Cardiopulmonary Bypass In Cardiac Surgery Research Articles

Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis.

Ultrafiltration (UF) would enhance coagulation profiles by concentrating coagulation elements during cardiopulmonary bypass (CPB) for cardiac surgery. We retrospectively reviewed electronic medical records of 75 patients who had undergone cardiac surgery with rotational thromboelastometry-based coagulation management in a university hospital and analyzed the UF-induced changes in the maximum clot firmness (MCF) of extrinsically activated test with tissue factor (EXTEM) during CPB in 30 patients. The median volume of filtered-free water was 1,350 ml, and median hematocrit was significantly increased from 22.5% to 25.5%. As the primary measure, UF significantly increased the median MCF-EXTEM from 48.0 mm to 50.5 mm (P = 0.015, effect size r = 0.44). The area under the receiver operating characteristic curve pre-UF MCF-EXTEM for discrimination of any increase of MCF-EXTEM after applying UF was 0.89 (95% CI [0.77, 1.00], P < 0.001), and its cut-off value was 50.5 mm (specificity of 81.8% and sensitivity of 84.2% in Youden's J statistic). In the secondary analyses using the cut-off value, UF significantly increased the median MCF-EXTEM from 40.5 mm to 42.5 mm in 18 patients with pre-UF MCF-EXTEM ≤ 50.5 mm. However, it did not increase MCF-EXTEM in 12 patients with pre-UF MCF-EXTEM > 50.5 mm. There was a significant interaction between pre-UF MCF-EXTEM values and applying UF (P < 0.001 for the subgroup, P = 0.046 for UF, P = 0.003 for interaction). Applying UF improved clot firmness, and the improvement was more pronounced when pre-UF MCF-EXTEM had been reduced during CPB.

“Con: Is Minimal Invasive Extracorporeal Circulation Superior to Conventional Cardiopulmonary Bypass in Cardiac Surgery?”

“Con: Is Minimal Invasive Extracorporeal Circulation Superior to Conventional Cardiopulmonary Bypass in Cardiac Surgery?”

Biochemical Changes in Cardiopulmonary Bypass in Cardiac Surgery: New Insights.

Patients undergoing coronary revascularization with extracorporeal circulation or cardiopulmonary bypass (CPB) may develop several biochemical changes in the microcirculation that lead to a systemic inflammatory response. Surgical incision, post-CPB reperfusion injury and blood contact with non-endothelial membranes can activate inflammatory signaling pathways that lead to the production and activation of inflammatory cells, with cytokine production and oxidative stress. This inflammatory storm can cause damage to vital organs, especially the heart, and thus lead to complications in the postoperative period. In addition to the organic pathophysiology during and after the period of exposure to extracorporeal circulation, this review addresses new perspectives for intraoperative treatment and management that may lead to a reduction in this inflammatory storm and thereby improve the prognosis and possibly reduce the mortality of these patients.

The association between intraoperative cardiopulmonary bypass power and complications after cardiac surgery.

Low cardiac power (product of flow and pressure) has been shown to be associated with mortality in patients with cardiogenic shock after acute myocardial infarction, but has not been studied in cardiac surgical patients. This study's hypothesis was that cardiac power during cardiopulmonary bypass for cardiac surgery would have a greater association with adverse events than either flow or MAP (mean arterial pressure) alone. We undertook a retrospective observational study using patient data from February 2015 to March 2022 undergoing cardiac surgery at Fiona Stanley Hospital in Perth Australia. Excluded were patient age less than 18years old, patients undergoing thoracic transplantation, ventricular assist devices, off pump cardiac surgery and aortic surgery. The primary outcome was a composite outcome of 30-days mortality, stroke or new-onset renal insufficiency. Overall, 1984 cardiac surgeries were included in the analysis. Neither duration nor area below thresholds tested for power, MAP or flow was associated with the primary composite outcome. However, we found that an area below MAP thresholds 35-50mmHg was associated with new renal insufficiency (adjusted odds ratio 1.17 [95% CI 1.02 to 1.35] for patients spending 10min at 10mmHg below 50mmHg MAP compared to those who did not). This study suggests that MAP during cardiopulmonary bypass, but not power or flow, was an independent risk factor for adverse renal outcomes for cardiac surgical patients.

