[Refresher Course] Best Strategy for Weaning from CPB after Cardiac Surgery🚑 TEE · MCS Algorithms

Описание: 📄 When the heart resumes its work, precision saves lives.
This comprehensive refresher course presents a structured, evidence-informed approach to weaning from cardiopulmonary bypass (CPB) after cardiac surgery. 🫀⚙️
Designed for anesthesiologists, cardiac anesthesiologists, intensivists, and perioperative physicians, this lecture integrates physiology, monitoring, echocardiography, pharmacology, and mechanical circulatory support (MCS) into a practical clinical framework.
________________________________________
🔹 Part 1. CPB Weaning – General Principles
🔹 Introduction: The technology that protects life while the heart rests
🔹 What is cardiopulmonary bypass (CPB)?
🔹 Pre-weaning preparation: the “pre-flight checklist”
• Rhythm, rate, contractility
• Afterload and preload optimization
🔹 CPB Weaning Checklist
• Temperature, electrolytes, metabolic and hematologic status, coagulation
• Hemodynamic monitoring: HR, rhythm, MAP, CO/CI, preload, SvO₂, lactate
• TEE assessment: ventricular function, chamber size, filling, valve function, surgical results, dynamic abnormalities 🖥️
🔹 Ventilator management
• Resumption of lung ventilation
• Key ventilatory parameters and fine adjustments
🔹 Stepwise transfer of responsibility from CPB to the heart
• Team communication 🤝
• Venous return and CPB flow reduction
• Preload optimization
• Complete separation from CPB
🔹 When additional support is required: concepts and mechanisms of difficult CPB weaning
________________________________________
🔹 Part 2. Advanced Management of CPB Weaning Failure
📌 Diagnostic framework for four major categories of difficult CPB weaning
• Diagnostic criteria, incidence, risk factors, and management strategies
📌 Summary of key studies on
• Risk factors for post-cardiac surgery vasoplegia
• Risk factors for postoperative ventricular dysfunction
📌 Stepwise algorithm for CPB weaning
1️⃣ Pre-weaning checklist verification
2️⃣ Hemodynamic goal setting and preload optimization
3️⃣ Pharmacologic intervention 💉
📌 Intraoperative use of inotropes and vasopressors
• Comparative table: dosing, mechanisms, hemodynamic effects, indications, adverse effects
📌 Mechanical circulatory support (MCS) selection algorithms in LCOS
• Cardio-respiratory failure
• RV failure
• LV failure
• Bi-ventricular failure
📌 Comparison of short-term and mid-term MCS devices
• Mechanism, access, position, maximal flow, advantages, and risks
________________________________________
🔹 Part 3. Failure Analysis and High-Risk Patient Management
📖 Introduction: clinical impact of failed CPB weaning
📖 Core principles for successful separation from CPB
• Patient state optimization
• Cardiopulmonary preparation
• Team and equipment readiness
🎯 The decisive role of transesophageal echocardiography (TEE)
📖 Case-based analysis using TEE (all three cases fully discussed):
1️⃣ Intracardiac air embolism
2️⃣ Aortic regurgitation occurring on CPB
3️⃣ Dynamic LVOT obstruction due to systolic anterior motion (SAM)
📌 Conclusion: improving outcomes through a TEE-guided, protocol-based approach