Guideline on Temperature Management during cardiopulmonary bypass
Numerous strategies are currently invoked by perfusion teams to manage the requirements of cooling, temperature maintenance, and rewarming patients during cardiac surgical procedures. To date there have been very few evidence-based recommendations for the conduct of temperature management during perfusion. Although Bartels and coauthors (2002) found no supporting evidence for an evidence-based guideline for managing the temperature gradient during cardiopulmonary bypass (CPB), Shann and coauthors (2006) recommended that "limiting arterial line temperature to 37C might be useful for avoiding cerebral hyperthermia," including checking "coupled temperature" ports for all oxygenators for accuracy and calibration.
The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of ExtraCorporeal Technology have published the clinical practice guidelines for cardiopulmonary bypass—temperature management during cardiopulmonary bypass. Following are its major recommendations :
Optimal Site for Temperature Measurement
- The oxygenator arterial outlet blood temperature is recommended to be used as a surrogate for cerebral temperature measurement during cardiopulmonary bypass (CPB). (Class I, Level C)
- To accurately monitor cerebral perfusate temperature during warming, it should be assumed that the oxygenator arterial outlet blood temperature underestimates cerebral perfusate temperature. (Class I, Level C)
- Pulmonary artery or nasopharyngeal (NP) temperature recording is reasonable for core temperature measurement. (Class IIa, Level C)
Avoidance of Hyperthermia
Surgical teams should limit arterial outlet blood temperature to less than 37°C to avoid cerebral hyperthermia. (Class I, Level C)
Peak Cooling Temperature Gradient and Cooling Rate
Temperature gradients between the arterial outlet and venous inflow on the oxygenator during CPB cooling should not exceed 10°C to avoid generation of gaseous emboli. (Class I, Level C)
Peak Warming Temperature Gradient and Rewarming Rate
- Temperature gradients between the arterial outlet and venous inflow on the oxygenator during CPB rewarming should not exceed 10°C to avoid outgassing when warm blood is returned to the patient. (Class I, Level C)
- Rewarming when arterial blood outlet temperature ≥30°C:
- To achieve the desired temperature for separation from bypass, it is reasonable to maintain a temperature gradient between the arterial outlet and the venous inflow temperature of 4°C or less. (Class IIa, Level B)
- To achieve the desired temperature for separation from bypass, it is reasonable to maintain a rewarming rate of 0.5°C/min or less. (Class IIa, Level B)
- Rewarming when arterial blood outlet temperature is lower than 30°C: To achieve the desired temperature for separation from bypass, it is reasonable to maintain a maximal gradient of 10°C between the arterial outlet and venous inflow temperature. (Class IIa, Level C)
Optimal Temperature for Weaning From CPB
No specific recommendation for an optimal temperature for weaning from CPB may be made due to inconsistent published evidence.
To read the full Guideline click on the following link:
http://www.sts.org/sites/default/files/documents/pdf/guidelines/Guidelines_CPB Temperature Management.pdf
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