Efficacy of Carbon Dioxide Insufflation for Cerebral and Cardiac Protection During Open Heart Surgery: A Systematic Review and Meta‐Analysis

Abstract

In spite of widespread application around the world, there has been controversy on the cerebral and cardiac protection efficacy of carbon dioxide insufflation (CDI) during open heart surgery. To make a comprehensive evaluation, we screened all relevant published randomized controlled trials to perform the first systematic review and meta-analysis for CDI during open heart surgery. We searched PubMed, EMBASE, the Cochrane Controlled Clinical Trial register, WANFAN, CQVIP, and CNKI database for published articles. Randomized controlled trials were included when the research provided data of neurological complications postoperatively, creatinine kinase, MB isoenzyme (CK-MB) on the first postoperative day, or all-cause mortality. We chose a fixed-effects model when the trials showed low heterogeneity, otherwise a random effects model was used. The quality of studies was assessed by modified Jadad scale. Four studies were included in this meta-analysis. The overall pooled relative risk (RR) for neurological complications was 1.59, 95% confidence interval (CI) = [0.57, 4.46], and the z-score for overall effect was 0.89 (P = 0.37). The standardized mean difference of the CK-MB between groups was 1.15, 95% CI = [-1.27, 3.56], and the z-score for overall effect was 0.93 (P = 0.35). The overall pooled RR for all-cause mortality was 0.5, 95% CI = [0.16, 1.64], and the z-score for overall effect was 1.14 (P = 0.25). There was no significant difference between groups. Because of the insufficiency of powerful evidences, the cerebral and cardiac protection efficacy of CDI during open heart surgery needs to be further verified by more high-quality trials.

The influence of carbon dioxide field flooding in mitral valve operations with cardiopulmonary bypass on S100ß level in blood plasma in the aging brain

“…CO 2 atmosphere has been debatable. 37 , 38 Nevertheless, we believe that notwithstanding shortages in our randomization assumptions, our study still offers important insights that are relevant to surgical practice.…”

Pulmonary collapse alone provides effective de-airing in cardiac surgery: a prospective randomized study

“…In such cases, the carbon dioxide insufflation of the open mediastinum might be an alternative option. [6][7][8] This study also shows that a gradual increase in cardiac output coupled with delayed and staged ventilation at the end of the cardioplegic arrest added little to the efficacy of the de-airing procedure in the group with intact pleurae and expanded lungs. However, we believe that gradual perfusion and ventilation of the lungs adds safety to the de-airing method in which bilateral, induced pulmonary collapse is the key factor for effective de-airing.…”

“…In such cases, the carbon dioxide insufflation of the open mediastinum might be an alternative option. 6–8…”

Commentary: Thinking back about our routine use of carbon dioxide

“…However, the behavior of carbon dioxide in the actual operating field (ie, open thorax) has not been well studied. 2,3 In the present study, Vandenberghe and colleagues 1 successfully visualized the current of carbon dioxide using a Charged Coupled Device camera and the Schlieren technique. They demonstrated that carbon dioxide behaviors varied depending on the diffusor types, gas delivery flow rate, hand motions, and use of suction in the field.…”