BoardsBridgeCABG on Cardiopulmonary Bypass (On-Pump): Anesthetic Management
On-pump CABG demands ACT-guided heparinization, antifibrinolytics, balanced general anesthesia with TEE, and vigilant separation from CPB.
CABG with cardiopulmonary bypass requires ACT-guided heparinization (>480s), antifibrinolytics, balanced general anesthesia, TEE for diagnosis and separation, and immediate management of post-CPB bleeding and low cardiac output.
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Headline: ACT >480s, antifibrinolytic, balanced anesthesia, TEE before/after CPB, careful separation
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Key numbers
- ACT >480s during CPB (most units); 250s acceptable with heparin-coated circuits (EACTS 2019)
- Aortic cannulation: lower SBP <100 mmHg; aortic dissection risk 0.06-0.23% (EACTS 2019)
- Post-CPB TEE influences surgical decision in 1.5% of CABG cases (EACTS 2019)
- KDIGO Stage 1 AKI: Cr rise ≥0.3 mg/dL within 48h or 1.5-1.9× baseline within 7 days
- Heparin 300-400 U/kg → ACT >480s; protamine 1-1.3 mg per 100 U heparin
- Ionized Ca2+ >1.1 mmol/L and K+ 4-5 mEq/L before weaning from CPB
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: EACTS EACTA EBCP CPB Fulltext 2019 · EACTS EACTA EBCP CPB Fulltext 2019 · ASA Perioperative Blood Management 2015 · ASA Perioperative Blood Management 2015
Re-review cadence: 12 months from reviewed date.
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Card ID: cabg-on-pump · Path: aba.cardiac.ischemic.cabg-on-pump