Perfusion Compendium 3.6 PDF

Compendium
for Perfusionists
Peter Fast Nielsen
2013. Version 3.6
The Scandinavian School of Cardiovascular Technology

Aarhus University Hospital, Denmark
A collection of equations, rules, formulas, calculations, numbers, abbreviations and more, - from different sources
including literature, protocols and guidelines from various centers, www, own studies and calculations, and others. Relevant
for Perfusionists in studies, science and clinical practice.
The Scandinavian School of Cardiovascular Technology and The University of Aarhus have no responsibility for the reliability
of the content.
The content is not representative for the syllabus of The Scandinavian School of Cardiovascular Technology.
Only p.4, Physics for Perfusionists, and p.5 "Pressure Units" are authoritative, and can be used for examinations.
Not to be copied, cited or placed on websites without permission from the author.
Corrections and suggestions are welcome to peterfast@city.dk
INDEX
Symbols used in the present Compendium .......................................................................................................................... 3
Physics for Perfusionists - Equation sheet ........................................................................................................................... 4
Pressure units and conversions ............................................................................................................................................ 6
Fluid dynamics in tubes ........................................................................................................................................................ 7
Tubing sizes and flow............................................................................................................................................................ 8
Flow at turbulent transition ................................................................................................................................................. 9
Tubings and needles diameter ............................................................................................................................................. 9
HLM set-up ......................................................................................................................................................................... 10
Quick Guide - Perfusion Sheet ............................................................................................................................................ 11
CPB disposables: Adult Oxygenators + filters ..................................................................................................................... 12
CPB disposables: Pediatric Oxygenators +filters ................................................................................................................. 13
Hemofiltration .................................................................................................................................................................... 14
ECMO and VAD ................................................................................................................................................................... 15
Pumps in CPB and ECMO .................................................................................................................................................... 16
Heater-Cooler: HCU and HE. ............................................................................................................................................... 17
In-line monitors for CPB. .................................................................................................................................................... 18
Cardiovascular Anatomy ..................................................................................................................................................... 19
Physiology - Cardiovascular System.................................................................................................................................... 20
Physiology - Metabolism.................................................................................................................................................... 21
Physiology - Body Size........................................................................................................................................................ 22
Formulas for Blood volume and flow ................................................................................................................................. 23
Calculations for hemodilution ............................................................................................................................................ 24
Chemistry ........................................................................................................................................................................... 25
Biochemistry ....................................................................................................................................................................... 26
Hypothermia ....................................................................................................................................................................... 28
Cardioplegia ........................................................................................................................................................................ 29
Cardioplegia solutions ........................................................................................................................................................ 30
Cardioplegia and MUF setup .............................................................................................................................................. 31
Perfusion in Animal Lab ...................................................................................................................................................... 32
Electricity ............................................................................................................................................................................ 33
Electrical Safety .................................................................................................................................................................. 34
Statistics ............................................................................................................................................................................. 35
Pre-Bypass Checklist ........................................................................................................................................................... 36
CPB phrases ........................................................................................................................................................................ 37
Abbreviations in perfusion ................................................................................................................................................. 38
Abbreviations in Cardio-Thoracic Disease .......................................................................................................................... 39
Abbreviations in Congenital Heart Disease ........................................................................................................................ 41
Perfusion Bibliography ....................................................................................................................................................... 42
Organizations and meetings ............................................................................................................................................... 43
Perfusion departments in Scandinavia ............................................................................................................................... 44
The Scandinavian School of Cardiovascular Technology .................................................................................................... 45
Perfusion Compendium 3.6.docx
2013
Peter Fast Nielsen.
peterfast@city.dk
SCANSCAT. Aarhus, Denmark
Symbols used in the present Compendium

Symbols used are listed below. Some symbols are explained in the individual pages.
SI units in physics are listed in page 4. Prefixes p.5. See also Abbreviation pages
Atm
Bar
BE
BF
BMI
BSA
BW
C ++
CaCl
Cpl
cm H2O
Da
EBF
EBV
Fr:
G
H (h)
H+
Hct
Hgb
HR
K+
Kg / cm2
LBW
MAP
Mg++
mmHg
mmol/L
n
Na+
NaHCO3
NS
p
pCO2
pO2
PrV
psi
Q
r
R
SBEc
SD
SEM
SvO2
V
W
WF
x
x
Physical Atmosphere, - at sea level

Meteorological bar
Base Excess
Blood Flow
Body Mass Index
Body Surface Area
Body Weight
1. Constant 2.Compliance
Calcium ionized
Chloride ionized
Cardioplegia
Cm of Water
Dalton: approximately equal to the mass of one proton (atom weight of H)
Estimated Blood Flow
Estimated Blood Volume
French (gauge) = Charriere
Gauge = Stubs Needle wire Gauge
Hour
Hydrogen ionized
Hematocrit
Hemoglobin
Heart rate, beats per minute
Potassium
Kg per square cm
Lean Body Weight
Mean Arterial Pressure
Magnesium ionized
Millimeters of Mercury
millimol per liter
Number of samples
Sodium
Sodium Bicarbonate
Not Stated
Partial Pressure
Carbon dioxide partial pressure
Oxygen partial pressure
Prime Volume
Pound per square inch (US)
Flow
Radius
Resistance
Standard Bicarbonate
Standard Deviation (SD or or s)
Standard Error of a single Mean
Oxygen Saturation of Venous Blood
Variance
Weight
Water Flow
Value of sample
Gradient, - or difference
Sample Mean
Proportional to
Inch

2013
Peter Fast Nielsen.
peterfast@city.dk
Physics for Perfusionists - Equation sheet

Symbol
Pressure
P
Power/Force F
Energy
E
Effect
U
Flow
Q
Density
Viscosity
Specific Heat c
Heat Fusion
Gravity
g
Height
h
Velocity
v
Area
A
Volume
V
Length
l-L
Mass
m
Temperature T
Compliance
C
Unit
1 Pa = kgm-1s-2
1 N = 1 kgms-2
1 J = 1 Nm
1 W = 1 J/s
m3/s
kg/m3
Pas = kgm-1s-1= Ns/m2
m2/s2/K = J/Kg/K
J/Kg
2
9.81 m/s
m
m/s
m2
m3
m
kg
K
m5/N
Equivalents and examples

1 Pascal = 1N/m2
1kp = 9.81Newton. 105 Dyn(e)= 1N
1 J = kg m2/s2
1 W = kg m2/s3
1 m3/s = 60.000 liters/min
Water: 998 Blood: 1060 Air: 1.2
Water: 0.001 Blod:0.0025 Air: 0.00002
Water: 4180 Tissue: 3470
Ice Water: 334.000
At ground level gravity: 1kg = 9.81N
1m = 100 cm
1 m/s = 3.6 km/t
Tubes: A= r2 Sphere: 4/3 r3
Tubes: V= l r2 = l A Sphere: 4
r2
1 inch(in) = 2.54 cm , 1 foot(ft)= 0.3048 m
1 pound (lb) = 0.454 kg
273 Kelvin = 0 Celsius
Arterial system, approx. 1.3 10-6 m5/N
Volume Flow: Q = v A
Mass Flow, conservation of mass: mflow, inlet = mflow,outlet =
Continuity Principle: Q1 = Q2
t A
v1 A1 = v2 A2
Potential Energy: Epot = F h = m g h , Fg =

Hydrostatic Pressure: P =
V g
g h
Kinetic Energy: Kinetic Energy density: KEd = v2 [J/m3]

KE = m v2 Effect = P Q Pressure: v2 (along current / Kinematic pressure component)
Bernoullis Equation: P +
v2 = constant energy/volume (along stream line)
g h +
Poiseuille's law (Frictional Energy Loss compare with Ohms law for electricity)
P=Q R
Resistance, R = (8 L) / ( r4 )
Q = ( P r4 )/ (8
Reynolds Number:
Re =
(alternatively: Re =
v D/
v r/
= 4
Q/(
Q/(
r)
D)
L)
(transition 2000-4000)
(transition 1000-2000))
Compliance: C = V / P
2013
Peter Fast Nielsen.
peterfast@city.dk
Shear Stress:
F
A
or

2013
P r
.
2 L
Damage at 100 Dynes/cm2 for platelets, 2000 for erytrocytes
Peter Fast Nielsen.
peterfast@city.dk
Pressure units and conversions

UNIT
Pa
cm H2O
mmHg
psi
Kg / cm2
1 Pa =
0.0102
0.00750
0.000145
1 cm H2O=
98.1
0.736
0.0142
10.2x10
0.00100
10.0x10
0.000981
9.87x10
0.000968
1 mmHg =
133
1.36
0.0193
0.00136
0.00133
0.00132
6.90 k
70.3
51.7
0.0703
0.0690
0.0680
98.1 k
1000
736
14.2
0.981
0.968
100 k
1020
750
14.5
1.02
0.987
101 k
1033
760
14.7
1.03
1.01
1 psi =
1 Kg / cm
1 bar =
1 Atm =
Pa
cm H2O
mmHg
psi
1 Kg / cm2
Bar
Atm
Pascal
(SI-unit)
Centimeters of Water
Millimeters of Mercury
Pound per square inch (US)
Kg per square cm
Meteorological bar
Physical Atmosphere at sea level
-6
Bar
Atm
-6
Prefix:
n Nano
Micro
m Milli
c Centi
h Hecto
k Kilo
M Mega
Equivalents:
mmHg = Torr
1 Kg/ cm2 = 1 Kp/ cm2 = 1000Kg / m2 = 1 m H2O
1 hPa = 1 mBar
Rules of thumb:
1 Atm 1 Bar 760 mmHg 100 KPa 1000 cm H2O

3 mmHg 4 cm H2O
1 kPa = 7.5 mmHg 1% atmospheric pressure
20 kPa 150 mmHg
-6
x10-9
x10-6
x10-3
x10-2
x102
x103
x106
1 Kg/cm2
(Car tire: 2 bar Bicycle tire: 4 bar)
Conversion of units:

2013
www.convertworld.com
http://en.wikipedia.org/wiki/Conversion_of_units
Peter Fast Nielsen.
peterfast@city.dk
Fluid dynamics in tubes

Poiseuilles law. Only for laminar, low flow conditions:
8
L
P=RQ
R=
4
r
Q=
r4
P x
8
L
Darcy-Weisbach equation, for turbulent conditions:
P f
L v2
D 2
or
L Q2
r5
0.25
f: Darcy friction factor

: roughness height
PVC: approx. 0025mm
f
4
log(
3.7 D
5.74
)
Re 0.9
or
L Q2
r5
0.3164
Re 0.25
Or:
f, is constant for complete turbulent flow, - for PVC tubes, approx: 0.03
Empiric Modification, - for transistent turbulence. Converted to clinical units:

