Conventional carbon dioxide application does not reduce cerebral or myocardial damage in open heart surgery

Effect of CO 2 Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery

“…The reason for its lack of success has only recently become clear, when it was found that the devices through which CO 2 has traditionally been delivered were not effective. 15 When CO 2 was supplied in this manner, the wound still contained 20% to 80% air. [15][16][17][18][19] In the present study, we used a new device that can achieve a CO 2 atmosphere in the wound with Ͻ1% remaining air.…”

Carbon dioxide de‐airing in cardiac surgery

“…Not until the last few years did it finally become clear that the insufflation devices used for so long, mainly open ended tubes, catheters, and the like, were unable to provide a true CO 2 atmosphere in the wound. 17,18 Most surgeons try to prevent air embolism during open-heart surgery. Usual surgical measures include atrial venting, vent suction, Trendelenburg's position, ventricle emptying by compression, evacuation of trapped air (diagnosed by TEE) by gravitation or aspiration, and the insufflation of the cardothoracic wound with CO 2 .…”

“…However, we are not aware of any clinical study where insufflation of the cardiothoracic wound with CO 2 through a traditional tube has been shown to reduce morbidity. In fact, in a recent clinical study in open-heart surgery Martens et al 17 used an open-ended perfusion line with an inner diameter of 2 mm for CO 2 insufflation at a flow of 2 l/min. They did not find any difference in neuropsychological outcome between patients in whom the cardiothoracic cavity had been insufflated with CO 2 and controls in whom it was not.…”

“…When CO 2 was supplied in the manner, which was then in common use, the wound was still found to contain 20% to 80% air. 17,18 Already much earlier the clinical impression had been that insufflation with CO 2 did not seem to make much difference and this is perhaps the reason why up to now the use of CO 2 insufflation is not wide spread.…”

“…The openended tube which has the great advantages of being cheap as well as easily obtainable, became on account of these qualities more or less the delivery device of choice. 9,17,19,20 Much later it was found that the conventional open-ended tube signally fails to provide efficient deairing. The probable reason of its failure to do so is its high outflow velocity which leads to turbulent mixing with ambient air.…”