Quick Assessment of the Lower Limit of Cerebral Autoregulation Using Transcranial Doppler during Cardiopulmonary Bypass in Cardiac Surgery: A Feasibility Study

Background: During cardiac surgery, maintaining a mean arterial pressure (MAP) within the range of cerebral autoregulation (CA) may prevent postoperative morbidity. The lower limit of cerebral autoregulation (LLA) can be determined using the mean velocity index (Mx). The standard Mx is averaged over a ten second period (Mx10s) while using a two second averaging period (Mx2s) is faster and may record more rapid variations in LLA. The objective of this study is to compare a quick determination of LLA (qLLA) using Mx2s with the reference LLA (rLLA) using Mx10s. Methods: Single center, retrospective, observational study. Patients undergoing cardiac surgery with cardiopulmonary bypass. From January 2020 to April 2021, perioperative transcranial doppler measuring cerebral artery velocity was placed on cardiac surgery patients in order to correlate with continuous MAP values. Calculation of each patient’s Mx was manually determined after the surgery and qLLA and rLLA were then calculated using a threshold value of Mx &gt;0.4. Results: 55 patients were included. qLLA was found in 78% of the cases versus 47% for rLLA. Despite a –3 mmHg mean bias, limits of agreement were large [–19 mmHg (95% CI: –13; –25), and +13 mmHg (95% CI: +6; +19)]. There was an important interobserver variability (kappa rLLA = 0.46; 95% CI: 0.24–0.66; and Kappa qLLA = 0.36; 95% CI: 0.20–0.52). Conclusions: Calculation of qLLA is feasible. However, the large limits of agreement and significant interobserver variability prevent any clinical utility or interchangeability with rLLA.

Predictive value of postoperative serum procalcitonin concentration for moderate to severe acute respiratory distress syndrome in patients undergoing cardiopulmonary bypass surgery

To explore the changes of serum procalcitonin (PCT) level in patients with moderate and severe acute respiratory distress syndrome (ARDS) after cardiac surgery under cardiopulmonary bypass (CPB), and try to find out the best cut-off of PCT to predict the progression to moderate and severe ARDS. Medical records of patients undergoing cardiac surgery with CPB in Fujian Provincial Hospital from January 2017 to December 2019 were retrospectively analyzed. Adult patients who were admitted in intensive care unit (ICU) for more than 1 day and had PCT values on the first postoperative day were enrolled. Clinical data such as patient demographics, past history, diagnosis, and New York Heart Association (HYHA) classification, and the operation mode, procedure duration, CPB duration, aortic clamp duration, intraoperative fluid balance, calculation of 24 hours postoperative fluid balance and vasoactive-inotropic score (VIS); 24 hours postoperative C-reactive protein (CRP), N-terminal B-type natriuretic peptide precursor (NT-proBNP) and PCT levels were collected. Two clinicians independently made the diagnosis of ARDS according to the Berlin definition, and the diagnosis was established only in patients with a consistent diagnosis. The differences in each parameter were compared between patients with moderate to severe ARDS and those without or with mild ARDS. Analysis of the ability of PCT to predict moderate to severe ARDS was evaluated by receiver operator characteristic curve (ROC curve). Multivariate Logistic regression was conducted to determine the risk factors of the development of moderate to severe ARDS. 108 patients were finally enrolled, including 37 patients with mild ARDS (34.3%), 35 patients with moderate ARDS (32.4%), 2 patients with severe ARDS (1.9%), and 34 patients without ARDS. Compared with patients with no or mild ARDS, patients with moderate to severe ARDS were older (years old: 58.5±11.1 vs. 52.8±14.8, P < 0.05), with a higher proportion of combined hypertension [45.9% (17/37) vs. 25.4% (18/71), P < 0.05], longer operative time (minutes: 363.2±120.6 vs. 313.5±97.6, P < 0.05), and higher mortality (8.1% vs. 0, P < 0.05), but there were no differences in the VIS score, incidence of acute renal failure (ARF), CPB duration, aortic clamp duration, and intraoperative bleeding, transfusion volume, and fluid balance between the two groups. Serum PCT and NT-proBNP levels in patients with moderate to severe ARDS at postoperative day 1 were significantly higher than those in patients with no or mild ARDS [PCT (μg/L): 16.33 (6.96, 32.56) vs. 2.21 (0.80, 5.76), NT-proBNP (ng/L): 2 405.0 (1 543.0, 6 456.5) vs. 1 680.0 (1 388.0, 4 667.0), both P < 0.05]. ROC curve analysis showed that the area under the curve (AUC) for PCT to predict the occurrence of moderate to severe ARDS was 0.827 [95% confidence interval (95%CI) was 0.739-0.915, P < 0.05]. When PCT cut-off value was 7.165 μg/L, the sensitivity was 75.7% and the specificity was 84.5%, for differentiating patients who developed moderate to severe ARDS from who did not. Multivariate Logistic regression showed that age and the elevated PCT concentration were independent risk factors for the development of moderate to severe ARDS [age: odds ratio (OR) = 1.105, 95%CI was 1.037-1.177, P = 0.002; PCT: OR = 48.286, 95%CI was 10.282-226.753, P < 0.001]. Patients with moderate to severe ARDS undergoing CPB cardiac surgery have a higher serum concentration of PCT than patients with no or mild ARDS. Serum PCT level may be a promising biomarker to predict the development of moderate to severe ARDS, the cut-off value is 7.165 μg/L.