P in mmHg Q in liters/min. D=diameter in mm.
C L
P = R Q2
and
R=
D5
P D5
C L Q2
P =
Q
=
C=88.000 for water 100.000 for blood. (Mod.1)
C L
D5
C L Q 1.75
Or more precise for pumped flow: P =
C=50.000 for water 60.000 for blood. (Mod.2)
D 4.75
Proportionality:
Double diameter => 5.7 times flow
Half diameter => 32 times pressure
Double flow => 4 times pressure
Double pressure => 1.4 times flow
Double length => 0.7 times flow
With reservations:
Water vs blood (0 to 30% hct)
Warm vs cold (37 to 20)oC
D 2,5 )
D -5 )
Q2)
P)
-0.5
L )
Theoretical ~ 1.75 times pressure. Empiric: ~ 1.2 times

Theoretical ~ 1.27 times pressure. Empiric: ~ 1.2 times
Resistance in parallel:
Rp =
R1 R2
R1 R2
Resistance in series:
Rs
R1

2013
(Q
(P
(P
(Q
(Q
R2
1
Rp
1
R1
1
R2
R3
Peter Fast Nielsen.
peterfast@city.dk

2013
Peter Fast Nielsen.
peterfast@city.dk
Tubing sizes and flow

Calculated flow and pressure according to empiric modification of Darcy-Weisbach equation, previous
page. For turbulence limits, see next page.
Maximum accepted pressure drop for tubings in CPB circuit is approx. up to 20 mmHg/meter for venous
line, and up to 50 for arterial line. See also HLM set-up, page 10.
Flow vs P.
(drainage flow)
Calculated flow in blood at specified pressure differences in 1 m tubing

(Mod.1)
Diam.
Volume Flow at Flow at Flow at Flow at Flow at Flow at
/meter 20mmHg 50mmHg 100mmHg 200mmHg 300mmHg 400mmHg
(L/min)
(L/min)
(L/min)
(L/min)
(L/min)
(L/min)
(mm)
(mL)
1.5
1.8
0.06
0.09
0.12
0.15
0.17
0.04
1.59
2.0
0.07
0.10
0.14
0.17
0.20
0.04
2.0
3.1
0.13
0.18
0.26
0.31
0.36
0.08
Diam.
(Inch)
Sample line
1/16
Sample line
Sample line
1/8
3/16
1/4
5/16
3/8
1/2
2.5
3.18
4.76
6.35
7.94
9.53
12.7
P vs Flow
4.9
7.9
18
32
50
71
127
0.22
0.14
0.40
0.25
1.1
0.70
2.3
1.4
4.0
2.5
6.3
4.0
13
8.1
Flow in L/min
0.31
0.57
1.6
3.2
5.6
8.9
18
0.44
0.80
2.2
4.5
7.9
13
26
0.54
0.98
2.7
5.6
9.7
15
31
0.63
1.1
3.1
6.4
11
18
36
(pumped flow)
Diameter
Calculated pressure drop in blood at specified flow in 1 m tubing

0.1L/min 0.25L/min 0.5L/min 1.0L/min 1.5L/min 2.0L/min 3.0L/min 4.0L/min
5.0L/min
6.0L/min
(mmHg)
(mmHg)
(mmHg)
(mmHg)
(mmHg)
(mmHg)
(mmHg)
(mmHg)
(mmHg)
(mmHg)
1.5 mm
155
773
2600
8744
17778
29412
59797
98929
146189
201133
1/16
119
590
1986
6680
13581
22468
45680
75573
111676
153648
2.0 mm
40
197
663
2230
4533
7500
15248
25227
37278
51289
2.5 mm
14
68
230
773
1571
2599
5283
8741
12916
17771
1/8
22
74
248
505
835
1698
2808
4150
5710
3/16
11
36
74
122
247
409
605
832
1/4
19
31
63
104
154
212
5/16
11
22
36
53
74
3/8
15
22
31
1/2
(Mod.2)
P in mmHg
2013
Peter Fast Nielsen.
peterfast@city.dk
10
Flow at turbulent transition

Tubing size
Sample
1/16
Sample
Sample
1/8
3/16
1/4
5/16
3/8
1/2
mm
1.5
1.59
2.0
2.5
3.18
4.76
6.35
7.94
9.53
12.7
Terminal velocity for bubbles:
Flow at
Re=2000
0.33
0.35
0.44
0.56
0.71
1.06
1.41
1.76
2.12
2.82
2 r2 g
(
9
Flow at
Re=4000
0.67
0.71
0.89
1.11
1.41
2.12
2.82
3.53
4.23
5.65
Flow at
v = 1L/min
0.1
0.1
0.2
0.3
0.5
1.1
1.9
3.0
4.3
7.6
is difference in density of blood-water: 1059
Tubings and needles diameter - comparison chart

mm
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Fr
3.0
6.0
9.0
12
15
18
21
24
27
30
33
36
39
42
45
48
51
Fr
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
mm
1.7
2.0
2.3
2.7
3.0
3.3
3.7
4.0
4.3
4.7
5.0
5.3
5.7
6.0
6.3
6.7
7.0
Fr
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
mm
7.3
7.7
8.0
8.3
8.7
9.0
9.3
9.7
10.0
10.3
10.7
11.0
11.3
11.7
12.0
12.3
12.7
G
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
mm
3.40
3.05
2.77
2.41
2.11
1.83
1.65
1.47
1.27
1.07
0.908
0.819
0.718
0.641
0.565
0.514
0.464
Fr
10.2
9.1
8.3
7.2
6.3
5.5
5.0
4.4
3.8
3.2
2.7
2.4
2.1
1.9
1.7
1.5
1.4
Sizes for arterial cannulaes and needles are Outer Diameter (OD)
Fr:
G:
Inch ():
French (French-gauge) FG (= Charrire) = Diameter(mm) x 3

Gauge = Stubs Needle wire Gauge
1 inch = 0.0254m = 2.54cm = 25.4mm

2013
Peter Fast Nielsen.
peterfast@city.dk
11
HLM set-up
Cannulas, tubing sets and oxygenator choice for CPB
-
Typical recommendations for sizing

Exact limits depend on make, design etc.
Venous cannula suggestions are without vacuum (VAVD or Centrifugal Pump)
Oxygenator
Neonatal
Infant
Pediatric
Adolescent
Small adult
EBF
max
0.6 L/min
1.2 L/min
2.3 L/min
3.0 L/min
4.2 L/min
approx
BW max
4 kg
11 kg
26 kg
40 kg
67 kg
Tubes
V-line
1/4
1/4
3/8
3/8
3/8
Tubes
A-line
3/16
1/4
1/4
5/16
3/8
Prime
Vol.
300 ml
400 ml
600 ml
800 ml
1100 ml
Accepted max pressure-drop for arterial cannulas is approx. 80-100 mmHg in CPB. 100-120 in ECMO.
For venous cannulas, max. approx: 10 mmHg in CPB, 40 with VAVD. 50-100 in femoral and ECMO.
Cannulas
(very much dependent of brand, shape and design)
Arterial - aorta
Flow max:
6
8 10 12 14 16
0.4 0.7 1.3 1.9 2.8 4.1
20
4.9
24 Fr
8 L/min
Venous - Sup
Venous - Inf
Bicaval Flow max:
12 14 14 16 16 16
12 12 14 14 16 20
0.4 0.7 1.0 1.3 1.6 1.8
20
20
2.3
20
24
3.1
24
24
4.0
14 16 20
0.6 0.9 1.3
36
46
Fr
5.2
L/min
Venous - single
Flow max:
24
2
28
2.8
31
4
Arterial - femoral
Flow max:
8 10 10 12 18 21 Fr
0.8 1.1 1.5 2.1 4.2 5.7 L/min
Venous - femoral
Flow max:
10 12 14 17 19 22
0.4 0.5 0.8 1.6 2.2 3.2
Cardioplegia cannulas
BW
Size
<5kg:
18G.
5-20kg
16G.
20-35kg:
14G.
>35kg:
12G.

2013
24
4
24 28
28 28
4.6 5.1
28
36
8.0
Fr
Fr
L/min
28 Fr
6 L/min
Aortic Vents:
BW
<14kg:
14-30kg:
30-50kg:
>50kg:
Peter Fast Nielsen.
OBS: Outer Diameter!
peterfast@city.dk
size
10Fr
13Fr
16Fr
20Fr
12
Quick Guide - Perfusion Sheet

Data
H:
W:
Calculated
Reference
EBF:
BSA:
EBV:
PrimeVol:
Age:
Peds: 2.6 L/m2
<25kg: (4xW+7) / (90+W)
>25kg: (H+W-60)/100
0-10kg: 85ml/kg. 10-20:80. 20-30:75. 30-40:70. 40-50:65

See below
Hct2 x (prV+EBV) - (EBVxHct1)
.
0.65
20-30ml pr kg
Blood:
Hb
Adults: 2.4L/m2
Max. 1000 ml
Cpl.Vol:
W<5kg:18G. 5-20kg:16G. 20-35kg:14G. >35kg:12G.
Cpl.can:
W<14kg:10Fr. 14-30kg:13Fr. 30-50kg:16Fr. >50kg:20Fr.
Vent:
30mg x W
(complex peds) Max: 2.000 mg ??
Methylprednisolone*
0.5g
x
W
Max.10.000 mmol
Mannitol*
0.5-1mg x W (only selected cases)
Max. 15 mg
Furosemid*
0.04 mmol per ml of bank blood
Bicarbonate*
*Addition of drugs is debated, - and in some centers avoided
**Normally BSA should be used for calculating EBF. Weight alone is only a rough approximation
~ W** EBF
Tubing
V
V
A
W
EBF
Tubing
(kg)
set
cava
RA can
(kg)
set
L/min
6
Adolescent
1
0.3 Neonate 12+12
14
25
2.3
2
0.4
0.5
0.6
0.7
0.8
0.9
1.0
1.1
10
1.2
11
1.3
12
1.4
13
1.5
14
1.5
15
1.6
16
1.7
17
1.8
18
1.8
19
1.9
20
2.0
Neonate
Neonate
Neonate
Infant
Infant
Infant
Infant
Infant
Infant
Pediatric
Pediatric
Pediatric
Pediatric
Pediatric
Pediatric
Pediatric
Pediatric
Pediatric
Pediatric

2013
12+12
14
30
2.6
12+14
16
35
2.8
12+14
16
40
3.1
12+14
16
45
3.4
20
10
50
3.6
14+14
20
10
55
3.8
14+14
20
10
60
4.1
14+14
20
10
65
4.3
14+16
20
10
70
4.5
14+16
20
10
75
4.6
16+16
24
10
80
4.8
16+16
24
12
85
4.9
16+16
24
12
90
5.0
16+16
24
12
95
5.2
16+20
24
12
100
5.3
16+20
24
12
105
5.4
16+20
24
12
110
5.5
20+20
24
12
115
5.7
24
14
120
5.8
14+14
20+20
Peter Fast Nielsen.
peterfast@city.dk
V
cava
V
RA
A
Can
20+20
28
14
Adolescent
Adolescent
20+24
28
14
20+24
28
14
Small adult
Small adult
Small adult
Small adult
Small adult
20+24
31
14
24+24
31
16
24+24
31
16
24+24
31
16
24+24
31
16
24+28
36
20
24+28
36
20
24+28
36
20
28+28
36
20
28+28
36
20
28+28
36
24
28+31
36
24
28+31
46
24
28+31
46
24
28+31
46
24
28+31
46
24
28+31
46
24
Adults
Adults
Adults
Adults
Adults
Adults
Adults
Adults
Adults
Adults
Adults
Adults
13
CPB disposables: Adult Oxygenators + filters

