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Weaning from cardiopulmonary bypass

Author
Michael G Fitzsimons, MD
Section Editor
Jonathan B Mark, MD
Deputy Editor
Nancy A Nussmeier, MD, FAHA

INTRODUCTION

Weaning from cardiopulmonary bypass (CPB) is the transition from the complete mechanical circulatory and respiratory support provided by CPB to the unassisted function of the patient's native heart and lungs. It is a gradual, multistep, interdisciplinary effort involving the surgeon(s), anesthesiologist(s), perfusionist(s), and operating room nurse(s).

This topic will discuss the process of weaning from CPB after completion of the cardiac surgical procedure, and problems that may be encountered during and after the weaning process. The physiology of CPB as well as preparations, initiation, and management of CPB are discussed separately. (See "Management of cardiopulmonary bypass in adults".)

PREPARATION FOR WEANING

A standardized weaning protocol and/or checklist is employed at most institutions during the initial attempt to wean from the mechanical support of cardiopulmonary bypass (CPB).

Anesthesiologist's preparation

Checklist — Checklists ensure that critical tasks are completed, correctable abnormalities have been addressed prior to the weaning attempt, and important information has been transmitted among team members [1-4]. One example is the mnemonic "WAAARRRRMM" (table 1):

Warm (temperature) – Generally, rewarming should be accomplished slowly to a target nasopharyngeal temperature of 37.0°C (but not higher), and a bladder (core) temperature of approximately 35.5°C prior to weaning. The target nasopharyngeal temperature should not be exceeded as this may result in cerebral injury [5-7]. (See "Management of cardiopulmonary bypass in adults", section on 'Temperature'.)

                                               

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Literature review current through: Apr 2017. | This topic last updated: Feb 22, 2017.
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