| A= Anesthesiologist; P= Perfusionist; S= Surgeon | |
| P | 1. Stop the Pump |
| S | 2. Clamp the arterial and venous lines (to isolate the patient from the circuit) |
| A | 3. Steep Trendelenburg position |
| S | 4. Make a stab wound or exit wound in the aorta |
| A | 5. Bilateral carotid compression |
| S / P | 6.Temporary retrograde perfusion |
| a. Remove the aortic cannula and purge arterial circuit of air | |
| b. Place aortic cannula in SVC | |
| c. Decrease perfusate temp to 20o C. | |
| d. Perfuse slowly 1-2 LPM until all air is expelled from the aortic stab wound. | |
| e. place aortic cannula to ascending aorta. Start CPB | |
| P | 7. Cool to a core temperature of 20-22o C. |
| S | 8. Massage the coronary arteries and vent all 4 chambers of the heart |
| P | 9. Elevate the mean arterial pressure to 65 mmHg or greater. |
| P | 10. Set Fi02 at 100% (decreases the nitrogen content between the lungs and blood) |
| P | 11, Maintain Arterial pC02's in the low 30's |
| P | 12. Maintain high blood flow rates (CI >2.6L/Min/M2) |
| A | 13. Steroids ( 2 grams Methyprednisolone +/or 20 mg. Dexamethosone) + Mannitol (25g) |
| P / A | 14. Come off bypass with arterial systolic pressure>100 mmHg and low filling pressures. |
| A / C | 15. Contact Hyperbaric Facility |
| A / C | 16. Arrange for patient Transport. |
Home-Amb-Card-Crit-Neuro-OB-Orth-Pain-Ped-Reg-Tran-Vasc-Misc