Performance Data
Adult
OXYGENATORS
Flow Range
Chalice Medical
Paragon
Eurosets
AMG / Alone
Admiral/Skipper/Concept
Medos
Hilite 7000
Medtronic
Affinity
Fusion
Maquet
Quadrox-i
Quadrox-i Small Adult
Sorin
Primox / Apex
Eos D905
Avant / Evo
Terumo
Capiox RX25/FX25.filter
Capiox RX15/FX15.filter
SX18
SX25
Prime Vol
(L/min)
Surface
Area
(m2)
1.0 - 8.0
1.8
225
60
0.44
310
1.0 - 8.0
1.0 - 7.0
1.8
1.4
220
190
140
140
0.48
0.50
315/280
280
1.0 - 7.0
1.9
275
120
1.0 - 7.0
1.0 - 7.0
2.5
2.5
270
260
60
110
0.40
0.51
320
300
0.5 - 7.0
0.5 - 5.0
1.8
1.3
*215/335
*175/295
45
-
0.59
0.63
433
271
NS - 8.0
NS - 5.0
NS - 7.5
1.9
1.1
1.7
250
160
250
NS
175
125
0.42
0.62
0.48
345
265
320
0.5 - 7.0
0.5 - 5.0
0.5 - 7.0
0.5 - 7.0
2.5
1.5
1.8
2.5
*250/260
*135/144
270
340
55
100
180
160
0.53
0.66
0.53
0.53
490
330
400
490
(ml)
HE-performance
P
10L/min WF
at 5L/min at-and
max BF
(mmHg)
(perform.fac)
Oxygen
Transfer
At 5L/min
(ml/min)
*Prime Volume, without/with build-in Arterial filter
Arterial filters (adult) 3/8"
Max Flow
(with pore size under 100 micron)
Eurosets
Eurosets
Medos
Medtronic
Maquet
Sorin
Sorin
Sorin
Sorin
Terumo
Sherlock
Mini-Sherlock
BMAF-A
Affinity
Quart
AF840
AF620 / AF640
D732 / D734
D731 / D733
AL6

2013
(L/min)
7.0
5.0
7.0
7.0
7.0
8.0
6.0
7.0
5.0
8.0
Peter Fast Nielsen.
Surface
Area
(m2)
0.5
0.2
0.62
NS
0.57
NS
0.29
0.65
0.30
0.55
peterfast@city.dk
Prime Vol
(ml)
179
90
175
205-221
180
128
92
195
100
100
P
at 5L/min
(mmHg)
35
56
11
Filter
pore
(micron)
40
40
40
20 or 38
40
40
20 / 40
27 / 40
27 / 40
40
14
CPB disposables: Pediatric Oxygenators + filters

Pediatric
OXYGENATORS
Eurosets
Trilly
Medos
Hilite 1000 Infant
Hilite 2800 pediatric
Medtronic
Pixie
Minimax Plus
Maquet
Quadrox-i Neonatal
Quadrox-i Pediatric
Sorin
Kids D100
Kids D101
Lilliput ??
Terumo
Capiox RX05
Flow
Range
(L/min)
Surface
Area
(m2)
Prime Vol
(ml)
P
at 1L/min
(mmHg)
0.5 - 3.2
0.69
90
NS - 1.0
NS - 2.8
0.39
0.80
57
98
NS - 2.0
NS - 2.3
0.67
0.80
48
149
0.2 - 1.5
0.2 - 2.8
0.38
0.80
*38/40
*81/99
NS - 0.7
NS - 2.5
0.22
0.61
31
87
0.1 - 1.5
0.50
43
Arterial filters (Ped) 1/4"

(with pore size under 100 micron)
HE-
Oxygen
performance
at 10L/min WF
-and max BF
(perform.fac)
Transfer
32
0.60
70
40
35
0.76
0.92
67
73
90
0.63
100
P
at 1L/min
(mmHg)
Filter pore
Max
Flow
(L/min)
3.2
Surface
Area
(cm2)
Prime Vol
(ml)
39
At 1L/min
(ml/min)
(micron)
30
Medtronic
Affinity Pixie
Sorin
Micro D735
Micro D736
Kids D130 - Neonatal
Kids D131 - Infant
2.5
2.5
140
140
40
40
27
40
Terumo
Capiox CX AFO2
2.5
NS
40
32

2013
Peter Fast Nielsen.
peterfast@city.dk
15
Hemofiltration
Definitions and abbrevations:
Ultra-filtration
Hemo-filtration
Hemo-dia-filtration
Hemo-dialyse
Modified UltraFiltration
UF
HF
HDF
HD
MUF
SCUF/ZBUF
CVVH(F)
CVVHDF
CVVHD
Typical filter size:

Dialysis filters: 50.000 Da. 0.005 m (30-65.000)
Hemofilters: 15.000 Da. 0.0015 m (12-20.000)
Molecule and particle sizes:

Albumine:
69.000 Da
Hemoglobin:
64.500 Da
Myoglobin:
17.000 Da
Heparin:
6-22.000 Dalton
Creatinine:
112 Da
KCl:
75 Da
Water:
18 Da
Dalton represent the mass of one proton, or one Hydrogen atom = 1.66 10 24 g
1000 Dalton equals approx the diameter of 1 ngstrm = 10-10 meter = 0.0001 m
Surface
Area (m2)
Hemofilter (adult)
Dideco
Maquet
Medtronic
Medos
Sorin/Cobe
Terumo
DHF 0.6
BC 60 plus
Minntech D-30NR
ME HFOS 0120
SH-14
Hemocor HPH 700
Trans Membrane Pressure, TMP =

2013
0.68
0.70
0.66
1.2
1.4
0.71
Pa Pv
2
Filtration at
TMP=100mmHg
Q = 100 ml/h
33 ml/min
38 ml/min
37 ml/min
NA
61 ml/min
39 ml/min
Pore size
(Dalton)
Prime Vol
(ml)
60
65
17.000
11800
12000
68
80
58
P(effluent )
Peter Fast Nielsen.
peterfast@city.dk
16
ECMO and VAD

Oxygenation Index (Oi) = (airway mean pressure) x FiO2 / PaO2
Oi > 20 cmH2O => consider ECMO.
Oi >40 => ECMO
Recirculation Factor in ECMO: (SpreO2 - SVO2) / (SpostO2 - SVO2)
(pre- and post oxygenator)
Suggested rough guidelines according to various center protocols (also depend on make):
BW
Flow
Tubing size
Cannulation
< 5 kg
100 ml/kg/min
1/4"
A8 + V10 Fr
Double lumen 12 Fr
5 - 10 kg
100 ml/kg/min
1/4"
A10 + V12 Fr
Double lumen 15 Fr
10 - 20 kg
75 ml/kg/min
1/4"
A12 + V15 Fr
Double lumen 18 Fr
20 - 30 kg
75 ml/kg/min
3/8"
A14 + V19 Fr
Double lumen 23 Fr
30 - 50 kg
50 ml/kg/min
3/8"
A17 + V21 Fr
Double lumen 27 Fr
50 - 90kg
50 ml/kg/min
3/8"
A19 + V21 Fr
Double lumen 31 Fr
> 90 kg
50 ml/kg/min
1/2"
A21 + V23 Fr
Pre-ECMO Heparin dose 100 iu/kg.

Heparin maintenance: Start/min: 10iu/kg/h Normal dose: 25-50 iu/kg/min
ACT target: 1 times start value, or 160-180 sec
APTT target: 1 times start value, or 60-80 sec
VAD pumps
Manufacturer
Thoratec
Thoratec
Thoratec
Thoratec
Heartware
Berlin Heart
Berlin Heart
Jarvik Heart
MicroMed
Terumo
Arrow
Medos
Pump
Thoratec PVAD
Thoratec IVAD
HeartMate 2
HeartMate 3
HVAD
Incor
Excor
Jarvik 2000
DeBakey
DuraHeart
LionHeart
VAD-III

2013
Type
Pulsatile - Pneumatic
Centrifugal with bearing
Centrifugal without bearing
Pulsatile - Electrical
Peter Fast Nielsen.
peterfast@city.dk
Ped? Remarks
Paracoporeal
Paracoporeal
Transcutaneous power
Paracoporeal
17
Pumps in CPB and ECMO

Roller pumps
HLM
Stckert S3
Stckert S3
Maquet HL20
Maquet HL20
Stckert S5
Stckert S5
Terumo Syst.1
Terumo Syst.1
Occlusion settings:
Hard
Medium
Light
Pump
Size
Single
Twin
Single
Twin
Single
Twin
6"
4"
tube:
1 RPM=
13 ml
6.8 ml
12 ml
6.0 ml
12 ml
6.3 ml
12.7 ml
8.0 ml
3/8 tube:
1 RPM=
28 ml
26 ml
26 ml
27.2 ml
16.0 ml
1/2 tube:
1 RPM=
45 ml
46 ml
46 ml
43.2 ml
(for Silicone Tube in pump segment)

Dynamic method:
Static method:
1 meter decent rate*
5 RPM
> 350 mmHg
250 350 mmHg
200 250 mmHg
0-1 cm/min
2-3 cm/min
4-10 cm/min
Max flow
For biggest tube
11 L/min
1.7 L/min
10 L/min
1.5 L/min
11 L/min
1.6 L/min
10 L/min
4.0 L/min
Clamped tube
method:
Flat + a little more
Only just flat
Barely flat
* The decent rates is for 3/8 tubes (holding 0.6 ml/cm),where decent is observed. Accept double rate for (holding 0,3 ml/cm.)
The most reliable is the dynamic method

Generally recommended occlusion setting is the upper end of medium interval
For VAVD and cardioplegia, occlusion should be hard
Centrifugal pumps:
Medtronic Biopump BPX-80
Medtronic Biopump BP-50
Sorin/Stckert SCP-revolution
Medos DeltaStream DP2 / DP3
Sarns Delphin
Terumo - Capiox
Maquet Rotaflow
Maquet Rotassist 9.9
Maquet Rotassist 2.8
Levitronix CentriMag
Levitronix Pedivas

2013
Prime
Vol.
86 ml
48 ml
57 ml
17 ml
48 ml
45 ml
32 ml
29 ml
18 ml
31 ml
14 ml
Connection
Peter Fast Nielsen.
size
3/8
1/4
3/8
3/8
3/8
3/8
3/8
3/8
1/4
3/8
1/4
Max
RPM
4300
4300
3500
10000
3600
3000
5000
5000
5000
5500
5500
peterfast@city.dk
Pressure at
max RPM
800
800
800
600
700
800
750
720
640
600
540
Intended
Max Flow
10 L/min
1.5 L/min
8.0 L/min
8.0 L/min
7.0 L/min
9.9 L/min
9.9 L/min
9.9 L/min
2.8 L/min
9.9 L/min
1.5 L/min
18
Heater-Cooler: HCU and HE.

