Current techniques in cardiac surgery sometimes require the use of cardiopulmonary bypass. The essential goal of cardiopulmonary bypass is to divert blood around a nonbeating heart through an extracorporeal circuit that functionally replaces the heart and lungs. There are several steps to be performed when placing a patient on bypass. After administration of heparin and attaining adequate activated clotting time (ACT), the arterial cannula (most commonly ascending aorta) is inserted first, to allow infusion of volume in case of hemorrhage associated with venous cannulation. When the arterial cannula is inserted, the systolic blood pressure should be decreased to 90 to 100 mm Hg to reduce the risk of aortic dissection and to facilitate cannulation. Venous blood returning to the right heart is drained by gravity to the venous reservoir through either two venous cannulas separately inserted into the inferior vena cava (IVC) and superior vena cava (SVC) or, more commonly, a single cannula inserted directly into the right atrium.

The composition of pump-priming solution generally consists of electrolytes, colloids, mannitol, and heparin. Depending upon the hematocrit of the patient, blood or packed red blood cells may be added to the priming solution. The volume of priming solution ranges from 1,800 mL to 2,200 mL. After the initiation of total cardiopulmonary bypass, mild to moderate hypothermia is induced (30° C to 32° C). The aorta is cross-clamped and cardioplegic solution is infused antegrade through the aortic root and retrograde via the coronary sinus to arrest the heart.