A Review of Goal-Directed Cardiopulmonary Bypass Management in Pediatric Cardiac Surgery

Author:

Medikonda Ravi1,Ong Chin Siang2,Wadia Rajeev3,Goswami Dheeraj3,Schwartz Jamie3,Wolff Larry2,Hibino Narutoshi2,Vricella Luca2,Barodka Viachaslau3,Steppan Jochen3

Affiliation:

1. Johns Hopkins School of Medicine, Baltimore, MD, USA

2. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA

3. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

Abstract

Cardiopulmonary bypass perfusion management significantly affects postoperative outcomes. In recent years, the principles of goal-directed therapy have been applied to the field of cardiothoracic surgery to improve patient outcomes. Goal-directed therapy involves continuous peri- and postoperative monitoring of vital clinical parameters to tailor perfusion to each patient’s specific needs. Closely measured parameters include fibrinogen, platelet count, lactate, venous oxygen saturation, central venous oxygen saturation, mean arterial pressure, perfusion flow rate, and perfusion pulsatility. These parameters have been shown to influence postoperative fresh frozen plasma transfusion rate, coagulation state, end-organ perfusion, and mortality. In this review, we discuss the recent paradigm shift in pediatric perfusion management toward goal-directed perfusion.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Pediatrics, Perinatology, and Child Health,Surgery

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