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KMID : 0377619740260050561
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Korean Jungang Medical Journal
1974 Volume.26 No. 5 p.561 ~ p.576
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Metabolic Effects of Extracorporeal Circulation
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Abstract
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The clinical cases of twenty consecutive intracardiac operations under the cardiopulmonary bypass with the disposable bubble oxygenator of RyggKyvsgaard and the Sigma Motor pump during past 3 months were reviewed to evaluate the effects of the extracorporeal circulation on the body by observing the hematologic and metabolic studies.
The hematological examinations observed periodically revealed the effect of hemodilution with the lowered hemoglobin and- hematocrit values with which patients did well, and the tendencyy of mild anemia continuing even on dismissal from hospital. The platelet counts were decreased markedly along with the bypass and remained rather low after the operation in most cases. However, these. alterations did not result in clinically related significant complications.
On the other hand, the changes in the serum electrolytes were minimal being kept in the near physiological range including calcium and magnesium levels_ Though, additional amounts of potassium were administered to keep the serum. potassium level a little high to avoid possible occurrence of cardiac arrhythmias after surgery.
The metabolic effects of extracorporeal circulation on the body were studied with the arterial blood gas analyses performed on the blood samples taken periodically before, during and after bypass. The general tendency was toward moderate respiratory alkalosis during perfusion and mild metabolic acidosis with the result of keeping the pH values within the normal range. The respiratory component of the alterations were mainly the moderately lowered carbon-dioxide tension in the blood during perfusion rising only to normal level with the termination of the bypass. It was suggested that the addition of small amounts "of carbon dioxide to the oxygenator along with the sufficient amount of ´oxygen -may be beneficial to avoid these potentially dangerous respiratory imbalance .during perfusion. The metabolic acidosis present before perfusion weremuch corrected toward normal with perfusiorz´-probably from the result of bicarbonate .added during and after surgery. However, these metabolic acidosis were not so :severe that extraordinary amounts of bicarbonate should be given for the cor section. The average amount of bicarbonate given during and after perfusion was 133.8 mEq. with several cases getting a little more because of the prolonged perfusion.
On the whole, the cardiopulmonary bypass was carried out successfully with the only mild deviation of the observed data from normal physiological values. There were 6 hospital deaths, 30% hospital mortality, 3 out of 10 cyanotic heart ,diseases, 2 out of 4 ventricular septal defects, none of 3 atrial septal defects and 1 out of 4 prosthetic valve replacements in 3 cases. The complications seen in the survivors from surgery were not definitely related to the bypass itself.
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