Performance Factor: =
TB out TB in
TW in TB in
1 Wh = 3.60 KJ
1 Cal = 4.18 J
Jostra
HC20
Maquet
HCU30
Maquet
HCU40
Stckert
3T
Hemotherm
Sarns
400MR
/Terumo
Cold Water Tank

Ice Tank?
Patient Circuits outlets
Cardioplegia Circuits
34 L
No
2
0
26 L
Yes
2
1
28 L
Yes
2
1
6L
No
2
1
8L
No
2
0
4.5 L
Yes
2
?
Initial cooling effect

(tank)
Cont. cooling effect
1050 Wh
1736 Wh
1764 Wh
800 W
1186 W
1352 W
2100 W
800 W
Warming effect
Water flow
Max. pump pressure
2250 W
20 L/m
0.8 bar
2760 W
10-23 L/m
*2.4 bar
3000 W
18.5 L/m
*1.5 bar
2500 W
15-17 L/m
0.7 bar
1200 W
15 L/m
0.9 bar
1000W
21 L/m
0.9 bar
Noise (with compressor)

Mains Fuse (at 230V)
Max. power consumption
45 dB
16A
3200 W
50 dB
16A
3680 W
45 dB
20A
3840 W
56 dB
18A
3600 W
?
11A
3450 W
?
12A
?
TMC2
*Max.value. Adjustable, - from flow setting

2013
Peter Fast Nielsen.
peterfast@city.dk
19
In-line monitors for CPB.

Monitor:
Company:
CDI.500 Datamaster Biotrend

Terumo
Sorin
Medtronic
BMU 40
Maquet
EDAC# GAMPT M4 M3 M2
Quantifier BCC200
Terumo
Gampt
pH
pCO2
pO2
SaO2
Tp
Tp
SvO2
a
a
a
Spectrum Medical
BE
b Hct
Hgb
b K+
G
eCO2
VO2
*
*
*
*
Flow
b Bubbles
# Inv.probes
# Clamp-ons
Update time SaO2
1-6 sec
10-30 sec
12 sec
12 sec
W(kg)
7.3
3.2
5.9
* a-Tp/37
9.0
# Device no longer sold in Europe
: Data from Invasive probes/connectors

: Data from non-invasive, clamp-ons
*: Data calculated from other parameters
G: Data from Gas-line probe
- No data
a: Measured on arteriel blood line
v: Measured on venous blood line
b: Measured on unspec.blood line

2013
Peter Fast Nielsen.
peterfast@city.dk
20
Cardiovascular Anatomy
Right Coronary Arteries

RCA = right coronary
AM = right marginal (Acute Marginal)
PDA = posterior descending
Left Coronary Arteries

LM: Left Main
LAD left anterior descending = left coronary
INT: ramus, intermediate
DX: Diagonal (D1, D2)
CX = circumflex branch
LMA = left (obtuse) marginal (OM1,OM2)

2013
Peter Fast Nielsen.
peterfast@city.dk
21
Physiology - Cardiovascular System

Stroke Volume
(SV)
=
Ejection Fraction
(EF)
=
Cardiac Output
(CO)
=
Cardiac Index
(CI)
=
Systemic Vascular Resistance (SVR)=
EDV ESV
(SV / EDV) 100%
SV HR
Q / Body Surface Area (BSA) = SV HR/BSA
(MAP-CVP)/CO/80
Cardiac measurements
Typical adult value
Normal range
End-Diastolic Volume (EDV)
120 ml
65 - 240 ml
End-Systolic Volume (ESV)
50 ml
16 - 143 ml
Stroke Volume (SV)
70 ml
55 - 100 ml
Ejection Fraction (EF)
60%
55 to 70%
Heart Rate (HR)
70 bpm
60 to 100 bpm
Systemic Vascular Resistance (SVR)
1200 dynes/s/cm5
900-1400 dynes/s/cm5
Cardiac Output (CO)
5 L/min
4.0 - 8.0 L/min
Typical volume and saturation for blood in circulatory system, for adults:
Saturation
Typical pressure (mmHg)
SVC Superior Vena Cava
75%
2
IVC Inferior Vena Cava
85%
2
RA
Right Atrium
75%
2
RV
Right Ventricle
75%
25/0
AP
Pulmonary artery
75%
25/10
VP
Pulmonary veins
99%
6
LA
Left Atrium
99%
6
LV
Left Ventricle
99%
110/0
AO
Aorta
99%
110/80
Arterioles
99%
Capillaries
50%
Venules
45%
Peripheral Veins
40%

2013
Peter Fast Nielsen.
peterfast@city.dk
22
Physiology - Metabolism
Oxygen Delivery (content): DO2
The oxygen content of blood in ml per liter blood: (O2 carried by Hgb) + (O2 in solution) =
(mlO2) = (21.6 x Hgb x SaO2) + (0.23 x PaO2)
(Hgb in mmol/L. - SaO2 in %. - PaO2 in kPa.)
(mlO2) = (13.4 x Hgb x SaO2) + (0.031 x PaO2)
(Hgb in g/dl. - SaO2 in %. - PaO2 in mmHg.)
Oxygen consumption (extraction): VO2 = Q x DO2
Fick's equation: VO2
Q x [Hgb] x (SaO2 - SvO2)
O2 consumption, VO2 = Q x (SaO2-SvO2)xHgbx0.134 + 0.003x(PaO2-PvO2)
Normal O2 consumption: 140 ml/min/m2 or 3.5ml/kg/min in adults and 7 ml/kg/min in neonates
Systemic Metabolic Status (a.m. Ranucci)
dO 2
>5
CO 2
NaHCO3 buffering: 0.3 x BE x BW
- half dose in pediatrics
BUFFER:
CO2 + H2O
H2CO3
lactate increase
HCO3- + H+
Distribution of Cardiac Output to Body Organs (resting)
Brain
Heart
Kidneys
Abdomen
Lung
Muscle
Rest (skin&bone)
Organ relative to
Body weight
2.0 %
0.43 %
0.43 %
2.1 %
1.5 %
39.7 %
55.3 %
Blood Flow
(ml/min)
775
175
1100
1400
175
1000
375
Organ flow
relative to CO
15 %
3.3 %
23 %
29 %
3.5 %
19 %
9.7 %
O2 consumption
(ml/min)
46
23
18
66
5
64
33
Dissociation curve.
Basic hemoglobin saturation curve.
It is moved to the right in higher acidity
(more dissolved carbon dioxide)
and to the left in lower acidity
(less dissolved carbon dioxide)

2013
Peter Fast Nielsen.
peterfast@city.dk
23
Physiology - Body Size

BSA. - different equations to estimate
(Height in cm. Weight in kg)
BSA = 0.007184 x W 0.425 x H 0.725

BSA = H W / 3600
= H W /60
BSA = (H+W-60)/100
(Adults only)
BSA = (4xW+7) / (90+W)
(Best in peds)
Dubois:
Mosteller:
Simple:
Weight
Approximation of BSA
From weight alone
1-5 kg:
6-10 kg:
11-20 kg:
21-70 kg:
71-100 kg:
0.05 x weight + 0.05

0.04 x weight + 0.1
0.03 x weight + 0.2
0.02 x weight + 0.4
0.01 x weight + 1.1
Pediatric norms:
Age
term
3 mo
6 mo
1 yr
3 yr
BW
3.5
6.0
7.5
10
14
BSA
0.23
0.31
0.38
0.47
0.61
Age
7
10
12
14
21
Approximation of Weight: Age:1-9y:
BW
22
30
38
50
70
BSA
0.86
1.1
1.3
1.5
1.8
W = (2 x Age) + 9
Age: 9-15y: W = 3 x age
Body Mass Index, BMI = W(kg) /H2 (m)

Severely underweight
BMI 16.5
Underweight
BMI 18.5
Normal
BMI 18.524.9
Overweight
BMI 2529.9
Obese Class I
BMI 3034.9
Obese Class II
BMI 3539.9
Obese Class III
BMI 40
Lean Body Weight (men) =
(1.10 x W) 128 (W2/(100 x H)2)
Lean Body Weight (women) =
(1.07 x W) 148 (W2/(100 x H)2)
- or:
LBW = C x H2C = 22-25 kg/m2
H: height in meter

2013
Peter Fast Nielsen.
peterfast@city.dk
24
Formulas for Blood volume and flow in CPB

Estimated Blood Flow / Cardiac Output:
EBF in adults:
EBF in pediatrics:
1.8 - 2.4 x BSA

2.4 - 2.8 x BSA
EBF from weight alone:
<3kg:
3-10kg:
10-15kg:
15-30kg:
30-55kg:
55-75kg:
75-100kg:
>100kg:
(L/min/m2)
200 ml/kg/min
150 ml/kg/min
125 ml/kg/min
100 ml/kg/min
75 ml/kg/min
65 ml/kg/min
60 ml/kg/min
50 ml/kg/min
(more precise to use BSA

from BW. Page 18)
Selective Cerebral perfusion: 10-15 ml/min /kg

- or 15-20% of EBF
Regional Low Flow Perfusion, in neonates -upper body: 30 ml/kg (20-60)
Estimated Blood Volume (ml)

EBV: W x 92.5 - (0.129xH) (H in cm) (best for peds)
EBV: 362 x H3 + 32.6 x W (H in meter) (Modification of Nadler formulae. Best for adults)
EBV from weight alone:
Abbreviations on this page

2013
0-10 kg:
10-20 kg:
20-30 kg:
30-40 kg:
40-50 kg:
Adults:
EBV:
BSA:
BW:
EBF:
H:
85 ml/kg
80 ml/kg
75 ml/kg
70 ml/kg
65 ml/kg
60 ml/ kg

Body Surface Area
Body Weight in Kg. (sometimes just W)
Estimated Blood flow
Height, - in cm. (unless mentioned otherwise)
Peter Fast Nielsen.
peterfast@city.dk
25
Calculations for hemodilution
Expected Hct on bypass: Hct2=
Hct1 EBV
(EBV Pr V )
or
ANH, donation and replacement volume needed for Hct1:
Hct1 EBV
(EBV Pr V AdV)
EBV
Hct 0 Hct1
Hct 0
Donor blood needed in prime for desired Hct2 at start bypass: dbV=
Donor blood needed for raising Hct during bypass: dbV =
Hct3 Hct 2
HctD Hct3
Added clear volume to lower Hct during bypass: adV =
Hct 2 Hct3
Hct3
Hemofiltration needed for raising Hct2 to Hct3:
EBV
Pr V
EBV
prV
Hemofiltration needed for raising Hct 0.1 point:
(EBV Pr V ) Hct 2 (EBV Hct1)

HctD
30
prV EBV
prV EBV
Hct 2
* EBV
Hct3
Pr V
(from 0.29 to 0.30)
Note: add extra volume, AdV, to PrV, - if relevant. Or subtract in case of taking volume out
Abbreviations on this page

