Temperature management is an essential element of cardiopulmonary bypass (CPB), as indicated in the Guide to Good Practice in Clinical Perfusion, ‘The safe conduct of CPB requires the clinical perfusionist to measure and control. . . blood temperature. . . during the period of bypass’. To review current practice, we have conducted a research survey into the management of temperature on CPB. Surveys were distributed to each centre in Great Britain and the Republic of Ireland, investigating numerous temperature management practices, to elucidate current practice and assess if recent research into temperature management marry routine clinical practice. Our results demonstrate that nasopharyngeal temperature is the most common (52%) temperature site used across the many centres, which correlates with previous research as a routine site for cerebral temperature management. The arterial outlet of the oxygenator temperature was used in 33% of centres, however, all centres lacked the knowledge to maintain this temperature below 37°C. There was significant variation between all centres, especially regarding rewarming times (20–40 minutes), demonstrating a lack of uniformity among perfusion centres. Interestingly, most centres have been using the same protocol that has been in place over the previous 10 years.
To conclude, the practice of temperature management is changing with the awareness of new research. Lower target temperatures are recommended for rewarming, ensuring a lower temperature gradient and a longer mean rewarming time.
Guide to good practice in clinical perfusion. The Department of Health, Leeds2009.
2.
EngelmanRBakerRALikoskyDS, et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: clinical practice guidelines for cardiopulmonary bypass – temperature management during cardiopulmonary bypass. Ann Thorac Surg2015; 100: 748–757.
PawleyMDMartinsenPMitchellSJ, et al. Brachial arterial temperature as an indicator of core temperature: proof of concept and potential applications. J Extra Corpor Technol2013; 45: 86–93.
5.
GinsbergMDBustoR.Combating hyperthermia in acute stroke: a significant clinical concern. Stroke1998; 29: 529–534.
GeisslerHJAllenSJMehlhornU, et al. Cooling gradients and formation of gaseous micro emboli with cardiopulmonary bypass: an echocardiographic study. Ann Thorac Surg1997; 64: 100–104.
8.
KaukuntlaHHarringtonDBilkooI, et al. Temperature monitoring during cardiopulmonary bypass – do we undercool or overheat the brain?Eur J Cardiothorac Surg2004; 26: 580–585.
9.
WhitbyJDDunkinIJ.Cerebral, oesophageal and nasopharyngeal temperatures. Br J Anaesth1971; 43: 673–676.
10.
CrowderCMTempelhoffRTheardMA, et al. Jugular bulb temperature: comparison with brain surface and core temperatures in neurosurgical patients during mild hypothermia. J Neurosurg1996; 85: 98–103.
11.
GrocottHPNewmanMFCroughwellND, et al. Continuous jugular venous versus nasopharyngeal temperature monitoring during hypothermic cardiopulmonary bypass for cardiac surgery. J Clin Anaesth1997; 9: 312–316.
12.
NussmeierNALiSStricklerAG, et al. Temperature measurement during cardiopulmonary bypass [abstract]. Anesth Analg2002; 93: SCA35.
13.
BissonnetteBHoltbyHMDavisAJ, et al. Cerebral hyperthermia in children after cardiopulmonary bypass. Anaesthesiology2000; 93: 611–618.
14.
SatoHYamakaMOkuyamaK, et al. Urinary bladder and oesophageal temperatures correlate better in patients with high rather than low urinary flow rates during non-cardiac surgery. Eur J Anaesthesiol2008; 25: 805–809.
15.
SiegelMNGravensteinN.Passive warming of airway gases (artificial nose) improves accuracy of oesophageal temperature monitoring. J Clin Monit1990; 6: 89–92.
16.
BissonnetteBSesslerDILaFlammeP.Intraoperative temperature monitoring sites in infants and children and the effect of inspired gas warming on oesophageal temperature. Anesth Analg1989; 69: 192–196.
17.
EricksonRS.The continuing question of how best to measure body temperature. Crit Care Med1999; 27: 2307–2310.
18.
AnnadataRDSesslerDITayefehF, et al. Desflurane slightly increases the sweating threshold but produces marked nonlinear decreases in the vasoconstriction and shivering thresholds. Anaesthesiology1995; 83: 1205–1211.
19.
De WitteJSesslerDI. Perioperative shivering: physiology and pharmacology. Anaesthesiology2002; 9: 467–484.
20.
DexterFHindmanBJ.Computer simulation of brain cooling during cardiopulmonary bypass. Ann Thorac Surg1994; 57: 1171–1179.
21.
NussmeierNAChengWMarinoM, et al. Temperature during cardiopulmonary bypass: the discrepancies between monitored sites. Anaesth Analg2006; 103: 1373–1379.
22.
SalahMSuttonRTsarvoskyG, et al. Temperature inaccuracies during cardiopulmonary bypass. J Extra Corpor Technol2005; 37: 38–42.
23.
MichenfelderJDMildeJH.The relationship among canine brain temperature, metabolism, and function during hypothermia. Anaesthesiology1991; 75: 130–136.