Effects of Desflurane on Inflammatory Response and Cardiac Function During Cardiopulmonary Bypass in Cardiac Surgery

Effects of Desflurane on Inflammatory Response and Cardiac Function During Cardiopulmonary Bypass in Cardiac Surgery

Experience of Using High-Frequency Lung Ventilation during Cardiopulmonary Bypass in Cardiac Surgery

The incidence of various postoperative complications including pulmonary ones is at a high level in a cardiac surgery. The objective: to evaluate the effectiveness of hig h-f requency lung ventilation during cardiopulmonary bypass as a preventive measure for postoperative pulmonary complications compared to lo w-v olume lung ventilation. Subjects and Methods. 60 patients undergoing cradiac surgery were included in the study. In HF Group ( HF ventilation with airway pressure control at the frequency of 30 0/m in, the ratio of duration of inhalation and exhalation is 1:2, mean airway pressure is 8 mbar) and VC Group (lung ventilation during CPB with parameters: tidal volume is 3 m l/k g, respiratory rate is 6/m in, and positive en d-e xpiratory pressure is +5 cm H 2 O). Results. No significant difference in the analysis of the oxygenation index were observed between groups. Frequency of pulmonary atelectasis on chest radiology in postoperative period made 3 (9%) in VC Group and 4 (12%) HF Group ( p = 0.71). The frequency of intraoperative recruiting lung maneuvers was 5 (16%) in VС Group and 6 in HF Group (18%) ( p = 0,75). The duration of postoperative ventilation did not differ between the groups. Conclusion. HF mechanical ventilation during CPB has no significant advantage over lo w-v olume mechanical ventilation. HF mechanical ventilation and lo w-v olume mechanical ventilation has the same protective effect on the oxygenating function of the lungs after CPB .

Application of Adsorptive Blood Purification Techniques during Cardiopulmonary Bypass in Cardiac Surgery.

By reason of surgical demand, the majority of cardiovascular procedures still depend on the use of cardiopulmonary bypass (CPB). Due to the nonphysiological state of CPB, it can cause complex and unpredictable inflammatory response, which may lead to significant morbidity and mortality. Unfortunately, the pharmacological and mechanical strategies that currently exist do not offer significant advantages in controlling inflammatory response and improving patient outcomes. The best strategy to reduce inflammation in CPB is still uncertain. In recent years, adsorptive blood purification techniques (BPTs) have emerged, among which CytoSorb is the latest representative device. Currently, the primary application area of adsorptive BPTs is in the control and treatment of systemic hyperinflammatory states, such as refractory septic shock patients. However, the evidences on efficacy and safety of adsorptive BPTs application during CPB surgery are still inconclusive, so we summarize the relevant evidences here and suggest future potential research areas.

