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Cardiopulmonary bypass (CPB) is a medical technique that permanently replaces the functions of the heart and lungs, thereby enabling surgeons to operate on a bloodless field.
Answer: False
Explanation: Cardiopulmonary bypass is a technique that temporarily takes over the functions of the heart and lungs, not permanently, allowing surgeons to operate on a bloodless field.
A perfusionist is the specialized medical professional tasked with operating the cardiopulmonary bypass machine during surgical procedures.
Answer: True
Explanation: The source explicitly states that a perfusionist is the specialized medical professional responsible for operating the cardiopulmonary bypass machine during surgery.
A primary advantage of cardiopulmonary bypass is its capacity to establish a bloodless surgical field, a critical requirement for intricate cardiac procedures.
Answer: True
Explanation: Cardiopulmonary bypass creates a bloodless surgical field by temporarily taking over the functions of the heart and lungs, which is crucial for complex heart procedures.
Cardiopulmonary bypass is exclusively employed for coronary artery bypass grafting (CABG) and is not indicated for surgical interventions necessitating the opening of cardiac chambers.
Answer: False
Explanation: Cardiopulmonary bypass is commonly used for coronary artery bypass grafting (CABG) and is necessary for operations requiring the opening of heart chambers, such as mitral valve repair or replacement.
Which of the following terms serves as an alternative designation for cardiopulmonary bypass (CPB)?
Answer: The heart-lung machine
Explanation: The flashcard identifies 'heart-lung machine' as an alternative name for cardiopulmonary bypass.
What constitutes the primary responsibility of a perfusionist during open-heart surgical procedures involving cardiopulmonary bypass?
Answer: To manage the cardiopulmonary bypass machine and circulate oxygenated blood.
Explanation: A perfusionist is a specialized medical professional who operates the cardiopulmonary bypass machine to mechanically circulate and oxygenate the patient's blood.
Beyond coronary artery bypass grafting (CABG), for what additional category of cardiac surgical intervention is cardiopulmonary bypass frequently indispensable?
Answer: Operations requiring opening the heart's chambers
Explanation: Cardiopulmonary bypass is necessary for operations that require opening the heart's chambers, such as mitral valve repair or replacement, to prevent air from entering the systemic circulation and to provide a clear surgical view.
The oxygenator component of the CPB machine is responsible for pumping blood throughout the body, while the pump facilitates gas exchange.
Answer: False
Explanation: The oxygenator is responsible for gas exchange (adding oxygen and removing carbon dioxide), while the pump is responsible for circulating blood throughout the body.
Oxygenators utilized in cardiopulmonary bypass typically possess a recommended maximum usage duration of 24 hours to mitigate complement protein accumulation.
Answer: False
Explanation: Oxygenators used in CPB typically have a recommended maximum usage time of six hours (sometimes up to ten), not 24 hours, to prevent complement protein buildup and worsening of coagulation cascade activation.
The two primary functional units of a cardiopulmonary bypass device are the pump and the heat exchanger.
Answer: False
Explanation: The two main functional units of a cardiopulmonary bypass device are the pump and the oxygenator, which work together to circulate and oxygenate blood.
Centrifugal pumps are generally favored over roller pumps in cardiopulmonary bypass circuits due to their reduced propensity for inducing blood trauma and their ability to prevent over-pressurization.
Answer: True
Explanation: Centrifugal pumps are considered superior to roller pumps in CPB circuits because they prevent over-pressurization, clamping, or kinking of lines, and cause less damage to blood products like hemolysis.
Bubble oxygenators are considered superior to membrane oxygenators owing to their diminished propensity for inducing blood trauma.
Answer: False
Explanation: Membrane oxygenators are considered superior to bubble oxygenators because they introduce a gas-permeable membrane between blood and oxygen, which significantly decreases blood trauma compared to direct-contact bubble oxygenators.
By what mechanism does the oxygenator component of the cardiopulmonary bypass machine emulate the physiological function of the lungs?
Answer: By enabling red blood cells to absorb oxygen and reduce carbon dioxide.
Explanation: The oxygenator mimics lung function by enabling red blood cells to absorb oxygen and reducing carbon dioxide levels in the blood, replicating natural gas exchange.
What is the typical recommended maximal usage duration for oxygenators within cardiopulmonary bypass circuits, beyond which the accumulation of complement proteins may occur?
Answer: Six hours
Explanation: Oxygenators used in CPB typically have a recommended maximum usage time of six hours (though sometimes up to ten) to prevent complement protein buildup.
What auxiliary component is integrated into a cardiopulmonary bypass circuit to regulate core body temperature?
Answer: A heat exchanger
Explanation: A heat exchanger is an additional component used in a CPB circuit to control body temperature by heating or cooling the blood.
