Cardiopulmonary Bypass: Emerging Trends and Continued Practices, A. H. Stammers. Boston: Little, Brown, & Co., 1996, ISBN 0020-5907, 199 pp, $149.00.
This monograph is a compendium of 12 subject areas related to cardiopulmonary bypass and was edited by a perfusionist with contributions from industry, multiple perfusionists, surgeons, and one anesthesiologist. Additional contributions from anesthesiologists perhaps would have better balanced this review since they have made many significant contributions to all aspects of bypass management. Despite this drawback, a reasonable review of current technology and techniques related to cardiopulmonary bypass is presented.
The chapters on microprocessors and perfusion equipment, blood gas exchange devices, and performance evaluation of blood gas exchange devices are very informative. The topic of circulatory mechanics and blood propulsion is very complex and was laborious reading for this reviewer. The clinically relevant aspects were stated at the very end of the chapter and included the mechanics of positive displacement pumps and constrained vortex pumps.
The chapter on ventricular assist devices is less detailed than others, with illustrations of only one particular assist device presented. Discussion of any intraoperative management considerations relevant to the anesthesiologist is not included.
The chapter on pediatric cardiopulmonary bypass is interesting and informative. The authors review the practices of pediatric centers related through survey data obtained at two different periods in time, 1989 and 1995. The authors nicely discuss special considerations of pediatric bypass and include many of the current management controversies.
The chapter dealing with the issues of biocompatibility and heparin-coated extracorporeal circuits serve as a reasonable introduction for the anesthesiologist. However, a more detailed discussion of the actual binding process to the surface of the bypass components, perhaps including illustrations representing the manufacturing process, would have been informative.
The chapter on renal considerations, dialysis, and ultrafiltration during bypass is also a nice general review of current practices in the cardiac operating room. Both this chapter and the pediatric chapter include a discussion of postbypass modified ultrafiltration, a currently applied technique in postbypass management used especially in pediatric patients.
The explanation of the inflammatory response to cardiopulmonary bypass summarizes a complex and controversial area. Included in this discussion is a helpful flow diagram and Table tosummarize the postulated pathophysiologic effects of bypass.
Reviews on hemostasis, myocardial protection, and deep hypothermia circulatory arrest complete the contents of the monograph. Of interest is the myocardial protection paper that addresses new methods for cardioplegic delivery.
In summary, this monograph is a good, general overview and primer of current trends in bypass technology and management. Obviously, an in-depth review of the individual subjects would require more extensive and better referenced sources.
The concept of this monograph is a good one: to inform anesthesiologists of current aspects related to cardiopulmonary bypass equipment, technology, and techniques. It is this reviewer's philosophy that anesthesiologists should continue to become more involved with the technical intricacies of bypass equipment as well as with bypass management. Only in this way can we as anesthesiologists interact in an intelligent and positive fashion with our perfusion and cardiac surgery colleagues.
Frederick A. Hensley, Jr., MD
Department of Anesthesiology and Critical Care Medicine; Sinai Hospital of Baltimore; The Johns Hopkins University School of Medicine; Baltimore, MD 21215