ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

PERIOPERATIVE USE Of EXTRACORPOREAL SYSTEMS

Seda Kurtbeyoğlu

Ankara Bilkent City Hospital, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Kurtbeyoğlu S. Perioperative Use of Extracorporeal Systems. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.543-553.

ABSTRACT

  • The perioperative period plays a vital role in patient management, and advancements in extracorporeal systems have significantly enhanced this process.
  • This chapter aims to explore the principles, indications, and various applications of extracorporeal systems in the perioperative setting, with a particular emphasis on cardiopulmonary bypass (CPB), the pioneering extracorporeal system developed for open-heart surgery; extracorporeal membrane oxygenation (ECMO); and extracorporeal carbon dioxide removal (ECCO2R).
  • During the CPB procedure, venous blood is carefully drawn from the right atrium or major venous vessels into the CPB circuit and reservoir. Following heat and gas exchange, the blood is then reinfused into the patient through an arterial cannula placed in the ascending aorta or another significant artery.
  • It is important to recognize that hemostatic changes can be quite pronounced and may become more severe with prolonged CPB duration, owing to the intricate pathophysiological processes involved.
  • While CPB requires comprehensive anticoagulation, it is essential to be mindful of its impact on hemostasis, which underscores the necessity for effective bleeding management and blood transfusion protocols during this period.
  • ECMO, designed for longer-term use, offers unique benefits as an extracorporeal system.
  • Venoarterial ECMO is often recommended for cases of isolated cardiac failure, while venovenous ECMO is typically preferred for isolated respiratory failure.
  • Like CPB, ECMO also brings about hemostatic changes, so prompt diagnosis and appropriate management of any arising complications are of utmost importance.

Keywords: Extracorporeal membrane oxygenation; Cardiopulmonary bypass

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