The Pathophysiology of Cerebral Arterial Gas Embolism

Mitchell, Simon; Gorman, Des

doi:10.1051/ject/200234118

Cited by 46 publications

(5 citation statements)

References 38 publications

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Section: Pathophysiology: the Immunothrombotic And Endothelial Respon...mentioning

confidence: 99%

“…The BBB may be disrupted because of activation and adhesion of polymorphonuclear leukocytes in the brain ( 104 ). Generation of immune mediators induced by complement and coagulation activation by bubbles can provoke resultant thromboinflammatory coagulopathies ( 32 , 35 , 44 , 104 – 109 ). A typical result of air embolism is the migration of air into small arteries with an average diameter range of 30–60 µm ( 2 , 52 ).…”

Section: Pathophysiology: the Immunothrombotic And Endothelial Respon...mentioning

confidence: 99%

“…In summary, the overall pathophysiologic effect of a gas bubble within the arterial circulation is an obstruction that is mediated by thromboinflammatory changes of the complement and hemostatic systems with resulting vasogenic edema, increased blood viscosity, leukocyte and platelet activation, and increase in ICP—all of which contribute to a decrease of CBF as well as disruption of the BBB ( 99 , 104 , 124 ). This effect of bubbles on cerebral circulation and the BBB leads us to describe the pathophysiological details of the endothelial changes of air-obstructed vessels that cause a transient and sub-lethal reduction of blood flow when compared to thrombotic strokes.…”

Section: Pathophysiology: the Immunothrombotic And Endothelial Respon...mentioning

confidence: 99%

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Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies

Marsh,

Moore,

Moore

et al. 2023

Front. Immunol.

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Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition.

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Section: Pathophysiology: the Immunothrombotic And Endothelial Respon...mentioning

confidence: 99%

Section: Pathophysiology: the Immunothrombotic And Endothelial Respon...mentioning

confidence: 99%

Section: Pathophysiology: the Immunothrombotic And Endothelial Respon...mentioning

confidence: 99%

See 1 more Smart Citation

Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies

Marsh,

Moore,

Moore

et al. 2023

Front. Immunol.

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“…Cognitive decline is a common complication following cardiac surgery and affects approximately 26%–40% of patients [24] . Therefore, recent studies have highlighted the importance of preventing the generation of MBs and their entry into a patient's body [24] , [25] , [26] .…”

Section: Introductionmentioning

confidence: 99%

The Number of Microbubbles Generated During Cardiopulmonary Bypass Can Be Estimated Using Machine Learning From Suction Flow Rate, Venous Reservoir Level, Perfusion Flow Rate, Hematocrit Level, and Blood Temperature

Miyamoto,

Soh,

Okahara

et al. 2024

IEEE Open J. Eng. Med. Biol.

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Goal: Microbubbles (MBs) are known to occur within the circuits of cardiopulmonary bypass (CPB) systems, and higher-order dysfunction after cardiac surgery may be caused by MBs as well as atheroma dispersal associated with cannula insertion. As complete MB elimination is not possible, monitoring MB count rates is critical. We propose an online detection system with a neural network-based model to estimate MB count rate using five parameters: suction flow rate, venous reservoir level, perfusion flow rate, hematocrit level, and blood temperature. Methods: Perfusion experiments were performed using an actual CPB circuit, and MB count rates were measured using the five varying parameters. Results: Bland–Altman analysis indicated a high estimation accuracy ( R 2 > 0.95, p < 0.001) with no significant systematic error. In clinical practice, although the inclusion of clinical procedures slightly decreased the estimation accuracy, a high coefficient of determination for 30 clinical cases ( R 2 = 0.8576) was achieved between measured and estimated MB count rates. Conclusions: Our results highlight the potential of this system to improve patient outcomes and reduce MB-associated complication risk.

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“…14,15 It has been observed that while larger bubbles usually embolize cerebral arterioles, causing focal ischemia and neuronal injury, small emboli navigate along the vessels, provoking an insult to the endothelium and triggering an inflammatory response, microvascular dysfunction, and cognitive decline. 16–18…”

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confidence: 99%

Hematic Antegrade Repriming Reduces Emboli on Cardiopulmonary Bypass: A Randomized Controlled Trial

et al. 2022

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Particulate and gaseous microemboli (GME) are side effects of cardiac surgery that interfere with postoperative recovery by causing endothelial dysfunction and vascular blockages. GME sources during surgery are multiple, and cardiopulmonary bypass (CPB) is contributory to this embolic load. Hematic antegrade repriming (HAR) is a novel procedure that combines the benefits of repriming techniques with additional measures, by following a standardized procedure to provide a reproducible hemodilution of 300 ml. To clarify the safety of HAR in terms of embolic load delivery, a prospective and controlled study was conducted, by applying Doppler probes to the extracorporeal circuit, to determine the number and volume of GME released during CPB. A sample of 115 patients (n = 115) was considered for assessment. Both groups were managed under strict normothermia, and similar clinical conditions and protocols, receiving the same open and minimized circuit. Significant differences in GME volume delivery (control group [CG] = 0.28 ml vs. HAR = 0.08 ml; p = 0.004) and high embolic volume exposure (>1 ml) were found between the groups (CG = 30.36% vs. HAR = 4.26%; p = 0.001). The application of HAR did not represent an additional embolic risk and provided a four-fold reduction in the embolic volume delivered to the patient (coefficient, 0.24; 95% CI, 0.08–0.72; p = 0.01), which appears to enhance GME clearance of the oxygenator before CPB initiation.

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The Pathophysiology of Cerebral Arterial Gas Embolism

Cited by 46 publications

References 38 publications

Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies

Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies

The Number of Microbubbles Generated During Cardiopulmonary Bypass Can Be Estimated Using Machine Learning From Suction Flow Rate, Venous Reservoir Level, Perfusion Flow Rate, Hematocrit Level, and Blood Temperature

Hematic Antegrade Repriming Reduces Emboli on Cardiopulmonary Bypass: A Randomized Controlled Trial

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