Dr. Eudailey Circulatory Arrest Notes   When handing lines from the sterile field to attach to the pump: 

-- Have Scrub hand off the Medusa with the Y attached. 

-- Hook up ⅜” tubing end to the pigtail off the arterial filter.  (This is where you would normally hook up the arterial line when handed from the field) 

-- CLAMP THE ¼” TUBING OF THE MEDUSA 

-- When the arterial line of the AV loop is handed off attach it to the open leg of the Y connector.  

-- Secure tie band 

-- After attaching Venous line to reservoir, remove clamp from arterial line of AV loop and recirculate like normal 

-- Attach and secure tie bands to all connections made on the ⅜” x ⅜” x ¼” “Y” connector 

-- While pump is recirculating, slightly open clamp on ¼” line of the Medusa, to de-air 

-- Run fluid up

 -- Once fluid is at the level of the table, clamp the ¼” line of the Medusa Going on Circulatory Arrest:

 -- Kyle will say, pump off for Circulatory Arrest 

-- Stop forward flow, turn off vacuum 

-- Clamp Main Arterial line 

-- Leave Venous line open 

-- Open oxygenator recirculation line, and begin recirculating the pump 

-- Start giving retrograde cardioplegia 

-- Do not run any flow through medusa until Kyle asks for it 

-- Remove clamp from ¼” Medusa 

-- You will run up to de-air 

-- Will start flowing 8-10 ml/kg down one head vessel 

-- Kyle will add another head vessel cannula, will let you know when it is opened 

-- Keep head saturations at acceptable levels, increase flow to keep them up.  (Even if you are flowing over the 10ml/kg.  If flows will not keep head saturations up, please let Kyle know.) Notes of Interest: 

-- Tell Kyle when is “Heart Fibrillating”, Kyle will place LV vent (WILL USE 20FR LV VENT, DO NOT PASS UP A 16FR

-- Let Kyle know at 30 minutes of cooling 

-- Will want to know at 60 min on Cardioplegia 

-- After that tell every 30 min 

-- Once circulatory arrested let Kyle know every 10 min of circulatory arrest time Coming off Circulatory Arrest: 

-- Will have you run Antegrade cerebral and open arterial line to de-air the graft and get ready to resume full flow

------------------------------------------------------------

Dr. Kyle EudaileyManufacturer / Catalog/Ref.Comments
Aortic Cannula
(Communicate)
ARTERIAL CANNULA 21FR SOFT-FLOW EXTENDED        (Eudailey)Terumo / 4949SMALL arterial use SMALL venous < 90 kg
ARTERIAL CANNULA 24FR SOFT-FLOW EXTENDED               (Eudailey)Terumo / 4951LARGE arterial use LARGE venous > 90 kg



ARTERIAL CANNULA OPTISITE 18 thru 22FR W/LLEdward Lifesciences / OPTI18 thru OPTI22Have available for ALL Re-Op or any Aortic - Circulatory Arrest with Aorta or Femoral Cannulation cases
PERCUTANEOUS ARTERIAL INSERTION KIT                                      .038 WIRE x 100CMEdwards Lifesciences / PIKAFor OPTISITE Cannulation in Aorta or Femoral Artery



 3/8" x 1/4" CONNECTOR W/ LL CARMEDAMedtronic / CB4620Use on (1/4")8mm side-arm Aortic Dacron graft - cannulation



QUAD ANTEGRADE CEREBRAL PERFUSION - MEDUSSALivaNova / 627391101ALL Circulatory Arrest using Antegrade Cerebral Perfusion
For Total Arch cases, wait to open Arterial Cannula until Kyle decides












Venous Cannula
(Communicate)
VENOUS CANNULA 29/37FR (small 3-STAGE)Edward Lifesciences / TF293702SMALL arterial use SMALL venous < 90 kg
VENOUS CANNULA 36/46FR (LARGE 3-STAGE)Edward Lifesciences / TF364602LARGE arterial use LARGE venous > 90 kg



VENOUS CANNULA 24 thru 28FR RIGHT ANGLE METAL TIPMedtronic / 69320 thru 69328SVC or IVC cannula for Bi-Caval cases
1/2" x 3/8" x 3/8" Y CONNECTORMedtronic / 6040Use with ALL Bi-Caval cases