What material is customarily employed for the tubing within a cardiopulmonary bypass circuit?
Answer: Silicone rubber or PVC
Explanation: The tubing in a CPB circuit is typically made of silicone rubber or PVC (polyvinyl chloride).
Which classification of pump within a cardiopulmonary bypass circuit exhibits greater susceptibility to over-pressurization if the lines become occluded or kinked?
Answer: Roller pump
Explanation: Roller pumps are susceptible to over-pressurization if lines become clamped or kinked, unlike centrifugal pumps which are designed to prevent this.
What constitutes the primary function of the arterial cannula in cardiopulmonary bypass?
Answer: To infuse oxygen-rich blood into the arterial system.
Explanation: The arterial cannula's primary function is to infuse oxygen-rich blood from the CPB machine into the patient's arterial system.
Cardiopulmonary bypass can be employed to induce total body hypothermia, enabling the body to be sustained without blood flow for a duration of up to 45 minutes.
Answer: True
Explanation: Cardiopulmonary bypass can induce total body hypothermia, which significantly slows the body's metabolic rate, allowing it to be maintained without blood flow for up to 45 minutes.
During cardiopulmonary bypass, cooled blood typically exhibits reduced viscosity, thereby simplifying its management within the extracorporeal circuit.
Answer: False
Explanation: Cooled blood typically has higher viscosity, which is managed by diluting the blood with crystalloid or colloidal solutions used to prime the bypass tubing.
There are no absolute contraindications for cardiopulmonary bypass; however, medical teams must meticulously evaluate various factors during pre-operative planning.
Answer: True
Explanation: The source explicitly states that there are no absolute contraindications to cardiopulmonary bypass, but careful consideration of various factors by the medical team is essential during planning.
Patients exhibiting heparin resistance necessitate reduced heparin dosages compared to standard protocols to attain adequate anticoagulation during cardiopulmonary bypass.
Answer: False
Explanation: Patients with heparin resistance, such as those with antithrombin III deficiency, require additional heparin, fresh frozen plasma, or other blood products to achieve sufficient anticoagulation during CPB, not less.
A persistent left superior vena cava (PLSVC) represents a rare anatomical variation that simplifies venous drainage during cardiopulmonary bypass procedures.
Answer: False
Explanation: A persistent left superior vena cava (PLSVC) is an anatomical variation that can complicate CPB by making it difficult to achieve proper venous drainage or to deliver retrograde cardioplegia.
Cardioplegia is a solution administered to the heart to augment its metabolic demand and activity during surgical intervention, thereby conferring myocardial protection.
Answer: False
Explanation: Cardioplegia is a solution used to arrest (stop) the heart, which significantly decreases its metabolic demand, thereby protecting it from damage during surgery.
What is the maximal duration for which the human body can be sustained without perfusion when total body hypothermia is induced through cardiopulmonary bypass?
Answer: Up to 45 minutes
Explanation: When total body hypothermia is induced via CPB, the body's metabolic rate is significantly slowed, allowing it to be maintained without blood flow for up to 45 minutes.
What constitutes the most extensively investigated heparin-alternative for cardiopulmonary bypass in patients diagnosed with heparin-induced thrombocytopenia (HIT)?
Answer: Bivalirudin
Explanation: Bivalirudin is identified as the most studied heparin-alternative for CPB in patients with heparin-induced thrombocytopenia (HIT).
What common anatomical variation can introduce complexities into cardiopulmonary bypass procedures by impeding venous drainage or the delivery of retrograde cardioplegia?
Answer: Persistent left superior vena cava (PLSVC)
Explanation: A persistent left superior vena cava (PLSVC) is a common anatomical variation that can complicate CPB by making it difficult to achieve proper venous drainage or to deliver retrograde cardioplegia.
What is the principal objective of administering cardioplegia during cardiopulmonary bypass?
Answer: To arrest, or stop, the heart to decrease its metabolic demand.
Explanation: Cardioplegia's main purpose is to arrest (stop) the heart, thereby significantly decreasing its metabolic demand and protecting it from damage during surgery.
Which of the subsequent anatomical locations represents a common cannulation site for venous lines during cardiopulmonary bypass?
Answer: Right atrium
Explanation: Common cannulation sites for venous lines include the right atrium, vena cavae, and femoral vein.
What pharmacological agent is administered to the patient prior to cannulation to mitigate blood coagulation within the cardiopulmonary bypass circuit?
Answer: Heparin or another anticoagulant
Explanation: Prior to cannulation, heparin or another anticoagulant is administered to the patient until their activated clotting time exceeds 480 seconds, to prevent blood clotting within the circuit.