Base Excess or Hyperlactatemia: Identifying the Superior Risk Factor for Increased Morbidity and Mortality in Cardiac Surgery

Objective: Cardiopulmonary bypass in cardiac surgery is often associated with metabolic changes. So, we conducted this study in order to find the supremacy between two risk factors base excess and hyperlactatemia in early prediction of morbidity and mortality in ICU after cardiac surgery. Material and Methods: Intraoperative data of total of 100 patients who had cardiac surgery was recorded. Intraoperative and postoperative data of base excess and lactate levels were recorded at 1st, 6th, 12th and 24th hour in ICU. Two perioperative groups for B.E(Group 1 B.E &lt; +/-2.5 mmol: Group 2 B.E &gt;+/- 2.5 mmol) and lactate (Group 1 Lactate &lt; 3 mmol: Group 2 Lactate&gt;mmol ) were created, Two post-operative groups for B.E(Group 1 B.E &lt; +/-5.0 mmol: Group 2 B.E &gt;+/- 5.0 mmol) and lactate( Group 1 Lactate &lt;5mmol: Group 2 Lactate&gt;5mmol )were created to find their correlation with early postoperative complications. Results: In our study ICU morbidity and mortality was more related to the lactate and base excess values in the early 24 hours. Progressive Hyperlactatemia and constant negative base excess values were both significantly associated with ICU complications. In the CPB period subgroup negative base excess was more superior in predicting ICU prognosis than Lactate. (P-value 0.001) similarly patients divided in subgroup BE &gt;+/- 5mmol/l had demonstrated superiority in making such prediction. Both CPB (0.013) and X.C (0.036) time were associated independently with ICU prognosis. .Longer ventilation times were also associated with bad ICU prognosis. Conclusion: Our study found negative base excess values in the early postoperative period to be superior in predicting ICU morbidity and mortality when studied at subgroup level both peri-operatively and postoperatively.

The gut microbiome and cardiac surgery an unusual symphony.

The relationship between the gut microbiome and various organ systems has gained interest throughout the scientific community in recent times. The understanding of these complex relationships has greatly improved with clinical benefits now being seen. Cardiopulmonary bypass (CPB) is a form of extracorporeal circulation that provides circulatory and respiratory support during cardiac surgery. This physiological support facilitates a still and bloodless field facilitating operations on the heart to be performed. Through various mechanisms CPB results in a systemic inflammatory response syndrome (SIRS). This response can vary from mild hypotension to multiple organ failure. It remains difficult to predict the degree to which a patient will experience SIRS post-operatively. The relationship between the composition of the gut microbiome and inflammatory processes associated with disease has been seen across several fields including gastroenterology, neurology, psychiatry and cardiology. To date, minimal research has been undertaken to examine the impact the gut microbiome has on outcomes following cardiac surgery. This review paper explores the pathophysiology behind the SIRS response associated with CPB for cardiac surgery and the hypothesis that a correlation exists between a patients gut microbiome composition and the degree of inflammatory response experienced following cardiac surgery.

Cerebral Oximetry-Monitored Nitroglycerin Infusion and Tissue Perfusion during Rewarming of Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Randomized Trial.