 
FEMORAL VENOUS CANNULA 60CM                                                 15 thru 25FR MULTI BIOMEDICUSMedtronic / 96600-015 thru Medtronic / 96880-025Have appropriate sizes available for ALL Re-Op or TAVR or Lead Extraction cases for Femoral Cannulation
1/2" x 3/8" STRAIGHT CONNECTORMedtronic / 6013Use with Biomedicus Femoral Cannula if needed
AVALON VASCULAR ACCESS KITMaquet / 12210Use with any Femoral Cannulation & OptiSite









Cardioplegia Needle (Aortic Root Vent)

CP AORTIC ROOT CANNULA 12GA(9FR)                                   W/ FLOW-GUARD (Eudailey)Medtronic / 11012ALL cases



CARDIOPLEGIA MULTI-Y W/ VENT (Octopus II) (Lewis)Medtronic / 14001ALL cases



RETRO CARDIOPLEGIA CATHETER 14FR (Lewis)Edward Lifesciences / RC014ALL cases using Buckberg (Blood) Cardioplegia



CORONARY ARTERY CANNULA 4 and 6MM STRAIGHTVitalcor / 315804 and 315806Any AI, AVR or Aortic Dissection cases, have open on field



RETRO CARDIOPLEGIA CANNULA MANUAL INFLATE 15FRMedtronic / 94915ALL Valve cases + Any Cerebral Perfusion (have 2 available)
RETRO CARDIOPLEGIA CANNULA MANUAL INFLATE 13FRMedtronic / 94113TCerebral Perfusion Smaller patients when requested
RETRO CARDIOPLEGIA CANNULA MANUAL INFLATE 10FRMedtronic / 94110Smaller patients when requested



CORONARY ARTERY CANNULA 10FR - 14FR
Aortic Root Replacement, Any case involving reimplantation of


the Coronary Buttons
Cardiac Sump

INTRACARDIAC SUMP 20FR (Plastic)Medtronic / 12112VALVE cases / use on #2 - yellow sucker pump









LV Vent

LEFT-HEART VENT 20FR RIGHT ANGLEMedtronic / 12002Pass up on all cases that need a vent
LEFT-HEART VENT 16FR RIGHT ANGLEMedtronic / 12016When requested - smaller vent









Ancillary or other Supplies

SENSOR OXIMETER ADULT (NIRS)Covidien / SAFB-SMALL cases - 2 each
PACING CABLE EXTENSION 6' (Screw-Down)FL-601-97ALL cases - 2 each
TUBING ORGANIZERSurge / 213-003ALL cases
TOURNIQUET KIT (Clear & Color)Medtronic / 79006When requested
INTRACARDIAC SUMP 12FR (CO2 Diffuser)Medtronic / 12013Use as 'CO2 diffuser' on Left-sided open-heart cases
SUCTION TUBE - 6FR SHAFT W/FRAZIER TIPMedtronic / 10050Lewis/Eudailey Cart / ALL CABG cases (CO2 Blower ONLY!)






PLEASE REMEMBER TO CHARGE FOR ANY EXTRA NON-REGULARLY USED ITEMS




Techniques and Notes for Kyle
Initiation of CPB:
"Give the Heparin"
When heparin is given and ACT is "200 seconds", turn "#3 pump sucker on"
To connect arterial line, "Pump up" will look for air bubbles. Will de-air leur lock. Will say "keep running" (don't stop running slow forward flow until he says "OFF")
Test forward flow when he asks.
If Surgeon and Anesthesia agree that is  safe to "RAP" this patient (optional); Then communicate with anesthesia, and begin arterial RAP. Venous cannula goes in next, as soon as Venous in, he will say “let me know” = V-RAP venous line. Once V-RAP complete say “ready to go on” or “waiting on ACT” (ACT >400 sec)
Once venous cannula is hooked up, will tell you to "go on bypass"
Once on bypass: he will tell you to "run your plegia", turn on the plegia and the root vent to de-air the octopus
He says "pressure down" you turn "pump flow down" and then when "pressure down" as he places cross-clamp on


