He provides an detailed overview of acid-base management during hypothermic cardiopulmonary bypass in the new textbook "Extracorporeal Circulation in Theory and Practice".
Blood PH is a result of interplay between the continuous production of acid through metabolism, the buffering of the acid load, and the ultimate elimination of that load from the body. When this balance is disrupted, clinically relevant acidosis or alkalosis can develop. Acidosis is known to cause myocardial depression, decreased responsiveness to catecholamines, increased risk of cardiac arrhythmias, decreases in systemic vascular resistance coupled with increased pulmonary vascular resistance, as well as insulin resistance and impaired immune function. Significant alkalosis also may cause myocardial depression and arrhythmia, as well as inhibit respiratory drive and decrease oxygen delivery through a leftward shift in the oxyhemoglobin dissociation curve.
Accordingly, both acidosis and alkalosis should be avoided.