Britain by Butler & Tanner Ltd What do you think about this book? Or any other Arnold title? Please send your comments to [email protected] Contents Contributors vii Foreword xi Preface to Fourth Edition – 50 years on xiii Preface to Third Edition xiv Preface to Second Edition xv Preface to First Edition xvi Acknowledgements xvii 1 A brief history of bypass 1 Anil Kumar Mulpur and Christopher M Munsch 2 Design and principles of the extracorporeal circuit 7 Medtronic, Inc., A Manufacturer of Technologies for Extracorporeal Circulation 3 Physiology and pathophysiology of extracorporeal circulation 23 Jonathan AJ Hyde and Ralph E Delius 4 Anaesthesia for cardiopulmonary bypass 57 Linda Nel and John WW Gothard 5 Monitoring and safety in cardiopulmonary bypass 76 Jonathan M Johnson, Stephen Robins and Jonathan AJ Hyde 6 Priming fluids for cardiopulmonary bypass 99 Piet W Boonstra and Y John Gu 7 Filters in cardiopulmonary bypass 108 Farah NK Bhatti and Timothy L Hooper 8 The inflammatory response to cardiopulmonary bypass 117 Saeed Ashraf 9 Pulsatile cardiopulmonary bypass 133 Terry Gourlay and Kenneth M Taylor 10 Cardiopulmonary bypass and the brain 148 G Burkhard Mackensen, Hilary P Grocott and Mark F Newman vi Contents 11 Cardiopulmonary bypass in children with congenital heart disease 177 Carin van Doorn and Martin Elliott 12 Intraoperative myocardial protection 184 John WC Entwistle III and Andrew S Wechsler 13 Blood conservation 210 Mike Cross 14 Mechanical circulatory support 236 Stephen Westaby and Satoshi Saito 15 Extracorporeal membrane oxygenation 254 Scott K Alpard, Dai H Chung and Joseph B Zwischenberger 16 The extended use of the extracorporeal circuit 292 Philip H Kay, Anil Kumar Mulpur, Dumbor Ngaage, Samir Shah, Kieran Horgan, John Pollitt and Stephen D Hansbro 17 Cardiopulmonary bypass during Port-access™ and robotic surgery 298 Alan P Kypson and W Randolph Chitwood Jr 18 Cardiac surgery without cardiopulmonary bypass 315 Joseph P McGoldrick 19A The development of clinical perfusion education and standards in the UK and Ireland 332 Michael Whitehorne 19B Standards, guidelines and education in clinical perfusion: the European perspective 337 Ludwig K Von Segesser 19C Perfusion education in the USA at the turn of the twentieth century 341 Alfred H Stammers Index 345 Contributors Scott K Alpard MD Mike Cross Surgical Research Fellow, Consultant Anaesthetist, Division of Cardiothoracic Surgery, Yorkshire Heart Centre, University of Texas Medical Branch, The General Infirmary at Leeds, Galveston, TX, USA Leeds, UK Saeed Ashraf FRCS(CTh)MD Ralph E Delius MD Consultant Cardiothoracic Surgeon, Children’s Hospital of Michigan, Regional Cardiothoracic Centre, Detroit, MI, US The Morriston Hospital, and Honorary Senior Lecturer, University of Swansea, Carin van Doorn Swansea, UK Senior Lecturer in Cardiothoracic Surgery, University College London, Farah NK Bhatti and Honorary Consultant Cardiothoracic Surgeon, Specialist Registrar in Cardiothoracic Surgery, Cardiothoracic Unit, Wythenshawe Hospital, Great Ormond Street Hospital for Children, Manchester, UK London, UK Piet W Boonstra Department of Cardiothoracic Surgery, Martin Elliott University Hospital, Consultant Cardiothoracic Surgeon, Groningen, The Netherlands Cardiothoracic Unit, Great Ormond Street Hospital for Children, Walt Carpenter London, UK Director of Cardiopulmonary R&D, Medtronic Perfusion Systems, John WC Entwistle III MDPhD Minneapolis, MN, USA Assistant Professor of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, W Randolph Chitwood Jr MD Drexel University College of Medicine, Senior Associate Vice Chancellor and Director, Philadelphia, PA, USA North Carolina Cardiovascular Institute, Professor and Chairman, Professor of Surgery, John WW Gothard FRCA Consultant Anaesthetist, Chief, Division of Cardiothoracic and Vascular Surgery, Royal Brompton Hospital, The Brody School of Medicine, London, UK East Carolina University, Greenville, NC, USA Terry Gourlay PhDBSc(Hons)CBiolMIBiolILTHEFRSH Dai H Chung MD British Heart Foundation Perfusion