Analysis of perfusion behavior in relation to the management of obese patients undergoing cardiac surgery with extracorporeal circulation. A systematic review.

Abstract

Introduction: With the increase in the population with obesity worldwide, the occurrence of cardiovascular diseases has also increased. As a result, more and more patients with obesity require cardiac surgery with extracorporeal circulation. Therefore, the question arises: Is the perfusion behavior in the management of obese patients undergoing cardiac surgery with extracorporeal circulation the same or different from non-obese patients?

Methods: A systematic review of articles published in the databases of Pubmed, Google Scholar, Cochrane, Prospero and Medline was carried out, and the PRISMA criteria were followed to identify the articles. The search was carried out using the terms: "obesity and cardiopulmonary bypass and/or cardiac surgery", "body mass index and cardiopulmonary bypass", "morbid obesity and cardiopulmonary bypass" and "large patients and cardiopulmonary bypass", including a total of 12 articles.

Results and Conclusion: There is not enough evidence and there is a lack of consensus on the strategy for the design of circuits and additives to achieve adequate oxygenation and avoid hemodilution in obese patients. It is recommended to manage obese patients with flows below the ideal 2.4 L/min/m2 of ASC as is done in non-obese patients, as long as the delivery of oxygen to the tissues is not compromised. It is highly recommended that heparinization of obese patients undergoing extracorporeal circulation be performed differently from non-obese patients.

Key words: Extracorporeal circulation, obesity, obese patients, morbid obesity, large patients.