2013
ANH
EBV:
EBF:
Hct0
Hct1:
Hct2:
Hct3:
HctD:
PrV:
AdV
Acute Normovolaemic Heamodilution

Estimated Blood flow
Hematocrit before ANH
Hematocrit before CPB
Hematocrit after initiation of bypass
Hematocrit efter filtration, - or after adding donro blood
Donor Blood Hematocrit
Prime Volume
Added Volume (non-blood)
Peter Fast Nielsen.
peterfast@city.dk
26
Chemistry
GAS
Air
Oxygen
Nitrogen
Hydrogen
Carbon Dioxide
Helium
O2
N2
H2
CO2
He
Boyle Mariottes law:

Charles Law:
Guy-Lussacs Law:
Combined gas Law:
P
V
P
P
Molar mass
g/mol
29
32
28
2
44
4.0
Density
g/L
1.20
1.35
1.19
0.09
1.87
0.17
V = constant
T = constant
T = constant
V/T = constant
Viscosity
Pas
17.0
19.1
16.6
8.7
13.7
0.00019
Solubility
g/l
0.038
0.070
0.029
0.002
3.37
0.009
P1 V1 = P2 V2
V1 / V2 = T1 / T2
P1 / P2 = T1 / T2
Diffusion
coefficient
71
123
55
14
5080
45
(T constant)
(P constant)
(V constant)
Ideal gas law:

P V = n R T
Dissolved gas in fluid proportional to Tp.
n = number of mol
R = Gas constant (8.31 J/K/mol)
Partial pressures equation P= P1+P2+P3
Henrys law: p = HenryCoefficient Conc.
Dissolved gas in fluid proportional to partial pressure
Valence
Salts
Potassium
Magnesium
Calcium
Sodium
Chloride
Molarmass
g / mol
+
K
Mg++
Ca++
Na+
Cl-
1
2
2
1
1
39.1
24.3
40.1
23.0
35.5
Osmolarity:
pH:
Potassium-Chloride
Sodium-Chloride
Water
Hemoglobin
Albumin
Plasma
mmol/L
Intracellular
mmol/L
Ringer
lactate
mmol/L
Ringer
Acetate
mmol/L
CPL: St.
Thomas
mmol/L
4
2
2.5
142
104
155
13
0
10
5
4
0
1.5
130
109
4
1
2
147
156
20
16
3.2
147
305
0
0
0
154
154
295
7.4
300
7.3
270
6.5
270
6.0
390
5.0
308
3.5-6.0
-atomweight
KCl
NaCl
H2O
Hgb
Alb
74.6
58.5
18.0
64500
69000
HAES
mmol/L
Hemoglobin, 1 g/dl = 0.621 mmol/L
1 mmol/L = 1.61 g/dl

9
Molar Mass (Mw: Molecular weight) in g/mol

Mol/g = 1/ molar mass
1000/Mw
Example:
1000/39.1
1g K = 25.6 mmol
+
KCl (39.1+35.5= 74.6)
1g KCl = 13.4 mmol K + 13.4 mmol ClNormal Saline: 9g NaCl pr. liter = 154 mmol/L
2013
Peter Fast Nielsen.
peterfast@city.dk
(osmolarity: 308 mmol/L)

27
meq /liter = Mass(mg) Valence / 10 / Molarmass

2013
Peter Fast Nielsen.
peterfast@city.dk
28
Biochemistry
ARTERIAL BLOOD GASES
- normal values in human blood

Comments
PaO2
PaCO2
P
pH
P
H+
P
HCO3
P
SBEc
P
Base Excess
Hb S02
Reference intervals - in SI
units
9.6 - 14.4 kPa
4.6 - 6.0 kPa
7.36 - 7.45
35 - 45 nmol/L
22 - 26 mmol/L
21 - 27 mmol/L
2 to +3 mmol/L
95 - 99%
METABOLISM
P
Glucose
P
Lactate
P
Creatinine (adult-male)
P
Creatinine (adult-female)
P
Creatinine (neonatal)
5.0 - 8.0 mmol/L

0.5 2.5 mmol/L
60 105 mol/L
45 90 mol/L
14 34 mol/L
Alternative:72-137 mg/dL
HEMATOLOGY
B
Hematocrit (Hct) - Male
B
Hematocrit (Hct) - Female
B
Hematocrit (Hct) - Neonatal
B
Hemoglobin (Hgb) - Male
B
Hemoglobin (Hgb) - Female
B
Hemoglobin (Hgb) - Neonatal
P
Plasma-Hgb
B
White Blood Cell Count (WBC)
B
Platelet Count (Plt)
40 - 50%
35 - 46%
38 - 70%
8.3 - 10.5 mmol/L
7.3 - 9.5 mmol/L
9.0 - 14 mmol/L
< 3mol/L
4.1-10.9 x103/L
145 - 380 x103/L
COAGULATION
P
Prothrombin Time (PT)
B
B-APTT
P
P-APTT
P
Fibrinogen
P
D-dimer
P
AntiThrombin (AT3)
B
ACT. Activated Clotting Time
P
INR
(PT-INR)
12 - 14 seconds
63 - 88 seconds
25 - 38 seconds
5.0 - 12.0 mol/L
<0.5 mg/L
0.8 - 1.3 units/L
84 139 sec (110-130)
1.0
ELECTROLYTES
P
Potassium (K)
P
Sodium (Na)
P
Calcium Total (Ca)
P
Calcium ionized
P
Magnesium (Mg)
P
Albumin
3.5 4.4 mmol/L

137 - 145 mmol/L
2.20 - 2.55 mmol/L
1.18 - 1.32 mmol/L
0.7 - 1.1 mmol/L
36 - 45 g/L
P
P

2013
Peter Fast Nielsen.
peterfast@city.dk
Alternative:72108 mmHg
Alternative:3545 mmHg
Dialysis if more than 300

Dialysis if more than 300
Alternative:13.2-16.2 gm/dL
Alternative:12.0-15.2 gm/dL
free-hemoglobin
Full-blood APTT
Plasma equivalent APTT
Alternative:170-420 mg/dL
Fibrin D-dimer
Std. Celite
Therapeutic: 2.5-3.5
8.9-10.4 mg/dl
29
Coagulation
Coagulation cascade:
Anticoagulation
Heparin - unfractioned
Heparin - low molecular
Novastan/Argatroban
Warfarin
Target factors
II X
II - X
IIa
II,VII, IX, X
Half life
- 2 h.
2 - 4 h.
Approx. 1 h.
20-60 h.
spec
Coagulation tests:
ACT
WB
APTT (activated partial thromboplastin time)
WB
APTT (activated partial thromboplastin time)
P
PT (prothrombin time)
P
(see also biochemistry, page 21)
Antidot
Protamine sulphate
Protamine sulphate
None
F.II (Konakion)or FFP
Mol.weight
3.000-40.000 Da
4.000 - 6.500 Da
Typical Activator
Normal value
Pathway tested
Celite
Kaolin
Kaolin
Innovin
< 140 sec

63 - 88 sec
25 - 38 sec
12 - 14 sec
Intrinsic +common
Intrinsic +common
Intrinsic +common
Extrinsic+common
ThromboElastoMetry (TEM):
Types
INTEM
HEPTEM
EXTEM
FIBTEM
Activator
Contact activation
Contact activation
Tissue factor
Tissue factor
Measurement parameters
CT (Clotting time):
CFT (Clot Formation Time)
(angle)
MCF (Maximum clot firmness)
A 10, A5, A15 or A20.

2013
Description
Clot formation and fibrinolysis. Influenced by heparin
An INTEM with heparinase. Testing clot as if no Heparin
Clot formation and fibrinolysis. Less influenced by heparin
An EXTEM without platelets. Testing fibrin part of clot
Description
Time from start until the clot starts to form
Time until a clot firmness of 20mm
Angle of tangent. Clot speed
Greatest vertical amplitude. Strength of clot
The clot amplitude after a given time
Peter Fast Nielsen.
peterfast@city.dk
Pathway
Intrinsic
Intrinsic
Extrinsic
Extrinsic
Normal INTEM values
100 240 s
30 110 s
70 - 83 o
50 72 mm
44 66 mm
30
Hypothermia
Metabolism, flow on CPB and maximum time for circulatory arrest, - vs Temperature
These are just rough guidelines, since there is no general agreement on rules
Temperature (oC)
37
32
28
20
18
10
Metabolism
100 %
61 %
41 %
18 %
15 %
7%
Min. Flow/BSA
2.4
2.0
1.6
1.0
0.9
0.6
Max. Arrest
2 min
5 min
10 min
30 min
35 min
60 min
Alpha-stat vs pH-stat
Hypothermia will increase CO2 and O2 plasma solubility. Therefore PCO2 and PO2 will decrease with
hypothermia. PO2 is always kept normal at measured at warm sample.
PCO2 management has two different strategies, to handle the decreasing PCO2 with hypothermia:
Principe:
Perfusion goal:
On cold sample:
On warm sample:
CO2 adjusted from
Blood gases at:
Comparison:
ALPHA STAT:
CONSTANT total CO2 content
(actually low PCO2)
Alcalosis
Normal pH
37oC (warmed, or corrected to)
More CO2 removed
High gas ventilation
pH STAT:
CONSTANT pH (at actual tp)
(actually high total CO2 content
Normal pH
Acidosis
Measured at (or corrected to)
patient/actual temperature.
Less CO2 removed
Low gas ventilation
CO2 normally need to be added
Example:
SAMPLE
Normothermia
Hypothermia

2013
ALPHA STAT:
Warm - 37oC
pH = 7.40
PCO2 = 5.3
pH = 7.40
PCO2 = 5.3
Actual tp.
(temp.corrected)
pH = 7.40
PCO2 = 5.3
pH = 7.65
PCO2 = 2.6
Peter Fast Nielsen.
peterfast@city.dk
pH STAT:
Warm - 37oC
pH = 7.40
PCO2 = 5.3
pH = 7.18
PCO2 = 10
Actual tp.
(temp.corrected)
pH = 7.40
PCO2 = 5.3
pH = 7.40
PCO2 = 5,3
31
Cardioplegia
Dose:
Adult: 1000 ml initial + 300 ml subsequently
Pediatrics: BW < 15kg: 30ml/kg. BW: 15-30kg: 25ml/kg.
BW >30kg: 20 ml/kg
Flow:
Initial dose often given over 3 minutes, or:
Adult antegrade cardioplegia flow: 10ml/kg/min, or 7-8% of EBF
- half flow in retrograde and ostia
Blood Cardioplegia:
Guideline for pressure and flow are protocol and hardware dependent. Pressure for cpl in pediatrics
should be less than stated in this scheme. Approx. half pressure-limits in neonates.
Pressures and Flow:

for adults
Delivery
Antegrade -aortic
Retrograde-sinus
cor.
Coronary-graft
dir.right coronary
dir.left coronary
FLOW
(liter/min)
Ratio
Initial/maintenance
Maintenance:
Continuous
Semi-continuous
Maintenance:
Maintenance
Maintenance
1:4
1:4 - 1:8
1:15 1:20
1:10 1:15
1:8
1:8
1:8
min
0.20
0.08
0.05
ideal
0.40
0.12
0.08
0.10
0.05
0.08
0.10
PRESS
(mmHg)
max
0.45
0.20
0.12
0.10
0.15
0.20
min
100
ideal
200
max
250
25*
35*
45*
50
100
100
150
120
180
* meas. at distal end
Delivered Potassium in Blood Cardioplegia (St.Thomas/Harefield type)
In blood cpl
With 80 mmol K
In concentrate
Ratio can be reduced

