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Cardiopulmonary Bypass Essay

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Cardiopulmonary bypass (CPB) has contributed to the evolution of modern day cardiac surgery. The establishment of extracorporeal circulation has helped the surgical team to carry out complicated surgical manouevers for treatment of complex cardiac lesions, especially complex congenital cardiac lesions, some of which were hitherto considered as inoperable. The advances in equipment and use of innovative techniques in perfusion have contributed to decreased mortality and/or morbidity in patients undergoing cardiac surgery in the modern day settings. However the necessity for monitoring the patient on cardiopulmonary bypass is of paramount importance. One of the key areas monitored during CPB is the neurological status of the patient. The inherent features of CPB like unphysiological flows, the fluctuations of temperature (use of hypothermia and rewarming), practices like hemodilution, organ protection strategies and unavoidable consequences like Systemic Inflammatory Response Syndrome (SIRS), all contribute to neurological sequelae. The possibility of neurological sequelae is enhanced in neonatal cardiopulmonary bypass, wherein the concept of extra-corporeal circulation is stretched to its limits. Hence neurological monitoring assumes a central place in the practice of ‘safe, optimal perfusion’ .…show more content…
It receives almost 14% of the total cardiac output. The average cerebral blood flow is 55ml/min/100gm of brain tissue, which can increase upto 100ml/min/100gm brain tissue in neonates. The brain also contributes to 25% of the Total Oxygen Consumption (3.5mlO2/min/100gm brain tissue). Studies have revealed that the white matter of the brain contributes to almost 94% of the cerebral oxygen consumption whereas the gray matter contributes the remaining 6%. The sensorimotor area of frontal cerebral cortex is most susceptible to ischemic brain injury
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