Buckberg(Blood) Cardioplegia for involving CABG cases:
Setup pump with a Retrograde Cardioplegia Transducer with a 60 mL syringe to flush monitoring line up to field (set alarm limits HIGH!)
Cardioplegia (Buckberg only): (WILL CALL IT "BLOOD CARDIOPLEGIA")
Initial Buckberg dose: 500-600mL antegrade, 500-600mL retrograde. (Retrograde pressure measured on CVP - keep ~40-50mmHg)
Remind on Buckberg at "12 minutes" maybe every 5 thereafter; he will typically re-dose at 15 minutes
Maintenance Dose: 200-300mL of Low K, most likely given retrograde
Ask if doing proximals under one clamp or using a partial
He says "pressure down" you turn "pump flow down" when taking cross-clamp off
Run Warm (blood only, retrograde) Start when x-clamp comes off, during partial occlusion for proximals. "Warm off" "drain it"


del Nido Cardioplegia for VALVE's (without AI) and w/o CABG:
Initial del Nido Antegrade dose will be 1000mL at a rate of 200-300 mL's and a pressure of 250-300 mmHg
Remind at "45 minutes since del Nido" (then 60), unless different reminder time requested by surgeon, (60 - 90 - 120 minutes)
Re-dose of del Nido will be determined by surgeon, (30 - 60 - 90 minutes)


Temperature Control:
Drift on temperatures, do not go below  34°C on the bladder  (Rewarm when on IMA / Rewarm when seating the valve)
If more cooling is necessary, he will communicate the temperature, 32*C down to 22*C.                                                                                                                                                                 (FYI: If patient has renal disease; have RNFA use 'rectal temp probe' instead of using foley.)


For Circ. Arrest Cases Prep Heater/Cooler: Have plenty of fresh ice cubes inside H/C tank to facilitate rapid cooling. Then have full tray of ice with two empty buckets, will be needed for longer cooling time and large patients.
Aortic Aneurysm or Dissections including Circulatory arrest cases: If cannulating the 8mm side-arm of Aortic Dacron graft to a 1/4" x 3/8" connector with a leur to start the case. If using a 10mm Dacron graft, a 3/8" x 3/8" connector with a leur will be used.
OR Kyle will use an OPTI femoral arterial with PIK-A insertion kit to cannulate the aorta
OR Kyle will use normal aortic cannula. (will discuss with you when he enters room for case)
As soon as you go on bypass start cooling patient core down to temperature specified by Kyle. (LET HIM KNOW IF HEART FIBRILLATES!)
SPECIAL NOTE; when "Give the Heparin" or sooner, have circulator to cool the room all the way down and turn off the patient warming pad
He will perform Selective Antegrade Cerebral Perfusion at a rate of 5-15 mL/kg (500 mL) through the Quad Antegrade Cerebral Perfusion - Smart Perfusion Pack "Medusa" (LivaNova / 627391101) and he will let you know how many he will be needing.(start with only 2 for the Carotids)                                                                                                                  15FR retrograde (Plegia) Cannulas "Kyle's" (Medtronic / 94915)
When he is ready to re-establish full pump-flow, he will move the 1/4" x 3/8" connector with luer and re-cannulate using the side-arm of the Aortic Dacron graft, also start rewarming patient core at this time                                                                                                                                       
SPECIAL NOTE; have circulator to warm the room up a little and turn on the patient warming pad
Mini AVR:                                                                                                                                                                                                                                                                                                                           If doing Hemi-Sternotomy use Central cannulation (21 - 24Fr Soft-Flow Extended Arterial and small or LARGE Dual-Stage Venous Cannulas)                                                                  If doing Anterior-Thoracotomy use Femoral cannulation (18 - 22Fr OptiSite Arterial and QD-25Fr Venous Cannulas - like Dr. Lewis)


Termination of CPB:
"Volume in"
"What are you flowing"
Come down to "whatever flow he tells you"
"Come off"


Conduct of Perfusion for Kyle:
Pump-Flow goals: 1.8 - 2.2
May need to drop flow to 1.8 index when heart is lifted on CABG's, due to less than optimal drainage, and Kyle getting flooded.
Maintain MAP of 65-70 mmHg on relatively healthy patients.  
For those patients who are of advanced age or who have kidney/carotid disease he would like a MAP of around 80 mmHg.
Aortic valve cases wean off CPB with MAP of 90-100 mmHg.
Has no problems with hemoconcentration.  
Notify if you think the HCT is low (21% from the Lab, not I-stat). Not opposed to giving blood on bypass.  
If giving FFP, will want this given on bypass, or he may ask anesthesia to order AT3