title: Update on management strategies for separation from cardiopulmonary bypass.
abstract: OBJECTIVE
  To update the reader about clinical management strategies for separation from cardiopulmonary bypass. A number of new drugs are being introduced in clinical practice, with significant utility in operative patient management. Further, there is increased routine use of complex devices to achieve separation from or avoidance of cardiopulmonary bypass.
  
  
  RESULTS
  Selected medical and device strategies from the most recent literature will be discussed. First, the rationale for selected innovative agents to achieve myocardial performance is reviewed in four perioperative settings: agents for the management of myocardial dysfunction, vasomotor dysfunction, pulmonary hypertension, and right ventricular failure. Second is an evaluation of less commonly considered aspects of mechanical device use in the context of failure to wean from cardiopulmonary bypass or use to avoid cardiopulmonary bypass. Three devices will be discussed: intra-aortic balloon pump, ventricular assist devices, and extracorporeal membrane oxygenation.
  
  
  CONCLUSIONS
  As our pharmacological and technological armamentarium improve, our population ages and procedures are attempted on patients with increasing co-morbid conditions, it will be important to both utilize newer pharmacological agents and consider innovative uses for device implementation to achieve optimal perioperative outcomes.
authors.affiliation: Division of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. Frederick.Lombard@duke.edu
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Lombard
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Grichnik
mesh_terms: D002303:Cardiac Output, Low / Q000188:drug therapy; D002315:Cardiopulmonary Bypass; D015199:Extracorporeal Membrane Oxygenation; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007423:Intra-Aortic Balloon Pumping