Cardiopulmonary Bypass & Temperature Management During Cardiopulmonary Bypass
Publication Date: August 1, 2015
Last Updated: March 14, 2022
Recommendations
The oxygenator arterial outlet blood temperature is recommended to be utilized as a surrogate for cerebral temperature measurement during CPB. (Level C, Class I (benefit > > >risk))
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To monitor cerebral perfusate temperature during warming, it should be assumed that the oxygenator arterial outlet blood temperature under-estimates cerebral perfusate temperature. (Level C, Class I (benefit > > >risk))
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Surgical teams should limit arterial outlet blood temperature to <37oC to avoid cerebral hyperthermia. (Level C, Class I (benefit > > >risk))
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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. (Level C, Class I (benefit > > >risk))
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Temperature gradients between the arterial outlet and venous inflow on the oxygenator during CPB rewarming should not exceed 10°C to avoid outgassing when blood is returned to the patient.
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Pulmonary artery or nasopharyngeal temperature recording is reasonable for weaning and immediate post-bypass temperature measurement. (Level C, Class IIa (benefit > > risk))
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Rewarming when arterial blood outlet temperature ≥30°C:
- 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.
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- To achieve the desired temperature for separation from bypass, it is reasonable to maintain a rewarming rate ≤0.5°C/min.
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Rewarming when arterial blood outlet temperature <30°C: To achieve the desired temperature for separation from bypass, it is reasonable to maintain a maximal gradient of 10°C between arterial outlet temperature and venous inflow. (Level C, Class IIa (benefit > > risk))
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No recommendation for a guideline is provided concerning optimal temperature for weaning from CPB due to insufficient published evidence.
Recommendation Grading
Overview
Title
Cardiopulmonary Bypass & Temperature Management During Cardiopulmonary Bypass
Authoring Organizations
American Society of Extracorporeal Technology
Society of Cardiovascular Anesthesiologists
Society of Thoracic Surgeons
Publication Month/Year
August 1, 2015
Last Updated Month/Year
June 30, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
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.
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Hospital, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D002315 - Cardiopulmonary Bypass
Keywords
temperature management, cardiopulmonary bypass
Source Citation
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
Engelman, Richard et al.The Annals of Thoracic Surgery, Volume 100, Issue 2, 748 - 757
Methodology
Number of Source Documents
218
Literature Search Start Date
January 1, 2000
Literature Search End Date
March 31, 2014