The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass--Temperature Management During Cardiopulmonary Bypass.
In order to improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including: 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendations: CLASS I RECOMMENDATIONS: a)The oxygenator arterial outlet blood temperature is recommended to be utilized as a surrogate for cerebral temperature measurement during CPB. (Class I, Level C) b)To monitor cerebral perfusate temperature during warming, it should be assumed that the oxygenator arterial outlet blood temperature under-estimates cerebral perfusate temperature. (Class I, Level C) c)Surgical teams should limit arterial outlet blood temperature to<37°C to avoid cerebral hyperthermia. (Class 1, Level C) d)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 1, Level C) e)Temperature gradients between the arterial outlet and venous inflow on the oxygenator during CPB rewarming should not exceed 10°C to avoid out-gassing when blood is returned to the patient. (Class 1, Level C) CLASS IIa


CONCLUSIONS
a)Pulmonary artery or nasopharyngeal temperature recording is reasonable for weaning and immediate post-bypass temperature measurement. (Class IIa, Level C)b)Rewarming when arterial blood outlet temperature ≥30° C: i.To achieve the desired temperature for separation from bypass, it is reasonable to maintain a temperature gradient between arterial outlet temperature and the venous inflow of≤4°C. (Class IIa, Level B) ii.To achieve the desired temperature for separation from bypass, it is reasonable to maintain a rewarming rate≤0.5°C/min. (Class IIa, Level B) NO RECOMMENDATION: No recommendation for a guideline is provided concerning optimal temperature for weaning from CPB due to insufficient published evidence.
Department of Surgery, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts. Electronic address: richard.engelman@baystatehealth.org.
Richard
R
Engelman
Cardiac Surgery Research and Perfusion, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia.
Robert A
RA
Baker
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Donald S
DS
Likosky
Department of Anesthesiology, University of Nevada, Las Vegas, Nevada.
Alina
A
Grigore
Clinical Performance Improvement, SpecialtyCare, Nashville, Tennessee.
Timothy A
TA
Dickinson
Department of Anesthesiology, Hofstra Northshore-Long Island Jewish School of Medicine, New Hyde Park, New York.
Linda
L
Shore-Lesserson
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
John W
JW
Hammon
D000776:Anesthesiology / Q000379:methods / Q000592:standards*; D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000592:standards*; D019468:Disease Management; D005112:Extracorporeal Circulation / Q000379:methods / Q000592:standards*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D017694:Rewarming / Q000379:methods / Q000592:standards; D012955:Societies, Medical / Q000592:standards; D066231:Surgeons / Q000592:standards*; D019616:Thoracic Surgical Procedures / Q000379:methods / Q000592:standards*; D014481:United States