Circulation extracorporelle

Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a heart-lung machine or "the pump". Cardiopulmonary bypass pumps are operated by perfusionists. CPB is a form of extracorporeal circulation. Extracorporeal membrane oxygenation is generally used for longer-term treatment. CPB mechanically circulates and oxygenates blood for the body while bypassing the heart and lungs. It uses a heart-lung machine to maintain perfusion to other body organs and tissues while the surgeon works in a bloodless surgical field. The surgeon places a cannula in the right atrium, vena cava, or femoral vein to withdraw blood from the body. Venous blood is removed from the body by the cannula and then filtered, cooled or warmed, and oxygenated before it is returned to the body by a mechanical pump. The cannula used to return oxygenated blood is usually inserted in the ascending aorta, but it may be inserted in the femoral artery, axillary artery, or brachiocephalic artery (among others). The patient is administered heparin to prevent clotting, and protamine sulfate is given after to reverse the effects of heparin. During the procedure, hypothermia may be maintained; body temperature is usually kept at 28 °C to 32 °C (82.4–89.6 °F). The blood is cooled during CPB and returned to the body. The cooled blood slows the body's basal metabolic rate, decreasing its demand for oxygen. Cooled blood usually has a higher viscosity, but the crystalloid solution used to prime the bypass tubing dilutes the blood. Cardiopulmonary bypass is commonly used in operations involving the heart. The technique allows the surgical team to oxygenate and circulate the patient's blood, thus allowing the surgeon to operate on the heart. In many operations, such as coronary artery bypass grafting (CABG), the heart is arrested (i.e., stopped) because of the difficulty of operating on the beating heart.