In this BoardsCast episode, we continue Tobias Chapter 106 — Cardiac Surgery with the most terrifying bypass trap:

The pump looks perfect… and the organ is still dying.

Because flow is delivery, but perfusion is exchange. Only one of those keeps tissue alive. 

This episode rebuilds cardiopulmonary bypass into the only board-safe framework:

Bypass success is microcirculation success. Not pump numbers. 

You’ll learn:

•  Why can pump flow look good, while tissue is starving 
•  The three perfusion pillars: delivery, distribution, oxygen-carrying capacity
•  Why MAP is the true driver of capillary perfusion (target 50–70 mmHg) 
•  Why hemodilution is necessary (viscosity) — but dangerous if HCT drops <18% (target ~25–28%) 
•  Why non-pulsatile flow can trigger vasoconstriction and maldistribution (global flow ≠ regional feeding) 
•  The two truth-tellers: SvO₂ (goal ≥70%) and lactate (rising = cellular suffocation) 

Key takeaway: Stop treating the pump. Treat the tissue.

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