A novel software program for detection of potential air emboli during cardiac surgery

Abstract

BackgroundRisks associated with air emboli introduced during cardiac surgery have been highlighted by reports of postoperative neuropsychological dysfunction, myocardial dysfunction, and mortality. Presently, there are no standard effective methods for quantifying potential emboli in the bloodstream during cardiac surgery. Our objective was to develop software that can automatically detect and quantify air bubbles within the ascending aorta and/or cardiac chambers during cardiac surgery in real time.FindingsWe created a software algorithm (“Detection of Emboli using Transesophageal Echocardiography for Counting, Total volume, and Size estimation”, or DETECTS™) to identify and measure potential emboli present during cardiac surgery using two-dimensional ultrasound. An in vitro experiment was used to validate the accuracy of DETECTS™ at identifying and measuring air emboli. An experimental rig was built to correlate the ultrasound images to high definition camera images of air bubbles created in water by an automatic bubbler system. There was a correlation between true bubble size and the size reported by DETECTS™ in our in vitro experiment (r = 0.76). We also tested DETECTS™ using TEE images obtained during cardiac surgery, and provide visualization of the software interface.ConclusionsWhile monitoring the heart during cardiac surgery using existing ultrasound technology and DETECTS™, the operative team can obtain real-time data on the number and volume of potential air emboli. This system will potentially allow de-airing techniques to be evaluated and improved upon. This could lead to reduced air in the cardiac chambers after cardiopulmonary bypass, possibly reducing the risk of neurological dysfunction following cardiac surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-7120-13-3) contains supplementary material, which is available to authorized users.

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“…The severity of venous air embolism and paradoxical air embolism can be quantitatively graded from 0 to 3 by the microbubble score. 25 Secretain et al 26 created a software algorithm ("Detection of Emboli using Transesophageal Echocardiography for Counting, Total volume, and Size estimation", or DETECTS TM ) to identify and measure potential emboli present during cardiac surgery using twodimensional ultrasound. The microbubble score and DETECTS TM may be useful in studies of CO 2 embolism in future.…”

Automatic detection of venous air embolism using transesophageal echocardiography in patients undergoing neurological surgery in the semi-sitting position: a pilot study

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