Cardiopulmonary Bypass in Adult Cardiac Surgery Clinical Practice Guidelines (2019)

European Association for Cardio-Thoracic Surgery (EACTS)/European Association of Cardiothoracic Anaesthesiology (EACTA)/European Board of Cardiovascular Perfusion (EBCP)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

November 04, 2019

Control of Ischemic Cardiac Arrest

It is recommended that patient-centered myocardial protective strategies be used on the basis of clinical condition and procedural complexity rather than the use of a fixed institutional cardioplegic solution.

Blood cardioplegia should be considered in selected patients to reduce hemodilution, bleeding complications, and transfusion requirements.

Lung Protection During CPB

Biocompatible modifications of circuits should be considered in order to protect the lungs from inflammatory responses and provide less oxidative stress.

Modified ultrafiltration (MUF) and selective pulmonary artery perfusion may be considered for improving postoperative respiratory function.

Leukocyte filtration and hyperoxia are not recommended for lung protection.

Positive end-expiratory pressure (PEEP) during CPB should be considered in order to protect the lungs. Ventilation during CPB may be considered for lung protection.

High-dose dexamethasone may be considered in order to protect the lungs in selected patients.

Use of Noninvasive Cerebral Monitoring

Routine use of processed electroencephalographic (EEG) monitoring to reduce the incidence of intraoperative awareness may be considered.

The use of NIRS-guided algorithms to improve clinical outcomes may be considered.

Management of Shed Blood

Discarding shed blood should be considered.

Processing and secondary filtration of red blood cells should be considered to decrease the deleterious effects of reinfused shed blood.

Minimally Invasive Surgery

Perfusionists should be adequately trained and educated in the different aspects of minimally invasive cardiac surgery techniques.

Minimally invasive heart valve surgery may be considered to reduce blood loss and the need for transfusion. Such surgery may be considered in experienced units with respect to the patient’s preference.

Emergency Institution and Reinstitution of CPB

It is recommended that a set-up CPB circuit be available at all times for emergency procedures.

After the patient is weaned from CPB, it is recommended that the CPB circuit be kept functional until the patient’s chest has been closed.

Hemodynamic Monitoring

A pulmonary artery catheter may be indicated in selected cases.

Cardiac output with pulse contour analysis may be indicated in selected cases.

Transesophageal echocardiography (TEE) should be considered in open-heart and thoracic aortic procedures unless there are contraindications.

Use of Positive Inotropes

Positive inotropic and/or vasopressor agents are recommended as a first-line treatment to reduce mortality in patients with hemodynamic instability.

The use of phosphodiesterase inhibitors should be considered to increase weaning success.

Prophylactic infusion of levosimendan to reduce adverse events and mortality is not recommended. Levosimendan as a therapeutic strategy in selected difficult-to-wean patients having CPB may be considered. In patients requiring hemodynamic support after cardiac surgery, adding levosimendan to other positive inotropes or vasopressors is not recommended.

Residual Blood Management

Retransfusion of the residual volume of the CPB circuit at the end of the procedure is recommended as part of a blood management program to minimize allogeneic blood transfusions.

Retransfusion of the processed residual volume of the CPB circuit at the end of the procedure should be considered for minimizing the risks of allogeneic blood transfusions.

For more information, please go to Failure to Separate From Cardiopulmonary Bypass and Circulatory Arrest and Cardiopulmonary Bypass Hypothermia.

For more Clinical Practice Guidelines, please go to Guidelines.

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