title: Pharmacologic approaches to weaning from cardiopulmonary bypass and extracorporeal membrane oxygenation.
abstract: Cardiopulmonary bypass (CBP) and extracorporeal membrane oxygenation (ECMO) are two modalities of mechanical circulatory support. They provide hemodynamic stability for patients undergoing invasive cardiothoracic interventions, and they can be lifesaving in emergencies resulting from cardiogenic shock or respiratory failure. Unlike implantable ventricular assist devices, CPB and ECMO are short-term solutions meant to last from hours to days, and the patient will need to be weaned from the mechanical support once the intervention has completed or when the underlying condition has improved. Weaning imposes major physiological strain upon the recovering cardiovascular and pulmonary systems, and it usually requires pharmacological support. This article focuses on the proper diagnosis of the underlying pathophysiology, an understanding of the pharmacology of available agents, and a rational approach to the management of patients weaning from CPB and ECMO.
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco Medical Center, San Francisco, CA 94143, USA. Electronic address: Wilson.cui@ucsf.edu.
authors.forename: Wilson W
authors.initials: WW
authors.lastname: Cui
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco Medical Center, San Francisco, CA 94143, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Ramsay
mesh_terms: D000818:Animals; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents
keywords: cardiopulmonary bypass; extracorporeal life support; extracorporeal membrane oxygenation; inotropic agents; left ventricular dysfunction; mechanical circulatory support; pulmonary hypertension; right ventricular dysfunction; vasoconstrictor agents; vasoplegic syndrome