Weaning from cardio-pulmonary bypass
This simulation will cover process of weaning of a patient from cardio-pulmonary bypass. The challenges to successful weaning will be depressed myocardial contractility, hypo or hypertension, hypo or hypervolemia, hypo or hyperthermia, and arrhythmias such as myocardial fibrillation and heart block. This simulation will occur in real time.
Your task will be to rewarm the patient and normalize the blood gases and electrolytes before reperfusing the heart. After reperfusion for the appropriate time, you will then gradually reduce the venous drainage and the pump flow until the patient’s heart rate, arterial blood pressure, central venous pressure, cardiac index and temperature are within acceptable clinical levels and maintain the patient's stability after the pump has been turned off for 5 minutes.
You may treat the patient with the following interventions:
- Increase or reduce flow of the cardiopulmonary bypass pump
- Increase or reduce the venous return to the cardiotomy reservoir.
- Infusion medications
- Bolus medications
- Fluid replacement
- Warming or cooling the patient
- Cardiac pacing
- Vital signs from the patient monitor
- Visual indication of beating and filling of the heart in the sternotomy
- Fluid intake and output
- Cardiac index
You have 15 minutes of real time to accomplish the task of successfully weaning the patient from cardiopulmonary bypass.