Cardiopulmonary Bypass & Temperature Management During Cardiopulmonary Bypass

Publication Date: August 1, 2015

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))
316232
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))
316232
Surgical teams should limit arterial outlet blood temperature to <37oC to avoid cerebral hyperthermia. (Level C, Class I (benefit > > >risk))
316232
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))
316232
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.
316232
Pulmonary artery or nasopharyngeal temperature recording is reasonable for weaning and immediate post-bypass temperature measurement. (Level C, Class IIa (benefit > > risk))
316232
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.
(Level B, Class IIa (benefit > > risk))
316232
  • To achieve the desired temperature for separation from bypass, it is reasonable to maintain a rewarming rate ≤0.5°C/min.
(Level B, Class IIa (benefit > > risk))
316232
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))
316232
No recommendation for a guideline is provided concerning optimal temperature for weaning from CPB due to insufficient published evidence.

Recommendation Grading

Disclaimer

Overview

Title

Cardiopulmonary Bypass & Temperature Management During Cardiopulmonary Bypass

Authoring Organizations

Publication Month/Year

August 1, 2015

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