Cardiopulmonary bypass is recognized for its activation of the coagulation cascade and stimulation of inflammatory mediators, potentially resulting in complications such as hemolysis.
Answer: True
Explanation: Cardiopulmonary bypass is known to activate the coagulation cascade and stimulate inflammatory mediators, which can lead to complications such as hemolysis and coagulopathies.
The most frequently encountered complication associated with cardiopulmonary bypass is a protamine reaction, which manifests during the reversal of anticoagulation.
Answer: True
Explanation: The source identifies protamine reaction, occurring during the reversal of anticoagulation, as the most common complication associated with cardiopulmonary bypass.
Patients with a history of vasectomy or NPH insulin utilization exhibit a diminished risk of Type II protamine reactions.
Answer: False
Explanation: Patients with a history of vasectomy or NPH insulin use are at an increased risk of Type II protamine reactions due to prior exposure to protamine and potential cross-sensitivity.
Which classification of protamine reaction has the potential to precipitate life-threatening hypotension?
Answer: Type I
Explanation: Type I protamine reactions are known to cause life-threatening hypotension.
What constitutes the immediate management strategy for any classification of protamine reaction occurring during or subsequent to cardiopulmonary bypass?
Answer: Stopping the protamine infusion
Explanation: The immediate management for any type of protamine reaction is to stop the protamine infusion.
Which of the subsequent factors, associated with cardiac surgery and cardiopulmonary bypass, may contribute to cognitive impairment, in addition to the release of debris?
Answer: Episodes of hypoxia
Explanation: Beyond debris release, episodes of hypoxia, high or low body temperature, abnormal blood pressure, irregular heart rhythms, and fever may contribute to mental damage related to heart surgery and CPB.
Extracorporeal Membrane Oxygenation (ECMO) is a more complex variant of the heart-lung machine, primarily designed for short-term cardiac surgical support.
Answer: False
Explanation: ECMO is described as a simplified version of the heart-lung machine, often used for longer-term support to allow organs time to repair, unlike CPB which is typically for the duration of cardiac surgery.
Patients presenting with severe nervous system damage or terminal conditions are generally deemed suitable candidates for ECMO, given its capacity to sustain life indefinitely.
Answer: False
Explanation: Patients with terminal conditions, cancer, severe nervous system damage, or uncontrolled sepsis are generally not suitable candidates for ECMO, as it is intended as a temporary solution for organ recovery, not indefinite life support for irreversible conditions.
Which of the subsequent conditions is NOT enumerated as a contraindication for Extracorporeal Membrane Oxygenation (ECMO)?
Answer: Acute pulmonary failure
Explanation: Acute pulmonary failure is listed as a condition for which ECMO is useful, whereas terminal conditions, severe nervous system damage, and uncontrolled sepsis are listed as contraindications.
The operational feasibility of heart-lung machines was realized only subsequent to the discovery of heparin in 1916.
Answer: True
Explanation: The discovery of heparin in 1916, an anticoagulant that prevents blood from clotting, was essential for the feasibility of heart-lung machines.
John Gibbon's heart-lung machine was primarily developed by a team at the University of Minnesota Medical Center in the late 1960s.
Answer: False
Explanation: John Gibbon's heart-lung machine was further developed by a surgical team led by John W. Kirklin at the Mayo Clinic in Rochester, Minnesota, during the mid-1950s, not the University of Minnesota in the late 1960s.
Who engineered an early prototype of a heart-lung machine in the year 1885?
Answer: Maximilian von Frey
Explanation: Maximilian von Frey, an Austrian-German physiologist, constructed an early prototype of a heart-lung machine in 1885.
Who spearheaded the team that conducted the inaugural human operation involving open cardiotomy with temporary mechanical cardiac and pulmonary takeover on April 5, 1951?
Answer: Dr. Clarence Dennis
Explanation: Dr. Clarence Dennis led the team that performed the first human operation involving open cardiotomy with temporary mechanical heart and lung takeover on April 5, 1951.
On what date was the first successful open-heart procedure on a human, employing the heart-lung machine, executed by John Gibbon and Frank F. Allbritten Jr.?
Answer: May 6, 1953
Explanation: The first successful open heart procedure on a human utilizing the heart-lung machine was performed by John Gibbon and Frank F. Allbritten Jr. on May 6, 1953.
What technological advancement in oxygenator design superseded direct-contact oxygenators in cardiac surgery theaters subsequent to the 1960s?
Answer: High-performance microporous hollow-fibre oxygenators
Explanation: After the 1960s, high-performance microporous hollow-fibre oxygenators replaced direct-contact oxygenators in cardiac surgery theaters due to their improved efficiency and reduced blood trauma.