From 4:1 down to 8:1
- or even 16:1

2013
Ratio
1:1
2:1
3:1
4:1
5:1
6:1
7:1
8:1
9:1
10:1
11:1
12:1
13:1
14:1
15:1
16:1
17:1
18:1
19:1
20:1
Peter Fast Nielsen.
Delivered K
44.0
30.7
24.0
20.0
17.3
15.4
14.0
12.9
12.0
11.3
10.7
10.2
9.7
9.3
9.0
8.7
8.4
8.2
8.0
7.8
peterfast@city.dk
32
Cardioplegia solutions - examples

Delivered amount after mixing blood and concentrate
HTK
II
Hare
field
Miniplegia
Ex1
Ex.2
Ex.3
Ex.4
Celcior
Bretschneider
Custodiol
80%
99%
80%
80%
80%
80%
K+
20
16
20
20
27
18
20
16
15
10
mmol/
L
Na+
147
110
143
140
138
140
100
15
mmol/
L
Mg++
16
16
17.6
5.1
1.6
16
13
mmol/
L
++
2.3
1.2
2.4
2.5
0.26
mmol/
L
Cl-
205
163
127
49
42
50
mmol/
L
NaHCO3
10
()
Procain
optional
0.6
0.5
Adeno.
sin
Tham
Glucose
monoh.
Glutamat
Lactabionat
Mannitol
Glutathion
Histidine
Tryptophan
Ketoglutarate
St.Thom
St.Thom
I
Blood
Ca
extra
KCl
mg
6.252
NaCl
8.600
MgCl2
16.262
CaCl2
Procain-HCl
330
1.364
per liter:
HAREFIELD solution
Harefield
+
K
+
Na
++
Mg
++
Ca
Cl
NaHCO3
Procain
SUM (osmolarity)

2013
konc.
per liter
84
147
80
2.25
396
0
5
718
Peter Fast Nielsen.
BLOOD
pr.liter
4
142
2
2.5
104
255
peterfast@city.dk
mmol/
L
mmol/
L
1:4
1:8
cardioplegia cardioplegia
delivered/L
delivered/L
20.0
12.9
143.0
142.6
17.6
10.7
2.4
2.4
163.2
136.9
0.0
0.0
1.0
0.6
346
305
33
Cardioplegia and MUF setup

Cpl. and MUF combined.
CPL delivery:
Changeover to MUF:

2013
Peter Fast Nielsen.
peterfast@city.dk
34
Perfusion in Animal Lab

Estimated Flow for Pigs:
Target Values:
pO2:
20 - 25 kPa
pCO2:
3.5 - 4.5 kPa
pH:
7.45 - 7.55
SvO2
> 65%
Lactate
< 5 mmol/L
MAP:
40 - 80 mmHg
Hct
> 0.22
ACT during ECC: > 800 sec.
PRIME for:
Additional Fluids:
Kg.
L/min
Kg
L/min
1
2
3
4
5
6
7
8
9
10
0.3
0.5
0.6
0.8
0.9
1.0
1.1
1.2
1.3
1.4
15
20
25
30
40
50
60
70
80
90
1.9
2.2
2.6
2.9
3.5
4.0
4.5
5.0
5.3
5.5
Adult Pigs, non survivor

500 ml Rheomacrodex
800 ml RingerLactat
Rheomacrodex
Sterile and Piglets

Ringer/macrodex, Donorblood
Blod/Macrodex
MEDICATION:
Before CPB:
(to the animal)
In Prime:
PN during CPB:
At weaning:
After CPB:
2013
Drug
Heparin
Solu-Medrol
Konc /ml.
Heparin
Solu-Medrol
NaHCO3
Furix
Mannitol:
5000 ie
Heparin
NaHCO3
Furix
Mannitol
Esmeron
5000 ie
CaCl
Protamin
0.5 mmol
5000 ie
62.5 mg
62.5mg
Pigs > 55 kg
10 ml.
8 ml.
Piglets < 55 kg
0.15 ml / kg.
0.2 ml / kg. Max. 8 ml.
1.5 ml.
8 ml.
1 ml. pr. liter prime

0.2 ml / kg. Max. 8 ml.
3 ml. pr. 100 ml. donorblood
0.1 ml / kg. Max. 2 ml.
3.3 ml / kg. Max. 150 ml.
1 mmol
- as ->
10 mg
150 mg
1 mmol
10 mg
150 mg
10 mg
10 mg
Peter Fast Nielsen.
2 ml.
100 ml.
2 ml.
150 ml.
10 ml.
0.04 ml / kg.
0.3 ml / kg / neg.BE.
0.04 ml / kg.
1.5 ml / kg.
0.2 ml / kg.
5 ml.
25 ml.
0.1 ml / kg.
0.5 ml / kg.
peterfast@city.dk
35
Electricity
Electric current:
The following laws describe the relationship between voltage, current, resistance and power in an
electric circuit.
Ohms law:
V=RI
V = voltage. Unit: V (volt). The difference in electrical potential between two points in a circuit.
I = current. Unit: A (ampere). flows from neg. to pos. on the surface of a conductor.
R = resistance. Unit: (ohm). Determines how much current will flow through a component.
Watts law
P=VI
P = power (Watt): the rate at which electric energy is transferred by an electric circuit (e.g. heat).
Ohms law and Watts law can be combined

to form Joules Law, and other combinations,
- as illustrated:
Joules law:
P = V2 / R
Frequency:
Frequency (f) is the number of occurrences of a repeating event per unit time. The unit of f is the
hertz (Hz). 1 Hz means that an event is repeated once per second. The period (T) is the length of time
of one cycle. The relationship between T and f is: T = 1/f
Alternating current (AC) and direct current (DC) :
AC is a type of electric current in which the direction of the flow of electrons switches back and forth
at regular intervals or cycles. Voltage is stated as mean value. 220 V gives a maximum voltage of
308V. AC is the standard current used in Europe and most other parts of the world, with a frequency
of 50 Hz, U.S. is 60 Hz.
DC is electric current which flows consistently in one direction. (e.g. Battery)
Three-phase High Voltage
Carry more power, and allows for bigger fuses.
5-pin connector: 0-F-J-F-F. 0 is neutral. F is Fase. J is Ground. 0 to F gives 220V. F to F gives 380 V.

2013
Peter Fast Nielsen.
peterfast@city.dk
36
Electrical Safety
Injuries received from electric current are dependent on the magnitude of the current, the pathway
that it takes through the body, the frequency and the time of its flow.
Leakage current:
Electrical devices are enclosed in non-conducting insulation. If the insulation deteriorates or breaks
down, current will leak through the insulation barrier and flow to earth, through the protective earth
conductor or through a person. Medical equipment is fitted with a number of protective devices to
protect the patient and operator from harmful leakage currents.
Safety standards and CE-marking
Medical equipment is designed and manufactured to comply with safety standards, namely IEC
60601-1-X, known as collateral standards. CE-marking is a legal requirement, and states that the
product satisfies the legislative requirements (e.g. level of safety).
Safety classes and -types
Class 1
Class 2
Type B (Body)
Type BF (Body Floating)
Type CF (Cardiac Floating)
Electric shock protection is achieved by basic insulation and protective earth.

All conductive parts which could assume hazardous voltages in the event of
failure of basic insulation must be connected to a valid protective earth.
There is no provision for protective grounding, and electric shock protection is
by double insulation or reinforced insulation.
Non-patient equipment, or equipment with grounded patient connection.
Equipment with a floating patient connection (no grounding)
Equipment with a floating connection for direct cardiac application (no
grounding)
Medical equipment needs to be safety tested, which is done by the local dept. of clinical/biomedical
eng., to provide some degree of assurance. Once tested, equipment has a safety test label attached.
Typically used symbols

for safety test labels:
Earth reference point is intended to minimize any voltage difference between earthed parts of
equipment and any other exposed metal in the room. This reduces the possibility of leakage currents
that can cause micro electrocution in patents with contact to multiple items of equipment.
2013
Peter Fast Nielsen.
peterfast@city.dk
37
Statistics -
Basic definitions and equations
Null Hypothesis(H0): The hypothesis that we try to reject with a statistical test, typically formulated
as two being equal, i.e. that there is no difference. Statistically the mean difference is zero.
Type I error: The null hypothesis is falsely rejected although it was actually true.
We are observing a difference when in truth there is none
Type II error: The null hypothesis is falsely not rejected (it is accepted) although it actually was false.
Failing to observe a difference when in truth there is one
P-value: The probability of getting a value of the test statistic as extreme as, or even more extreme,
than that observed by chance alone, when the null hypothesis H0 is true. Normally p < 0,05 is defined
as significance level.
A t-test is any statistical test in which the test statistic follows a Student's t distribution (normal /
central) when the null hypothesis is true (i.e. under the null)
An F-test is any statistical test in which the test statistic has an F-distribution (noncentral) when the
null hypothesis is true
ANOVA (ANalysis Of Variance) are statistical tests of whether or not the means of several groups are
all equal, and therefore generalizes t-tests or f-tests to more than two groups.
Normal distribution and probability ranges

corresponding to multipla of standard deviations
around its mean value.
Median: The middle value of a data set arranged in numerical order. In an even numbered data set
the mean of the two middle values.
Power: The power is the test's ability to reject the null hypothesis when it is actually false - that is,
not make a type II error. It is the probability of finding significance. Should be >0.8
OBS. The use of the following equations are limited to certain types of samples and tests.
2
(x x )
2
Variance: V or s =
(mean of sample differences to mean value)
n
1
(x x) 2
Standard Deviation (SD or or s):
=
( 2 SD contains 95% of data)
V
n
SD
Standard Error of a single mean: SEM =
(SD of the sample mean relative to the true mean
n
Confidence Interval (CI):
1,96 SEM
- for 95% CI
Bland-Altman Plot: The mean of the two measurements as the abscissa (x-axis) value, and the
difference between the two values as the ordinate (y-axis) value.

