Extracorporeal Circulation Course

Lesson 1 • Principles of Blood-Material Interaction

Explains how blood contacts synthetic surfaces, triggering coagulation and inflammatory cascades. Establishes the rationale for anticoagulation and biocompatible circuit coatings.

Lesson 2 • Cardiovascular Anatomy for Perfusionists

Reviews cardiac chambers, great vessels, and coronary anatomy relevant to cannulation and bypass. Builds anatomical fluency required for all subsequent circuit management topics.

Lesson 3 • Physiology of Normal Circulation

Covers pressure-flow relationships, oxygen delivery, and venous return mechanisms. Provides the physiological baseline against which ECC-induced changes are measured.

Lesson 1 • Tubing, Connectors, and Reservoirs

Details tubing material properties, connector types, and venous reservoir function. Correct component matching prevents leaks and air entrainment during bypass.

Lesson 2 • Oxygenators and Heat Exchangers

Covers membrane oxygenator design, gas transfer efficiency, and integrated heat exchanger function. Proper selection ensures adequate gas exchange throughout bypass.

Lesson 3 • Pumps: Types and Operating Principles

Compares roller and centrifugal pump mechanics, flow characteristics, and failure modes. Selecting the appropriate pump type is foundational to safe circuit assembly.

Lesson 4 • Circuit Priming Techniques

Covers crystalloid, colloid, and blood prime strategies, including de-airing protocols. A correctly primed circuit is prerequisite to safe initiation of bypass.

Lesson 1 • Activated Clotting Time Monitoring

Teaches ACT measurement, target ranges, and point-of-care device operation. Continuous ACT monitoring guides heparin supplementation throughout bypass.

Lesson 2 • Protamine Reversal and Complications

Details protamine dosing calculations, administration technique, and adverse reaction management. Safe heparin reversal is essential for haemostasis after bypass.

Lesson 3 • Alternative Anticoagulants

Covers bivalirudin and other direct thrombin inhibitors for heparin-induced thrombocytopenia. Recognising HIT and switching protocols prevents life-threatening complications.

Lesson 1 • Flow, Pressure, and Temperature Management

Teaches target perfusion flow indices, mean arterial pressure goals, and temperature management strategies. Maintaining these parameters protects end-organ perfusion during bypass.

Lesson 2 • Weaning from Cardiopulmonary Bypass

Details criteria for weaning, gradual flow reduction, and de-cannulation sequence. Successful weaning requires coordinated assessment of cardiac function and volume status.

Lesson 3 • Monitoring During Bypass

Covers arterial line pressure, venous oxygen saturation, and near-infrared spectroscopy monitoring. Integrated monitoring enables early detection of perfusion inadequacy.

Lesson 4 • Cannulation Strategies and Considerations

Reviews arterial and venous cannulation sites, cannula sizing, and insertion sequence. Cannulation choice directly affects venous drainage and arterial perfusion adequacy.

Lesson 1 • Rewarming and Cardiac Resuscitation

Details controlled rewarming, defibrillation protocols, and assessment of cardiac recovery. Proper resuscitation technique minimises reperfusion injury after arrest.

Lesson 2 • Principles of Cardioplegic Arrest

Explains the electromechanical basis of cardioplegic arrest and myocardial energy conservation. Understanding arrest physiology guides selection of cardioplegia composition.

Lesson 3 • Delivery Routes and Techniques

Covers antegrade, retrograde, and combined delivery methods, including pressure and flow targets. Delivery route selection ensures uniform myocardial distribution.

Lesson 1 • Pharmacological Haemostasis Adjuncts

Reviews antifibrinolytics, desmopressin, and recombinant factor concentrates used to reduce surgical bleeding. These agents complement mechanical and transfusion-based strategies.

Lesson 2 • Transfusion Triggers and Blood Products

Defines evidence-based transfusion thresholds for red cells, platelets, FFP, and cryoprecipitate. Appropriate product selection reduces transfusion-related morbidity.

Lesson 3 • Point-of-Care Coagulation Testing

Teaches thromboelastography, rotational thromboelastometry, and platelet function analysis at the bedside. POC testing guides targeted haemostatic therapy and reduces empirical transfusion.

Lesson 4 • Cell Salvage and Autotransfusion

Covers intraoperative cell salvage device operation, washing parameters, and reinfusion criteria. Cell salvage is the primary blood conservation tool during cardiac surgery.

Lesson 1 • Massive Air Embolism

Covers causes, detection, and immediate management of massive arterial air embolism during bypass. Rapid recognition and protocol execution are critical to neurological outcome.

Lesson 2 • Haemodynamic Crises on Bypass

Covers low-flow states, vasoplegic syndrome, and hypertensive emergencies encountered during ECC. Systematic diagnosis and pharmacological intervention restore adequate perfusion.

Lesson 3 • Oxygenator Failure and Gas Exchange Crisis

Explains oxygenator clotting, plasma leakage, and emergency oxygenator change-out procedures. Timely oxygenator replacement prevents hypoxic injury during bypass.

Lesson 4 • Protamine Reactions and Anaphylaxis

Identifies protamine reaction types, severity grading, and emergency treatment algorithms. Distinguishing anaphylaxis from pulmonary vasoconstriction guides correct intervention.

Lesson 1 • Minimally Invasive and Endoscopic Bypass

Explains peripheral cannulation, endoscopic venous drainage, and vacuum-assisted venous return for minimally invasive surgery. Reduced incision approaches require modified circuit configurations.

Lesson 2 • Paediatric and Neonatal ECC

Covers size-appropriate circuit design, deep hypothermic circulatory arrest, and neonatal physiology. Paediatric ECC demands unique prime composition and flow index adjustments.

Lesson 3 • Aortic Surgery and Circulatory Arrest

Details deep hypothermic circulatory arrest, selective cerebral perfusion, and spinal cord protection strategies for aortic arch procedures. Cerebral protection is the primary goal.

Lesson 4 • Extracorporeal Membrane Oxygenation Basics

Introduces ECMO circuit configuration, veno-arterial versus veno-venous modes, and patient management principles. ECMO extends ECC concepts to prolonged cardiorespiratory support.