1 / 16

CPB Problems

CPB Problems. Mike Poullis. Overview. General Cold Agglutinins Sickle Thalassaemia Hereditary spherocytosis and eliptocytosis Polycythemia G6PD Deficiency Pregnancy SLE VF. In General. If patient warm and well Do CABG off pump Do CPB work warm with blood cardioplegia.

rosalyn-conley
Download Presentation

CPB Problems

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CPB Problems Mike Poullis

  2. Overview • General • Cold Agglutinins • Sickle • Thalassaemia • Hereditary spherocytosis and eliptocytosis • Polycythemia • G6PD Deficiency • Pregnancy • SLE • VF

  3. In General • If patient warm and well • Do CABG off pump • Do CPB work warm with blood cardioplegia

  4. Cold Agglutinins 1 • Agglutination and haemolysis of RBC • Cold causes Ab binding • Warm causes complement activation • Screen @ 4oC. If +Ve thermal amplitude test

  5. Cold Agglutinins 2 • Monoclonal lymphoreticular tumours • Polyclonal • Mycoplasma • Glandular fever • CMV

  6. Cold Agglutinins 3 • If polyclonal & elective, cancel and reschedule in 4-6 weeks • Warm CPB and plegia • If cold blood • Warm crystalloid, cold blood, use hot shot • Plasmapheresis, polyclonal Abs, steroids

  7. Sickle 1 • Sickle due to hypoxia, acidosis, infection, capillary stagnation • Homozygous sickle if sats < 85 % • Heterozygous sickle if sats < 40 % • Therefore venous problem • Exchange transfusion, bicarb for venous ABG acidosis, crystalloid or blood(with high Hb A), keep warm • Beware mechanical heart valves causing haemolysis

  8. Thalassaemia • Minor and major • Give blood to make up anaemia • No problems on CPB

  9. Hereditary spherocytosis and eliptocytosis • Increased osmotic and mechanical fragility • Beware mechanical heart valves causing haemolysis • Free haemoglobin possible

  10. Polycythemia • Hct ~70 % • Bleed secondary to [clotting factors] • Autotransfusion good

  11. G6PD Deficiency • 10 to 15% Afro Americans • X linked • Beware sulphonamides, Aspirin, Vit K, ?Sux

  12. Pregnancy 1 • 1st trimester organgenesis, treatogenesis warfarin converted to heparin • 2nd trimester no organogenesis, normal circulation • 3rd trimester hyperdynamic circulation and risk premature labour

  13. Pregnancy 2 • Normal uterine blood flow 1-2 % CO • Pregnant uterine blood flow 10-15 % CO • No autoregulation • Fetal heart rate good monitor • Uterine blood flow reduced by alpha receptors use adrenaline not phenylephrenine

  14. Pregnancy 3 • Keep warm • Use pulsatile • BP > 60 to 70 mean (by flow not alpha blockers) • Hct >22 • Rt flank elevated to reduce caval compression • Tocolytics terbutaline, ritodrine, pregesterone, Mg • Beware serum [k+]

  15. SLE • Lung • interstitial lung disease, PA pressure • Heart • coronary • valve, • conduction • Kidney • renal failure • Blood • Lupus anticoagulant • Neutrophil function with immunosuppression • Brain • encephalopahy • Adrenal • Steroid suppression

  16. VF • Before cross clamp • Cross clamp and pleg • Defib after a few minutes to reduce subendocardial ischaemia • After cross clamp • [k+], lignocaine, suck blood out, Mg2+ • Repleg with warm blood to break reenterant circuit

More Related