2013
Peter Fast Nielsen.
peterfast@city.dk
38
Pre-Bypass Checklist
This is a modification of the EBCP Checklist, some items added (ex Cardioplegia), - some removed
It is recommended to limit the number of items to the most necessary. Some items are not relevant for all
PATIENT DATA:
. Height and weight
Hct, Crea, Stenosis, ect.
SAFETY & ALARMS:

and tested
STERILITY:
HEART-LUNG MACHINE:
OXYGENATOR:
-up normal
-up power
-escape open
HEATER-COOLER:
DEBUBBLING:
Tubing, oxygenator, ect
GAS SUPPLY:
CARDIOPLEGIA:
r shut off
- done and shut
-line open
-line closed
PUMP:
ACCESSORIES:
s
TUBING:
ANTICOAGULATION:
-way valves / direction correct
MONITORING:
Signature: ..........................................
-line sensors calibrated

2013
Peter Fast Nielsen.
peterfast@city.dk
39
CPB phrases
Typical, although not uniformly accepted, phrases and commands in Scandinavia, between surgeons
and perfusionists. Phrases and commands will vary from institution to institution.
ENGLISH
DANISH
NORWEGIAN
SWEDISH
High flow
Devide the lines
Check the vent
Cardiotomy suction on
Fully heparinized
Slowly forward
Go on Bypass
Pump is on
Up in flow
Full flow
Cooling to ...
Flush cardioplegia
Down in flow
Hurtigt p slangerne
Dele slanger
Tjek venten
Maskinsug krer
Fuld hepariniseret
Langsomt frem
Start maskinen
Maskinen startet
Op I flow
Fuld flow
Kle til ...
Frem p kardioplegien
Ned I flow
Dele slanger
Sjekk vent
Maskinsug gr
Full heparinisert
Kjr langsomt frem
G p maskin
Full maskin
Opp i flow
Full flow
Kjler til ...
Kjr frem cardioplegi
Ned i flow
Hga Flden
Dela slangerna
Kolla venten
Maskinsug gr
Full heparinisered
Sagta frem
Starta maskin
Maskinen gr
Upp i flde
Fulla flde
Kyl till ...
Flusha plegin
Ner i flda
Cross clamp is on
Give cardioplegia
Cardioplegia running
Cardioplegia given
--min since cardioplegia:
Rewarming
Poor venous return
Reduced flow
Air in venous line
Air lock
High line pressure
Tang p
Giv cardioplegi
Kardioplegien krer
Kardioplegi givet
--min siden kardioplegi
Varme
Drligt tilbagelb
Nedsat flow
Luft p venesiden
Air lock
Hjt tryk (art)
Tang p
Kjr cardioplegi
Cardioplegien gr
Cardioplegien str
Min siden cardioplegi
Start varming
Drlig retur
Redusert flow
Luft p venen
Luftls
Hyt arterietrykk
Tng p
Ge kardioplegi
Kardioplegin gr
Kardioplegin str
--min sedan plegi
Vrm
Drliga terflden
Snkta flden
Luft p venesidan
Luft block
Hga tryck
Fill the heart

Venous line clamped
Off Bypass
Say again
Fylder/ stase
Venesiden lukket
Pumpen standset
Gentag
Tm maskinen
Fyll opp hjertet

Venen er klemt
Maskinen str
Gjenta
Fyll upp
Venen stngd
Maskinen str
Upprepa

2013
Peter Fast Nielsen.
peterfast@city.dk
40
Abbreviations in perfusion
Perfusion Techniques:
ACP
Antregrade Cerebral Perfusion
ALF
Arterial Line Filter
ANH
Acute Normovolemic Hemodilution
BSA
Body Surface Area
BVAD
Bi-Ventricular Assist Device (BiVAD)
CAVH
Continuous Arterial-Venous Hemofiltration
CPB
CardioPulmonary Bypass
CPS
CardioPulmonary Support
DHCA
Deep Hypothermic Circulatory Arrest
EBF
Estimated Blood Flow
EBV
ECBP / ECBS
Emergency CardioPulmonary Bypass / Support
ECC
ExtraCorporeal Circulation
ECCO(2)R
ExtraCorporeal CO2 Removal
ECHLA
ExtraCorporeal Heart-Lung Assist
ECLA
ExtraCorporeal Lung assist
ECLS / ELS
ExtraCorporeal Life Support (System)
ECMO
ExtraCorporeal Membrane Oxygenation
ECPR
Extracorporeal CardioPulmonary Resuscitation
HCU
Heater Cooler Unit
HE
Heat-Exchanger
HLM
Heart-Lung Machine
HLS
Heart-Lung Support
IABP
Intra Aortic Balloon Pump
ILA
Interventional Lung Assist
ILP
Isolated Limb Perfusion
LHBP
Left Heart By-Pass
LVAD
Left Ventricular Assist Device
MCS
Mechanical Circulatory Support
MECC
Minimized Extracorporeal Circulation
MUF
Modified Ultra Filtration
PALP
Pump Assisted Lung Perfusion
PBUF
Pre Bypass Ultra Filtration (or Post-)
PCCS
Post Cardiotomy Circulatory Support
PECLA
Pumpless ExtraCorporeal Lung assist
RAP
Retrograde Autologous Prime
RCP Regional Cerebral Perfusion (- or Retrograde..)
RHBP
Right Heart By-Pass
RLFP
Regional Low Flow Perfusion
RVAD
Right Ventricular Assist Device
TAH
Totally Artificial Heart
UF
Ultra Filtration
VAD
Ventricular Assist Device
VAP
Venous Antegrade Prime
VAVD
Vacuum Assisted Venous Drainage
VRP
Venous Retrograde Prime
Z-BUF
Zero Balance UltraFiltration
2013
Peter Fast Nielsen.
peterfast@city.dk
41
Abbreviations in Cardio-Thoracic Disease

- Treatment and Science
ABG
ACT
AI
AMI:
AP
APTT
ARDS
ARF
AS
AVR
CABG
CHD
CI
CNS
CO
COL
COP
CPR
CRRT
CVVHD
CVP
CX
DIC
DM
DVT
ECHO
EF
FFP
GME
GUCH
HA
HD
HES
HF
HIT(T)
HITS
HMS
HTA
Arterial Blood Gas

Activated Clotting Time
Aortic Insufficiency
Acute Myocardial Infarction
Angina Pectoris
Activated Partial Thromboplastin Time
Adult Respiratory Distress Syndrome
Adult Respiratory Failure
Aortic Stenosis - Stenosis valvulae aortae
Aortic Valve Replacement
Coronary Artery Bypass Grafting
Coronary Heart Disease
See also pages:
Cardiac index
Cardiovascular anatomy
Central Nervous system
Physiology - Cardiovacular system
Cardiac Output
Biochemestry
Chronic Obstructive Lung Disease
Colloidal Osmotic Pressure
CardioPulmonary Resuscitation
Continuous Renal Replacement Therapy
Continuous Veno-Venous Hemo-Dialyses
Central Venous Pressure
Arteria Circumflex coronary artery
Disseminated intravascular coagulopathy
Diabetes Mellitus
Deep Venous Thrombosis
Echocardiogram
Ejection Fraction
Fresh Frozen Plasma
Gaseous Micro-Emboli
Grown-Ups with Congenital Heart disease
Human Albumin
Hemo-Dialysis
Hydroxy-Ethyl-Starch
Hemo-Filtration
Heparin-Induced Thrombocytopenia
High Intensity Transient Signal (microbubbles)
Hemostasis Management System
HyperTensio Arterialis
- cont.next page .

2013
Peter Fast Nielsen.
peterfast@city.dk
42
Abbrevations, - cont.
HTX
ICU
IDDM
IVC
LA
LAD
LCA
LIMA
LM
LOP
LV
MAP
MI
MIDCAB
MOF
MR(I)
MS
MVR
NIRS
OPCAB
PCI
PI
PRBC
PVR
PS
PTEA
PTCA
RA
RIMA
RM
RV
SIRS
SVC
SVR
STEMI
TAVI
TEE
TEG
Heart Transplant
Intensive Care Unit
Insulin Dependent Diabetes Mellitus
Inferior Vena Cava
Left Atrium
Left Anterior Descending Coronary Artery
Left Coronary Artery
Left internal mammary artery
left Main Coronary Artery
Low Output Syndrome
Left Ventricle
Mean Arterial Pressure
Mitral insufficiency
Minimally Invasive Coronary Artery Bypass
Multi Organ Failure
Magnetic Resonance (Imaging)
Mitral Stenosis
Mitral Valve Replacement
Near-Infrared SpectroScopy
Off Pump Coronary Artery Bypass
Percutaneous Coronary Intervention
Pulmonary Insufficiency
Packed Red Blood Cells
Pulmonary Vascular Resistance
Pulmonary Stenosis - Stenosis valvulae pulmonalis
Pulmonary Thromb-End-Arterectomy
Percutaneous Transluminal Aoronary Angioplasty
Right Atrium
Right internal mammary artery
Right Main Coronary Artery
Right Ventricle
Systemic Inflammatory Response Syndrome
Superior Vena Cava
Systemic Vascular Resistance
ST-Segment Elevation Myocardial Infarction
Transcatheter Aortic Valve Implantation
Trans Esophageal Echocardiography
Thrombo Elasto Graphy

2013
Peter Fast Nielsen.
peterfast@city.dk
43
Abbreviations in Congenital Heart Disease
ALCAPA
APW
ASD
AVSD
CCTGA
COA
DILV
DOLV
DORV
HLHS
IAA
LVOTO
MAPCA
PATR
PAPVD
PCPC
PDA
PFO
RVOTO
TA/TATR
TAPVD
TCPC
TGA
TOF
T.Art
TRUNC
TS
VSD
UVH
Abnormal Left Coronary Artery from the Pulmonary Artery

Aorto-Pulmonary Window
Atrial Septal Defect - Defectus septi atriorum
Atrio-Ventricular Septal Defect - (Atrio-ventricularis communis)
Congenital Corrected Transposition of the Great Arteries
Coarctation of the Aorta (Coarctatio Aortae)
Double Inlet Left Ventricle
Double Outlet Left Ventricle
Double Outlet Right Ventricle
Hypoplastic Left Heart Syndrome
Interrupted Aortic Arch
Left Ventricular Outflow Tract Obstruction (valvular or subvalvular aortic stenosis)
Major Aortico Pulmonary Collateral Arteries
Pulmonary Atresia - (atresia arteria pulmonalis)
Partially Abnormal Drainage of the Pulmonary Veins
Partial Cavo Pulmonary Connection
Patent Ductus Arteriosus - (Ductus arteriosus persistens)
Patent Foramen Ovale
Right Ventricular Outflow Tract Obstruction ((sub)valvular pulmonary stenosis)
Tricuspid Atresia - (atresia valvula tricuspidalis)
Totally Abnormal Drainage of the Pulmonary Veins
Total Cavo-Pulmonary Connection
Transposition of the Great arteries (transpositio vasorum)
Tetralogy Of Fallot - (Tetralogia Steno-Fallot)
Tricuspidal Atresia
Truncus Arteriosus
Tricuspidal Stenosis
Ventricular Septal Defect - (Defectus septi ventriculorum)
UniVentricular Heart - (cor univentriculare)

