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Perfusion Considerations 

Perfusion Considerations
Chapter:
Perfusion Considerations
Author(s):

Phillip Scott

and Jeffrey Riley

DOI:
10.1093/med/9780190909291.003.0025
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date: 16 January 2021

The effects of hemodilution during cardiopulmonary bypass (CPB) negatively impact a patient’s hemodynamic and coagulopathic states throughout all operative stages and into the postoperative care environment. Decisions by the surgical team to minimize fluid administration prove beneficial, and combining contemporary perfusion circuit prime reduction techniques, such as body mass index (BMI) correction, venous autologous priming (VAP), retrograde autologous priming (RAP), and antegrade prime displacement, greatly enables efforts of maintaining proper colloidal osmotic pressures (COP) while maximizing delivery of oxygen (DO2) during CPB. Adjuncts such as ultrafiltration (UF), use of vacuum assist venous drainage (VAVD), hyper-osmotic/oncotic solutions administration, and proportional volume replacement better prepare a patient for post-bypass management. Minimizing hemodilution tools facilitates transition onto mechanical circulatory support (MCS) devices such as extracorporeal membrane oxygenation (ECMO) and/or right or left ventricular assist device (RVAD/LVAD). Avoiding heparin rebound and dilutional coagulopathy in the intensive care unit further prevents additional blood product transfusions.

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