Role of Perfusionist

• Still
• Bloodless
• Sterile

Artificial Lungs

• Lungs
• Temperature Control
• Filter Blood of clots and debris etc
• Reservoir

• Cardioplegia
• Sucking of excess blood x 2
• Single chamber Pump

1 - Cannulate the right atrium - so blood entering the right atrium flows out of the heart and down tubes into the reservoir

2 - Blood flows to the main artificial heart pump where it is temperature controlled and passes through oxygenator for gaseous exchange

3 - This leaves via the aorta to the rest of the body

4 - Hand held suckers suck bleeding blood away from the surgery site and into the filter, where it rejoins and point 2

Flushing heart with cold potassium into the coronary arteries to stop its contractions

To prevent back flow of K into the body

To slow down all metabolic activity as the patient does not lots of blood flow

• Running heart and lung machine
• Maintaining physiological functions of the patient

• Going on bypass
• Maintaining adequate blood flow to patient
• Maintaining blood pressure
• Maintaining safe levels of blood in oxygenator
• Stopping the heart
• Controlling blood gases and electrolytes
• Monitoring ECG during cardioplegia
• Controlling temperature
• Observing Hb levels
• Manage clotting factors

Turning on bypass whilst simultaneously draining blood from patient

Surface area of patient should be measured and multifplied by 2.4

Kept low because no cardiac output but some organs require minimal BP like kidneys so kept at 45-75mmHg

Must always have blood in reservoir or air will go to patient

Provide cardioplegia solution

Control context of O2 and CO2 by sending samples regularly for analysis

Only interested in asytole

• Kept at 32 if heart is continue beating
• Dropped to 25-30 if heart is stopped
• Dropped to 15 for total circulatory arrest

• Maintain Hb above 7g/dl
• Done by removing excess water

• Clotted with heparin
• Accellerated clotting time measured every 30mins - takes roughly 8 mins

Protamine