title: Lean Flow: Optimizing Cardiopulmonary Bypass Equipment and Flow for Obese Patients-A Technique Article.
abstract: The goal of this chart review was to investigate the use of down-sized cardiopulmonary bypass (CPB) circuits for obese patients. The effects of transitioning from larger to smaller oxygenators, reservoirs, and arteriovenous tubing loops were evaluated through a retrospective review of 2,816 adult non-congenital procedure perfusion records. This technique report and case series is a continuation of our original prescriptive CPB circuit quality improvement project. An algorithm was derived to adjust body surface area (BSA) to lower body mass index (BMI) to provide down-sized extracorporeal circuit components capable of meeting the metabolic needs of the patient. As a result of using smaller circuits, decreased priming volumes led to significantly increased hemoglobin (HB) nadirs (p< .05) leading to significant decreases in homologous donor blood product exposures (p< .05). Patients with large BSAs were supported safely with smaller circuits by using lean body mass (LBM)-adjusted BSA and target blood flow algorithm. Based on this case series, large BMI patients may be safely supported with smaller circuits selected based on BSAs adjusted more toward LBM. Use of smaller circuits in high BMI patients led to higher HB nadirs and less donor blood components during the surgical procedure. Renal function and hospital stay were not affected by this approach.
authors.affiliation: Center for Cardiovascular Services, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Blessing
authors.affiliation: University Hospitals Cleveland Medical Center, Cleveland, Ohio.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Riley
mesh_terms: D000328:Adult; D000465:Algorithms; D001783:Blood Flow Velocity; D049628:Body Size; D001830:Body Surface Area; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000592:standards*; D057189:Checklist / Q000592:standards*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000175:diagnosis* / Q000503:physiopathology*; D017410:Practice Guidelines as Topic; D014481:United States