Background: Nitroglycerin facilitates microcirculation and oxygen delivery through vasodilation. The purpose of this study was to clarify the effects of nitroglycerin-induced vasodilation and potential hypotension on tissue perfusion under cerebral oximetry monitoring during rewarming in cardiopulmonary bypass. Methods: Elective cardiac surgical patients were randomly assigned to either a nitroglycerin group (n = 32) with an intravenous infusion of 1–5 mcg/kg/min or a control group (n = 31) with 0–0.1 mcg/kg/min infusion, since the initiation of rewarming. Perioperative arterial blood gas data were collected in addition to hemodynamic variables, cerebral oximetry values, urine output, and postoperative outcomes. Results: Nearly one-fifth (6/32) of patients in the nitroglycerin group experienced transient (≤5 min) profound hypotension (mean arterial blood pressure ≤40 mmHg) after the initiation of infusion. There were no significant differences between groups in terms of perioperative levels of cerebral oximetry, cardiac index, plasma glucose, lactate, bicarbonate, base excess, or post-bypass activated coagulation time. In the nitroglycerin group, urine output was nonsignificantly higher during cardiopulmonary bypass (p = 0.099) and within 8 h after surgery (p = 0.157). Perioperative transfused blood products, postoperative inotropic doses, extubation time, and intensive care unit stay were comparable for the two groups. Conclusions: Initiation of intravenous nitroglycerin infusion (at 1–5 mcg/kg/min) during rewarming in hypothermic cardiopulmonary bypass resulted in transient profound hypotension in one-fifth of patients and did not improve perioperative cerebral oxygenation, tissue perfusion, and coagulation in cardiac surgery.

CARDIOPULMONARY BYPASS IN PREGNANCY. A SINGLE-CENTER EXPERIENCE

The aim: Presentation of a single-center experience of cardiac surgery with cardiopulmonary bypass (CPB) in pregnant women with critical cardiac pathology. The possibility of minimally invasive technique in this group of patients were presented. Materials and methods: The present study included 19 cases of multidisciplinary care with CPB surgery in pregnant women in single center from December 2013 to December 2020. 8 patients underwent J-form median mini-sternotomy. Maternal and neonatal outcomes depending on the type of surgery (urgent or elective) were reviewed. Results: There were no negative maternal consequences; there were 4 perinatal losses (21%): three after urgent and one after elective interventions. All other pregnancies (n=15) finished successfully with the birth of healthy newborns. We compared some values in two groups (urgent and elective) of patients who underwent CPB surgery during pregnancy. Despite the variability in some parameters the difference between the groups was not significant. Follow-up was from 5 to 72 months (39.7±16.9) without negative consequences. Conclusions: Multidisciplinary team management is an effective strategy for pregnant women with cardiac pathology. Elective cardiac surgery in expert centers during pregnancy is a safe and effective option. Urgent CPB cardiac surgery during pregnancy increases the risk for the fetus. J-form median mini-sternotomy is a good option during pregnancy in high-experienced centers.

Energy Level and Success of Internal Defibrillation for Shockable Rhythm during Cardiopulmonary Bypass in Cardiac Surgery: A Retrospective Study

Internal defibrillation is commonly indicated for shockable rhythm following cross-clamp removal in cardiac surgery. Low energy decreases the success rate of defibrillation but high energy can cause myocardial damage. This study aimed to determine the success rate of internal defibrillation for shockable arrhythmias after cardiac surgery.Retrospective data of 1,424 patients who developed shockable rhythms (ventricular fibrillation or ventricular tachycardia), and required internal defibrillation after aortic cross-clamp removal during cardiac surgery, without deep hypothermic circulatory arrest technique, from August 2015 to July 2017, were reviewed.The overall success rate of internal defibrillation in the first attempt of defibrillation was 61.5%. The success rate of the energy levels at 30, 10, and 7 Jules were 66.7, 64.9, and 61.5%, respectively. The success rate was higher in patients who had a better ejection fraction than those who failed after defibrillation. This was significantly associated with higher pH, higher bicarbonate, lower serum calcium, and lower total cardioplegic volume during cardiopulmonary bypass (CPB). Redo-valve surgery, valvular surgery, and combined coronary artery bypass graft with valvular surgery had a non-significantly lower success rate (p-value = 0.989). Incidence of failure for defibrillate patients in redo-valvular surgery, combined coronary artery bypass graft with valve surgery, adult congenital heart defect, and valvular surgery; requiring four or five shocks was non-significantly increased. Recurrent rate of ventricular fibrillation/ventricular tachycardia was 13.5%.The success rate of internal defibrillation was not related to the dose of energy used after being weaned off CPB.

