Cardiopulmonary Bypass, 2nd ed.

Abstract

Few aspects of medicine are as awe-inspiring as the act of intentionally arresting the heart, performing a lifesaving surgery, and then bringing the dormant organ back to life a short time later. Ghosh and colleagues (the majority from the United Kingdom, with Mayo Clinic and Yale representing a distant second and third) seek to provide an “alternative to the large reference tomes” that predominate the subject of cardiopulmonary bypass (CPB). Their overview of the details of this complicated and multidisciplinary process is just over 250 pages and weighs less than half a pound. Approximately the size of a small tablet and in paperback form, the portability of the book lends itself to use as a primer by those in training, and it would slip easily into the pocket of a lab coat. The book is divided into 16 short, easily digestible chapters (the longest totals 23 pages) and includes complementary images, figures, and tables. The authors provide a concise description of the necessary equipment, management, and implications of the use of CPB. The content flows logically and, while not explicitly divided, is presented in 3 distinct portions. The first portion describes the basic components of the bypass circuit through the physiologic weaning process. Each component of the bypass system is individually discussed and placed in the context of the entire circuit. The necessary system checks and choices of priming solutions are reviewed, followed by an analysis of anticoagulation strategies. The reader is then walked through the process of initiating CPB and providing myocardial protection. Physiologic weaning from the CPB circuit is explored, and a basic checklist of the important parameters that must be met before separation can occur is provided. After chapters on mechanical circulatory support and deep hypothermic circulatory arrest, the second portion focuses on the physiologic impact of subjecting a patient to CPB. Individual chapters are dedicated to the central nervous system and renal injury. Another addresses current theoretical concepts of organ damage associated with CPB as well as pharmacologic strategies that have been employed to try to mitigate these deleterious effects. The third portion enumerates the ways CPB technology is extended outside cardiac operating rooms. Topics include extracorporeal membrane oxygenation (ECMO), pediatric CPB, and the use of CPB in noncardiac surgery. New to the second edition (the first edition was published in 2009) is the addition of self-assessment questions at the conclusion of each chapter, which further the educational mission of the book. While the questions are well written and highlight key points, the answers are listed immediately below the questions and offer no explanations of wrong answer choices. Another feature of the updated version is the addition of 5 color image plates found in the midsection of the text, each of which has a corresponding black and white image located in its assigned chapter. The color versions of the figures that illustrate the directional flow of blood through the CPB and ECMO circuits serve to enhance the readers’ comprehension. Two color images (one of myocardial membrane potential and the other of Interagency Registry of Mechanically Assisted Circulatory Support mortality data) are not necessarily enhanced by this updated version. This book is well written and effectively speaks to its intended audience of clinicians and perfusionists looking for an introduction to the wide breadth of the topic, a previously unoccupied space in the CPB reference library. While some of the information at the end of the volume is repetitive and reads more like discrete chapters as opposed to a unified text, each chapter provides a complete review of its assigned subject. Topics are analyzed in a thorough and easily comprehensible manner, with the exception of an ambiguous explanation of α-stat and pH-stat management that differs between chapters. The authors do address the growing field of minimally invasive cardiac surgery in Chapter 7, “Myocardial Protection and Cardioplegia;” however, coverage is limited to only a few paragraphs. And while they discuss the use of endoaortic balloon clamps, there is no explanation of the coronary sinus catheter or pulmonary artery vent. Supplementary online material is not available, which could serve to enhance the authors’ descriptions of CPB, ECMO circuits, and newer minimally invasive techniques for bypass. In summary, the authors achieve their intended goal of providing an intermediate resource on CPB. For an in-depth exploration of the subject for those already familiar with the technology or for those looking for detailed analysis, an alternative source should be sought. Given its affordability, portability, and readability, this book is well suited for residents in training and fellows, as well as for those attending physicians looking to refresh their memories on the basics of CPB. Elizabeth K. Healy Cotter, MDMark A. Chaney, MDDepartment of Anesthesia and Critical CareUniversity of ChicagoChicago, Illinois[email protected]