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The Effects of Cardiopulmonary Bypass Following Pediatric Cardiac Surgery

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Critical Care of Children with Heart Disease

Abstract

Despite many advances since Gibbon’s first cardiopulmonary bypass (CPB) in 1953, end-organ damage and neurologic dysfunction remain a challenge in the management of pediatric patients undergoing cardiac surgery. A comprehensive understanding of the inflammatory process caused by CPB has led to intraoperative strategies that intend to minimize such responses.

Exposure of blood to the CPB circuit induces a complex systemic inflammatory response (SIRS), which involves the activation of multiple, interdependent cellular and humoral pathways. The coagulation and complement pathways are activated when the plasmatic proteins are exposed to the circuit material. Once cellular activation occurs, released proinflammatory cytokines, adhesion molecules, and chemokines are responsible for the amplification of the inflammatory cascade.

Each of the inflammatory cascade components has an important role in a process that ultimately results in vascular injury and end-organ damage.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Ana Maria Manrique

  2. Department of Pediatrics – Cardiac Neonatal Intensive Care Unit, Columbia University Medical Center, New York, NY, USA

    Diana P. Vargas

  3. CVOR Cardiac Cath Lab, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA

    David Palmer

  4. Department of Cardiovascular Surgery, Nemours Children’s Hospital, Orlando, FL, USA

    Kent Kelly

  5. Division of Cardiac Anesthesiology, Department of Cardiovascular Services, Nemours Children’s Hospital, Orlando, FL, USA

    Steven E. Litchenstein

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  1. Ana Maria Manrique
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  2. Diana P. Vargas
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  3. David Palmer
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  4. Kent Kelly
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  5. Steven E. Litchenstein
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Corresponding author

Correspondence to Ana Maria Manrique .

Editor information

Editors and Affiliations

  1. Chief, Division of Cardiac Critical Care Medicine Executive Director, Telemedicine Co-director, Children’s National Heart Institute, Professor of Pediatrics, George Washington University School of Medicine, Children’s National Health System, Washington, DC, USA

    Ricardo A. Munoz

  2. Department of Pediatric Cardiothoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Victor O. Morell

  3. Associate Medical Director, CHCO Heart Institute Head, Pediatric Cardiac Critical Care Program & Inpatient Services Director, Cardiac Intensive Care Unit Children’s Hospital Colorado, Tenured Professor of Pediatrics, Pediatric Cardiology and Intensive Care University of Colorado Denver, School of Medicine, Aurora, CO, USA

    Eduardo M. da Cruz

  4. Department of Pharmacy, Pediatric Critical Care, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Carol G. Vetterly

  5. Department of Pediatric Cardiothoracic Surgery, UPMC – Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Jose Pedro da Silva

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Manrique, A.M., Vargas, D.P., Palmer, D., Kelly, K., Litchenstein, S.E. (2020). The Effects of Cardiopulmonary Bypass Following Pediatric Cardiac Surgery. In: Munoz, R., Morell, V., da Cruz, E., Vetterly, C., da Silva, J. (eds) Critical Care of Children with Heart Disease . Springer, Cham. https://doi.org/10.1007/978-3-030-21870-6_10

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  • DOI: https://doi.org/10.1007/978-3-030-21870-6_10

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