24.
WassCTLanierWLHoferRE, et al. Temperature changes of > or = 1 degree C alter functional neurologic outcome and histopathology in a canine model of complete cerebral ischemia. Anaesthesiology1995; 83: 325–335.
25.
NussmeierNA.Management of temperature during and after cardiac surgery. Tex Heart Inst J2005; 32: 472–476.
26.
HicksSDDeFrancoDBCallawayCW.Hypothermia during reperfusion after asphyxial cardiac arrest improves functional recovery and selectively alters stress-induced protein expression. J Cereb Blood Flow Metab2000; 20: 520–530.
27.
HoKMTanJA.Benefits and risks of maintaining normothermia during cardiopulmonary bypass in adult cardiac surgery: a systematic review. Cardiovasc Ther2011; 29: 260–279.
28.
TokutomiTMiyagiTTakeuchiY, et al. Effect of 35 degrees C hypothermia on intracranial pressure and clinical outcome in patients with severe traumatic brain injury. J Trauma2009; 66: 166–173.
29.
DixonSRWhitbournRJDaeMW, et al. Induction of mild systemic hypothermia with endovascular cooling during primary percutaneous intervention for acute myocardial infarction. J Am Coll Cardiol2002; 40: 1928–1934.
30.
TiainenMMParikkaHJMMakijarviMAM, et al. Arrhythmias and heart rate variability during and after therapeutic hypothermia for cardiac arrest. Crit Care Med2009; 37: 403–409.
31.
ValeriCRFeingoldHCassidyG, et al. Hypothermia-induced reversible platelet dysfunction. Ann Surg1987; 205: 175–181.
32.
RohrerMJNataleAM.Effect of hypothermia on the coagulation cascade. Crit Care Med1992; 20: 1402–1405.
33.
SchmiedHSchifererASesslerDI, et al. The effects of red-cell scavenging, hemodilution, and active warming on allogenic blood requirements in patients undergoing hip or knee arthroplasty. Anaesth Analg1998; 86: 387–391.
34.
HogueCWJrMurphySFSchechtmanKB, et al. Risk factors for early or delayed stroke after cardiac surgery. Circulation1999; 100: 642–647.
35.
GrocottHPWhiteWDMorrisRW, et al. Perioperative genetics and safety outcomes study (PEGASUS) investigative team. Genetic polymorphisms and the risk of stroke after cardiac surgery. Stroke2005; 36: 1854–1858.
36.
GrigoreAMMurrayCFRamakrishnaH, et al. A core review of temperature regimens and neuroprotection during cardiopulmonary bypass: does rewarming rate matter?Anaesth Analg2009; 109: 1741–1751.
37.
GrigoreAMMathewJGrocottHP, et al. Prospective randomised trial of normothermic versus hypothermic cardiopulmonary bypass on cognitive function after coronary artery bypass graft surgery. Anesthesiology2001; 95: 1110–1119.
38.
TortoriciMAKochanekPMPoloyacSM.Effects of hypothermia on drug distribution, metabolism, and response: a focus of hypothermia-mediated alterations on the cytochrome P450 enzyme system. Crit Care Med2007; 35: 2196–2204.
39.
NathanHJWellsGAMunsonJL, et al. Neuroprotective effect of mild hypothermia in patients undergoing coronary artery surgery with cardiopulmonary bypass: a randomized trial. Circulation2001; 104: I85–I91.
40.
InslerSRO’ConnorMSLeventhalMJ, et al. Association between postoperative hypothermia and adverse outcome after coronary artery bypass surgery. Ann Thorac Surg2000; 70: 175–181.
41.
ShannKGLikoskyDSMurkinJM, et al. An evidence-based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycaemic control, hemodilution, and the inflammatory response. J Thorac Cardiovasc Surg2006; 132: 283–290.
42.
BarbutDHintonRBSzatrowskiTP, et al. Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke1994; 25: 2398–2402.
43.
PugsleyWKlingerLPaschalisC, et al. The impact of micro emboli during cardiopulmonary bypass on neuropsychological functioning. Stroke1994; 25: 1393–1399.
44.
Van der LindenJCasimir-AhnH. When do cerebral emboli appear during open heart operations? A transcranial Doppler study. Ann Thorac Surg1991; 51: 237–241.
45.
BarkerTADandekarUFraserN, et al. Minimising the risk of Mycobacterium chimaera infection during cardiopulmonary bypass by the removal of heater-cooler units from the operating room. Perfusion2017; 33: 264–269.
46.
GottingTKlassenSJonasD, et al. Heater-cooler units: contamination of crucial devices in cardiothoracic surgery. J Hosp Infect2016; 93: 223–228.
47.
BlakeyAKHoltDW.Improving decreased heater-cooler efficiency as a result of heater-cooler infection control strategy. J Extra Corpor Technol2019; 51: 73–77.
48.
GuoZLiX.2016 survey about temperature management during extracorporeal circulation in China. Perfusion2018; 33: 219–227.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