Abstract 11053: The Association Between the Systemic Immune-Inflammation Index with the Duration of Cardiopulmonary Bypass in Cardiac Surgery: A Retrospective, Single-Center Study

Introduction: Systemic inflammatory response evoked by cardiac surgery involving a cardio-pulmonary bypass (CPB) in combination of surgical trauma, ischemia/reperfusion injury, hypothermia, and endotoxin release contributed to the postoperative morbidity and mortality. This study aimed to explore the potential of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) as novel markers to evaluate and predict the adverse clinical outcomes after longer CPB time in cardiac surgery. Methods: Patients who underwent cardiac surgery with or without CPB were allocated into two groups, CPB group (n=11) and N-CPB group (n=21). The time course of NLR, PLR, SII, and C-reactive protein (CPR) were analyzed at preoperative day 1 and postoperative day 1, 3, and 7. The baseline and postoperative parameters, the ICU and hospital stay were recorded. Results: There were no differences of baseline parameters between groups. The level of NLR, PLR, SII, and CPR at postoperative day 1 was higher than that in the preoperative day 1 in both groups (p &lt; 0.01). The level of NLR, SII and CPR at postoperative day 3 was higher than that in the preoperative day 1 in both groups (p &lt; 0.05). The NLR and SII at postoperative day 3 were higher in CPB group than that in N-CPB group (p &lt; 0.05). The ICU and hospital stay was longer in CPB group than N-CPB group (p &lt; 0.05). Conclusions: The longer duration of CPB time induced higher systemic inflammatory response characterized by higher level of NLR, PLR and SII. The SII predicted the poor outcome after longer CPB. The peak of systemic inflammatory response occurred on the third day after cardiac surgery.

Association Between Hyperoxemia and Increased Cell-Free Plasma Hemoglobin During Cardiopulmonary Bypass in Infants and Children.

To determine potential risk factors for severe hemolysis during pediatric cardiopulmonary bypass and examine whether supraphysiologic levels of oxygen and cardiopulmonary bypass duration are associated with hemolysis. Prospective observational study. Cardiac ICU in a university-affiliated children's hospital. Greater than 1 month to less than 18 years old patients undergoing cardiopulmonary bypass for cardiac surgery. None. Plasma samples from 100 patients to assess cell-free plasma hemoglobin levels were obtained at start cardiopulmonary bypass, at the end of cardiopulmonary bypass, and 2 and 24 hours after reperfusion. Arterial blood gas samples were obtained before and every 30 minutes during cardiopulmonary bypass. Patient demographics and laboratory data were collected from the electronic medical record. Plasma hemoglobin levels peaked at the end of cardiopulmonary bypass and haptoglobin levels continued to fall throughout all time points. There were 44 patients with severe hemolysis (change in cell-free plasma hemoglobin > 50 mg/dL). Younger age (odds ratio/sd 0.45 [95% CI, 0.25-0.81]) and higher mean Pao2 × cardiopulmonary bypass duration (31.11 [1.46-664.64]) were identified as risk factors for severe hemolysis in multivariable analysis. Severe hemolysis was associated with longer hospital and ICU lengths of stay as well as acute kidney injury. We observed younger age and the exposure to both oxygen and duration of cardiopulmonary bypass as risk factors for hemolysis. Oxygen delivery through the cardiopulmonary bypass circuit is an easily modifiable risk factor. Its role in the production of reactive oxygen species that could alter the erythrocyte membrane deserves further examination in larger prospective studies.

Flow characteristics and hemolytic performance of the new Breethe centrifugal blood pump in comparison with the CentriMag and Rotaflow pumps.

