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Clinical review: management of weaning from cardiopulmonary bypass after cardiac surgery

Diaper, John
Cartier, Vanessa
Kalangos, Afksendyios
Published in Annals of Cardiac Anaesthesia. 2012, vol. 15, no. 3, p. 206-23
Abstract A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB) as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.
Keywords Cardiac Surgical ProceduresCardiopulmonary BypassCardiotonic Agents/adverse effectsEchocardiography, TransesophagealExtracorporeal Membrane OxygenationHeart-Assist DevicesHemodynamicsHumansPrognosisRisk FactorsVentricular Dysfunction, Right/drug therapy/etiology
PMID: 22772515
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Article (Published version) (923 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Research group Groupe de Recherche en Hémodynamique (913)
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LICKER, Marc et al. Clinical review: management of weaning from cardiopulmonary bypass after cardiac surgery. In: Annals of Cardiac Anaesthesia, 2012, vol. 15, n° 3, p. 206-23. doi: 10.4103/0971-9784.97977 https://archive-ouverte.unige.ch/unige:26721

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Deposited on : 2013-03-12

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