Specialist, Assistant Professor of Surgery, Department of Cardiothoracic Surgery, Chief, Section of Pediatric Surgery, NHLI, Department of Surgery, Imperial College Medical School, University of Texas Medical Branch, Hammersmith Hospital Campus, Galveston, TX, USA London, UK viii Contributors Hilary P Grocott MDFRCPC G Burkhard Mackensen MD Associate Professor, Assistant Professor, Department of Anesthesiology, Klinik für Anaesthesiologie, Duke Heart Center, Technische Universität München, Duke University Medical Center, Klinikum rechts der Isar, Durham, NC, USA München, Germany Joseph P McGoldrick MDFRCS Y John Gu Consultant Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, The Yorkshire Heart Centre, University Hospital, The General Infirmary at Leeds, Groningen, The Netherlands Leeds, UK Stephen D Hansbro Anil Kumar Mulpur MSMChFRCS(Edin) Department of Clinical Perfusion, FRCS(Glasgow)FRCSC/Th(Edin)FETCS Leeds General Infirmary, Consultant Cardiothoracic Surgeon, Leeds, UK Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India Timothy L Hooper Christopher M Munsch ChMFRCS(C/Th) Consultant Cardiac Surgeon, Consultant Cardiothoracic Surgeon, Wythenshawe Hospital, Department of Cardiothoracic Surgery, Manchester, UK The Yorkshire Heart Centre, The General Infirmary, Kieran Horgan Leeds, UK Department of General Surgery, Leeds General Infirmary, Linda Nel FRCA Leeds, UK Consultant Anaesthetist, Southampton University Hospitals Trust, Southampton, UK Jonathan AJ Hyde MDFRCS(CTh) Consultant Cardiac Surgeon, Mark F Newman MD Royal Sussex County Hospital, Professor and Chairman, Brighton, UK Department of Anesthesiology, Duke Heart Center, Jonathan M Johnson BScACP Duke University Medical Center, Chief Clinical Perfusionist, Durham, NC, USA Royal Sussex County Hospital, Dumbor Ngaage Brighton, UK Department of Cardiothoracic Surgery, Leeds General Infirmary, Bruce Jones Leeds, UK Cardiopulmonary Product Manager, Medtronic Perfusion Systems, John Pollitt Minneapolis, MN, USA Department of General Surgery, Leeds General Infirmary, Philip H Kay MADMFRCS Leeds, UK Consultant Cardiothoracic Surgeon, Stephen Robins PgDipAACP The Yorkshire Heart Centre, Chief Clinical Perfusionist, The General Infirmary, New Cross Hospital, Leeds, UK Wolverhampton, UK Alan P Kypson MD Satoshi Saito MDPhD Assistant Professor of Surgery, Senior Clinical Research Fellow, Division of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Brody School of Medicine, Oxford Heart Centre, East Carolina University, John Radcliffe Hospital, Greenville, NC, USA Oxford, UK Contributors ix Ludwig K Von Segesser Andrew S Wechsler MD Service de Chirurgie Cardio-Vasculaire, Professor and Chairman, Centre Hospitalier Universitaire Vaudois (CHUV), Department of Cardiothoracic Surgery, Lausanne, Switzerland Drexel University College of Medicine, Philadelphia, PA, USA Samir Shah Department of Cardiothoracic Surgery, Stuart Welland Leeds General Infirmary, European Marketing Manager, Leeds, UK Medtronic Europe Sàrl, Tolochenaz, Switzerland Alfred H Stammers MSACCP Chief Perfusionist, Stephen Westaby PhDFETCSMS Department of Surgery, Consultant Cardiac Surgeon, Geisinger Medical Center, Department of Cardiothoracic Surgery, Danville, PA, USA Oxford Heart Centre, John Radcliffe Hospital, Editor, Journal of Extracorporeal Technology Oxford, UK Jeanne Stanislawski Michael Whitehorne MSCACPFCCPS Cardiopulmonary Product Manager, Consultant Clinical Perfusion Scientist, Medtronic Perfusion Systems, Department of Cardiothoracic Surgery, Minneapolis, MN, USA King’s College Hospital, London, UK Wendy Svee Cardiopulmonary Product Manager, Joseph B Zwischenberger MD Medtronic Perfusion Systems, Professor of Surgery, Medicine, and Radiology, Minneapolis, MN, USA Director, General Thoracic Surgery and ECMO Programs, Kenneth M Taylor Division of Cardiothoracic Surgery, Professor of Cardiac Surgery, University of Texas Medical Branch, Department of Cardiothoracic Surgery, Galveston, TX, USA NHLI, Imperial College Medical School, Hammersmith Hospital Campus, London, UK