Blood pumps have been increasingly used in mechanically assisted circulation for ventricular assistance and extracorporeal membrane oxygenation support or during cardiopulmonary bypass for cardiac surgery. However, there have always been common complications such as thrombosis, hemolysis, bleeding, and infection associated with current blood pumps in patients. The development of more biocompatible blood pumps still prevails during the past decades. As one of those newly developed pumps, the Breethe pump is a novel extracorporeal centrifugal blood pump with a hybrid magnetic and mechanical bearing with attempt to reduce device-induced blood trauma. To characterize the hydrodynamic and hemolytic performances of this novel pump and demonstrate its superior biocompatibility, we use a combined computational and experimental approach to compare the Breethe pump with the CentriMag and Rotaflow pumps in terms of flow features and hemolysis under an operating condition relevant to ECMO support (flow: 5 L/min, pressure head: ~350 mmHg). The computational results showed that the Breethe pump has a smaller area-averaged wall shear stress (WSS), a smaller volume with a scalar shear stress (SSS) level greater than 100 Pa and a lower device-generated hemolysis index compared to the CentriMag and Rotaflow pumps. The comparison of the calculated residence times among the three pumps indicated that the Breethe pump might have better washout. The experimental data from the in vitro hemolysis testing demonstrated that the Breethe pump has the lowest normalized hemolysis index (NIH) than the CentriMag and Rotaflow pumps. It can be concluded based on both the computational and experimental data that the Breethe pump is a viable pump for clinical use and it has better biocompatibility compared to the clinically accepted pumps.

The impact of exogenous nitric oxide during cardiopulmonary bypass for cardiac surgery.

Cardiac surgery using cardiopulmonary bypass frequently provokes a systemic inflammatory response syndrome. This can lead to the development of low cardiac output syndrome (LCOS). Both of these can affect morbidity and mortality. This study is a systematic review of the impact of gaseous nitric oxide (gNO), delivered via the cardiopulmonary bypass (CPB) circuit during cardiac surgery, on post-operative outcomes. It aims to summarise the evidence available, to assess the effectiveness of gNO via the CPB circuit on outcomes, and highlight areas of further research needed to develop this hypothesis. A comprehensive search of Pubmed, Embase, Web of Science and the Cochrane Library was performed in May 2020. Only randomised control trials (RCTs) were considered. Three studies were identified with a total of 274 patients. There was variation in the outcomes measures used across the studies. These studies demonstrate there is evidence that this intervention may contribute towards cardioprotection. Significant reductions in cardiac troponin I (cTnI) levels and lower vasoactive inotrope scores were seen in intervention groups. A high degree of heterogeneity between the studies exists. Meta-analysis of the duration of mechanical ventilation, length of ICU stay and length of hospital stay showed no significant differences. This systematic review explored the findings of three pilot RCTs. Overall the hypothesis that NO delivered via the CPB circuit can provide cardioprotection has been supported by this study. There remains a significant gap in the evidence, further high-quality research is required in both the adult and paediatric populations.

Respiratory tactics during cardiopulmonary bypass in cardiac surgery

An important place in the structure of the causes of postoperative respiratory failure in cardiac surgery is occupied by atelectasis of the lung tissue, which is formed during cardiopulmonary bypass (CPB). The incidence of this complication makes 54–92%.The objective: to evaluate the effectiveness of various respiratory support techniques during CPB.Subjects and methods. 60 patients were randomly included in the study. CPAP Group (positive airway pressure +5 cm H2O) and VC Group (lung ventilation during CPB with parameters: tidal volume 3 ml/kg, respiratory rate 6/min, positive end-expiratory pressure +5 cm H2O).Results. The oxygenation index in VC Group was higher than in CPAP Group at the stages after the end of CPB (289.6 ± 100.0 in VC Group and 223.1 ± 152.0 in CPAP Group), at the end of surgery (in VC Group 318,7 ± 73.8 and in CPAP Group 275.2 ± 90.0) The frequency of intraoperative (VC 16% and CPAP 43%) and postoperative recruiting lung maneuvers (VC 7% and CPAP 26%) in VC Group was lower versus CPAP Group. The incidence of atelectasis in VC Group (10%) decreased compared to CPAP (36.6%).Conclusion: Low-volume ventilation during cardiopulmonary bypass has a more favorable effect on the oxygenating function compared to respiratory support in the CPAP mode.

Evaluation of the Effect of Nursing Cooperation during Cardiopulmonary Bypass in Cardiac Surgery

Evaluation of the Effect of Nursing Cooperation during Cardiopulmonary Bypass in Cardiac Surgery