Cardiotomy Suction: A Major Source of Brain Lipid Emboli During Cardiopulmonary Bypass

Brooker, Robert F.; Brown, William R.; Moody, Dixon M.; Hammon, John W.; Reboussin, David M.; Deal, Dwight D.; Ghazi-Birry, H. Simon; Stump, David A.

doi:10.1016/s0003-4975(98)00289-6

Cited by 225 publications

(137 citation statements)

References 17 publications

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“…First, our data assess only 30-day complications, and although the majority of CVAs in patients having noncardiac surgery occur in this interval, some CVAs undoubtedly occur later, therefore it is likely that CVA rates are somewhat higher than those we report [19]. Additionally, the ACS NSQIP 1 database does not differentiate between ischemic and hemorrhagic stroke, and although studies [6,23,34] have shown that the majority of perioperative strokes is ischemic, we are unable to comment on the specific proportions in our study. Moreover, although the ACS NSQIP 1 database contains a comprehensive list of preoperative and operative variables, certain predictors of CVA (such as atrial fibrillation and carotid stenosis) are not included, which may be potential confounders in our results [9,12].…”

Section: Discussionmentioning

confidence: 90%

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Minhas

Goyal

Patel

2016

Clinical Orthopaedics &Amp; Related Research

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Background Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery. Questions/purposes Our goals were to (1) establish the national, baseline proportion of patients experiencing a 30-day CVA and the timing of CVA; and (2) determine independent risk factors for 30-day CVA rates after common elective orthopaedic procedures. Methods Patients undergoing elective TKA, THA, posterior or posterolateral lumbar fusion, anterior cervical discectomy and fusion, and total shoulder arthroplasty, from 2006 to 2012, were identified from the American College of Surgeons National Surgical Quality Improvement Program 1 database. A total of 42,150 patients met inclusion criteria. Thirty-day CVA rates were recorded for each procedure, and patients were assessed for characteristics associated with CVA through univariate analysis. Multivariate regression models were created to identify independent risk factors for CVA. Results A total of 55 (0.13%) patients experienced a CVA within 30 days of the procedure, occurring a median of 2 days after surgery (range, 1-30 days) with 0.08% of patients experiencing a CVA after TKA, 0.15% after THA, 0.00% after single-level anterior cervical discectomy and fusion, 0.38% after multilevel anterior cervical discectomy and fusions, 0.20% after single-level posterior or posterolateral lumbar fusion, 0.70% after multilevel posterior or posterolateral lumbar fusion, and 0.22% after total shoulder arthroplasty. Independent risk factors for CVA included age of 75 years or older (odds ratio [OR], 2.50; 95% CI,

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Section: Discussionmentioning

confidence: 90%

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Minhas

Goyal

Patel

2016

Clinical Orthopaedics &Amp; Related Research

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“…It has been reported that the majority of microemboli come from the cardiotomy suction line. 46 -48 In dogs undergoing CPB, Brooker et al 49 found a 10-fold increase in microemboli when pericardial blood was scavenged and returned to the circuit. Evidently, embolic fat is a major problem with the pericardial blood.…”

Section: Discussionmentioning

confidence: 99%

Longer Duration of Cardiopulmonary Bypass Is Associated With Greater Numbers of Cerebral Microemboli

Brown

Moody

Challa

et al. 2000

Stroke

204

107

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Background and Purpose-Many patients who undergo cardiac surgery assisted with cardiopulmonary bypass (CPB) experience cerebral injury, and microemboli are thought to play a role. Because an increased duration of CPB is associated with an increased risk of subsequent cerebral dysfunction, we investigated whether cerebral microemboli were also more numerous with a longer duration of CPB. Methods-Brain specimens were obtained from 36 patients who died within 3 weeks after CPB. Specimens were embedded in celloidin, sectioned 100 m thick, and stained for endogenous alkaline phosphatase, which outlines arterioles and capillaries. In such preparations, emboli can be seen as swellings in the vessels. Cerebral microemboli were counted in equal areas and scored as small, medium, or large to estimate the embolic load (volume of emboli). Results-With increasing survival time after CPB, the embolic load declined (PϽ0.0001). (Lipid emboli are known to pump slowly through the brain.) Also with increasing time after CPB, the percentage of large and medium emboli became lower (Pϭ0.0034). This decline is consistent with the concept that the emboli break into smaller globules as they pass through the capillary network. A longer duration of CPB was associated with increased embolic load (Pϭ0.0026).For each 1-hour increase in the duration of CPB, the embolic load increased by 90.5%. Conclusions-Thousands of microemboli were found in the brains of patients soon after CPB, and an increasing duration of CPB was associated with an increasing embolic load. (Stroke. 2000;31:707-713.)

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“…Krwawienie do mózgu, prowadzące do wystąpienia objawów udaru mózgu, występuje zaledwie u około 1% chorych leczonych chirurgicznie [15,16,111,112]. Wystąpienie udaru w pierwszym okresie po operacji związane jest zwykle z przemieszczeniem materiału zatorowego z jam serca, aorty czy naczyń szyjnych.…”

Section: Powikłania Ze Strony Układu Nerwowegounclassified

Powikłania ogólne operacji nowotworów złośliwych głowy i szyi

Sierszeń¹

2011

Otolaryngologia Polska

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Cardiotomy Suction: A Major Source of Brain Lipid Emboli During Cardiopulmonary Bypass

Cited by 225 publications

References 17 publications

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Longer Duration of Cardiopulmonary Bypass Is Associated With Greater Numbers of Cerebral Microemboli

Powikłania ogólne operacji nowotworów złośliwych głowy i szyi

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