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The Surgeon's Response to a Low‐Output State After Cardiopulmonary Bypass: Etiologies and Remedies
Author(s) -
Doty Donald B.
Publication year - 1990
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.1990.5.3s.256
Subject(s) - medicine , preload , cardiopulmonary bypass , afterload , cardiac output , cardiology , cardiac tamponade , cardiac surgery , left atrial pressure , cardiac function curve , hemodynamics , heart failure
Following cardiopulmonary bypass, a series of steps can usually be used to restore function to the heart. A low postbypass cardiac output can be countered with a response checklist that includes adjusting heart rate, correcting cardiac arrhythmia, ensuring adequate hematocrit, adjusting preload and afterload, and stimulating cardiac contractility. It is the surgeon's responsibility to make a thorough investigation of any structural abnormality that may contribute to the low‐output state; adequate repair of cardiac defects will often result in an improved hemodynamic state. Hemorrhage is an important cause of poor cardiac performance. Tamponade of the heart is usually due to retained clots associated with hemorrhage after operation and is indicated by a low‐output state with equalization and elevation of atrial pressures. In a low‐output, postsurgical state, the possibility of residual shunts and obstructions, inadequate valve repair, and closure or inadequate flow through a graft may need to be investigated. Once that has been achieved, the appropriate steps can be taken to improve cardiac performance.