2013
Peter Fast Nielsen.
peterfast@city.dk
44
Perfusion Bibliography
Books:
Cardiopulmonary Bypass. Gravlee, Davis, Stammers, Ungeleider. Williams & Wilkins, 2008
Cardiopulmonary Bypass. Ghosh. Cambridge Clinical Guides, 2009
ECMO Specialist Training Manual Third Edition. ELSO. 2010
ECMO: Extracorporeal Cardiopulmonary Support in Critical Care Third Edition. ELSO
Mechanical Circulatory Support. Richenbacher 1999)
Extracorporeal Life Support (ECMO). Dan M. Meyer. 2001
Techniques in Extracorporeal Circulation 4d. Philip H. Kay and Christopher. Munsch. 2004
The manual of clinical Perfusion, 2d. Brown, Licht. Perfusion.com. 2004
On Bypass: Advanced Perfusion Techniques. Mongero, Beck. Humania Press. 2008
Most Books available at: http://www.perfusion.com/cgi-bin/productcart/pc
Journals:
Perfusion Journal, UK.
The Journal of Extracorporeal Technology, USA
European Journal of Cardio-Thoracic Surgery. GE
Journal of Cardiovascular Surgery, USA
Cardiovascular Engineering. NL.
http://prf.sagepub.com/
http://www.ject.org/
http://ejcts.ctsnetjournals.org/
http://jtcs.ctsnetjournals.org/
http://www.springerlink.com/content/106592/
Websites:
Perflist
Perfusion Line
The CardioThoracic Surgery Network
The Perfusion home page
www.amsect.org/sections/perftopics/perflist/
http://perfline.com
http://www.ctsnet.org
http://www.perfusion.com/
Cardiac Surgery in the adult (webbook)

The Virtual Textbook of Extracorporeal Technology
http://cardiacsurgery.ctsnetbooks.org/?ck=nck
www.perfline.com/textbook/textbook.html
Industry
Dideco/Sorin /Stckert/Cobe
Edwards
Eurosets / Krauth
Maquet/Jostra/Datascope
Medtronic
Terumo
Vingmed
http://www.dideco.com
http://www.edwards.com/
http://www.eurosets.it/
http://www.maquet.com/
http://www.medtronic.com/
http://www.terumo-cvs.com/
http://www.vingmed.se/

2013
Peter Fast Nielsen.
peterfast@city.dk
45
Organizations and meetings

Meeting time:
AACP
American Academy of Cardiovascular Perfusion

www.theAACP.com
ABCP
American Board of Cardiovascular Perfusion

http://www.abcp.org/
AMSECT
American Society of ExtraCorporeal Technology

http://www.amsect.org/
Ultimo January
Mid September
DANSECT
Danish Society of ExtraCorporeal Technology

http://www.dansect.dk
Mid March
EACTA
European Association of Cardiothoracic Anesthesiologists

http://www.eacta.org/
Ultimo May
EACTS
European Society for Cardiovascular Surgery

http://www.eacts.org/
Primo October
EBCP
European Board of Cardiovascular Perfusion

http://www.ebcp.org/
Primo October
ELSO
Extracorporeal Life Support Organization

http://www.elsonet.org/
FECECT
Foundation European Congress on Extracorporeal Circulation Technology

http://www.fecect.org/
Mid June, every two years
ICEBP
International Consortium for Evidence-Based Perfusion

http://www.bestpracticeperfusion.org/
NORSECT
SATS
SCANSECT
SWESECT
Primo May (Europe)
Primo October
Norwegian Society of ExtraCorporeal Technology

www.norsect.net
Mid January
Scandinavian Society for Cardiovascular Surgery

http://www.scandinavian-ats.org/
Mid August
Scandinavian Society of ExtraCorporeal Technology

http://www.scansect.org/
Mid August
Swedish Society of ExtraCorporeal Technology

www.swesect.se
CCP
ECCP

2013
Primo February
Certified Clinical Perfusionist

European Certified Clinical Perfusionist
Peter Fast Nielsen.
peterfast@city.dk
46
Perfusion departments in Scandinavia

NORWAY
Oslo - RH
Oslo Univ.sh. Rikshospitalet
Oslo - Ullevl
Ullevl Sykehus
Feiring
Feiring klinikken
Trondheim
St.Olavs Hospital
Bergen
HaukelandUniversitetssykehus
Troms
Univ.sykehuset Nordnorge
DENMARK
Kbenhavn
Rigshospitalet
Odense
Odense Universitets Hospital
Varde
Hjertecenter Varde
Aarhus
Aarhus Univ.Hosp. Skejby
Aalborg
Aalborg Sygehus Syd
SWEDEN
Gteborg
Sahlgrenska Univ.sjukhuset
Lund
Universitetssjukhuset i Lund
Karlskrona
Blekingesjukhuset
Stockholm
Karolinska Sjukhuset
Linkping
UniversitetsSH Linkping
rebro
Regionssjukhuset rebro
Ume
Norrlands Universitetssjukhus
Uppsala
Akademiska Sjukhuset
ICELAND
Reykjavik
Landspitali University Hospital

2013
Adress
Thoraxkir.afd. Boks 4950
N-0424 Oslo
Hjertelungesenteret. Kirkeveien 166
N-0407 Oslo
Feiringklinikken AS
N-2093 Feiring
Klinikk Thoraxkir. Prinss.Kristinesgt.30
N-7006 Trondheim
Hjerte-Th. sektion. Jonas Liesvei
N-5021 Bergen
Sykehusveien 38
N-9038 Troms
Phone and mail
Blegdamsvej 9. Afd. RT 3043

DK-2100 Kbenhavn
Sdr. Boulevard 29
DK-5000 Odense C
Hjertensvej 1
DK-6800 Varde
Brendstrupsgaardsvej. Afd.T-Perf.
DK-8200 Aarhus N.
Hobrovej 18. Postbox 365
DK-9100 Aalborg
+45 3545 3070

Casper.seidelin@regionh.dk
+45 6541 1774 ode.t.Perfusionistkontoret
Thoraxoperation/barnoperation
S-413 45 Gteborg
Thoraxklinikken
S-221 85 Lund
Thoraxklinikken
S-371 85 Karlskrona, Sverige
Solna. Thoraxklinikken. Box 110
S-171 76 Stokholm
Thoraxklinikken
S-581 85 Linkping
Thoraxklinikken
S-701 85 rebro
Thorax operation. Hjrtcentrum
S-901 85 Ume
Thoraxklinikken
S-751 85 Uppsala
+46 31 342 7732

annica.dahlin@vgregion.se
+46 4617 1664
leif.pierre@skane.se
+46 4557 35096
ulf-b.johansson@ltblekinge.se
+46 8 5177 2115
Hringbraut. Thoraxklinikken
101 Reykjavk, sland
+354 560 1000

liney@landspitali.is
Peter Fast Nielsen.
peterfast@city.dk
+47 2307 2538

mringdal@ous-hf.no
+47 2211 9669
uxcoan@ous-hf.no
+47 6392 4256
kristian.aasmundrud@feiringklinikken.no
+47 7282 6868

kjetil.sundt@stolav.no
+47 5597 2314
else.nygreen@helse-bergen.no
+47 7762 8064
Ulf.Larsen@unn.no
@ouh.regionsyddanmark.dk
+45 7695 0100

hcv@bypass.dk
+45 7845 3182
sksaftperf@rm.dk
+45 9932 1111
precon@home3.gvdnet.dk
per.srisophon-stensved@karolinska.se
+46 13 224 832

bo.carnstam@lio.se
+46 19 602 5965
jan.svensson@orebroll.se
+46 90 785 3650
soren.haggmark@vll.se
+46 18 611 4028
sten.lindgren@akademiska.se
47
The Scandinavian School of Cardiovascular

Technology
The Faculty of Health Sciences. University of Aarhus
Located at Aarhus University Hospital, Skejby
SCANSCAT
The Scandinavian School of Cardiovascular Technology
Brendstrupgaardsvej 1
DK-8200 Aarhus N
Web page:
http://www.perfusionistskolen.au.dk
Phone:
Fax:
Lecture Room 23
Wet-lab
+45 7845 3080

+45 7845 3079
+45 7845 9153
+45 7845 3078
Secretary:
Jette Breiner, T-forskning
breiner@ki.au.dk
Principal:
Hans Nygaard. Professor, DMSc. Biomed.Eng.
NYGAARD@KI.AU.DK
***********************************
Physiology and treatment
Henrik Jensen. MD, MMSc, Ph.d.
hjensen@dadlnet.dk
Biomedical technology
Morten lgaard Jensen. cand.scient.med., ph.d.
morten.jensen@ki.au.dk
Perfusion Techniques, - and Practical education

Peter Fast Nielsen. ECCP. Master of CVT.
peterfast@city.dk
************************************
Acknowledgements
I wish to thank the following contributors to this compendium: Anne Louise Bellaiche, Steven Brantlov,
Peter Johansen, Morten Jensen, Kim Houlind, Mariann Tang, representatives for the industry ...
- and more...

2013
Peter Fast Nielsen.
peterfast@city.dk

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Compendium

The Scandinavian School of Cardiovascular Technology

Peter Fast Nielsen.

SCANSCAT. Aarhus, Denmark

Symbols used in the present Compendium

Physical Atmosphere, - at sea level

Perfusion Compendium 3.6.docx

Peter Fast Nielsen.

SCANSCAT. Aarhus, Denmark

Physics for Perfusionists - Equation sheet

Equivalents and examples

Potential Energy: Epot = F h = m g h , Fg =

Kinetic Energy: Kinetic Energy density: KEd = v2 [J/m3]

v2 = constant energy/volume (along stream line)

Peter Fast Nielsen.

SCANSCAT. Aarhus, Denmark

Perfusion Compendium 3.6.docx

Damage at 100 Dynes/cm2 for platelets, 2000 for erytrocytes

Peter Fast Nielsen.

SCANSCAT. Aarhus, Denmark

Pressure units and conversions

1 Atm 1 Bar 760 mmHg 100 KPa 1000 cm H2O

(Car tire: 2 bar Bicycle tire: 4 bar)

Perfusion Compendium 3.6.docx

Peter Fast Nielsen.

SCANSCAT. Aarhus, Denmark

Fluid dynamics in tubes

Darcy-Weisbach equation, for turbulent conditions:

f: Darcy friction factor

Empiric Modification, - for transistent turbulence. Converted to clinical units:

Theoretical ~ 1.75 times pressure. Empiric: ~ 1.2 times

Perfusion Compendium 3.6.docx

Peter Fast Nielsen.

SCANSCAT. Aarhus, Denmark

Perfusion Compendium 3.6.docx

Peter Fast Nielsen.

SCANSCAT. Aarhus, Denmark

Tubing sizes and flow

Calculated flow in blood at specified pressure differences in 1 m tubing

Calculated pressure drop in blood at specified flow in 1 m tubing

Peter Fast Nielsen.

SCANSCAT. Aarhus, Denmark

Flow at turbulent transition

Terminal velocity for bubbles:

is difference in density of blood-water: 1059

Tubings and needles diameter - comparison chart

French (French-gauge) FG (= Charrire) = Diameter(mm) x 3

Perfusion Compendium 3.6.docx

Peter Fast Nielsen.

SCANSCAT. Aarhus, Denmark

Typical recommendations for sizing

(very much dependent of brand, shape and design)

Perfusion Compendium 3.6.docx

Peter Fast Nielsen.

OBS: Outer Diameter!

SCANSCAT. Aarhus, Denmark

Quick Guide - Perfusion Sheet