Vacuum Assist: Angel or Demon CON

Willcox, Timothy W.

doi:10.1051/ject/201345128

Cited by 9 publications

(2 citation statements)

References 45 publications

(39 reference statements)

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“…The literature indicates that air in the CPB venous line is directly associated with arterial emboli. The presence of venous air is explained by different reasons ranging from residual air in the venous cannula [ 36 ], use of left ventricular vent [ 37 ], to air entrainment from the venous line caused by loss of the right atrial seal around the venous cannula following a surgical manipulation [ 32 , 38 ]. Before or after aortic cross-clamp positioning, paradoxical embolism of venous air across atrial or ventricular septal defects can also occur.…”

Section: Discussionmentioning

confidence: 99%

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Jarry,

Couture,

Beaubien-Souligny

et al. 2024

J Cardiothorac Surg

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Background During cardiac surgery, transcranial Doppler (TCD) represents a non-invasive modality that allows measurement of red blood cell flow velocities in the cerebral arteries. TCD can also be used to detect and monitor embolic material in the cerebral circulation. Detection of microemboli is reported as a high intensity transient signal (HITS). The importance of cerebral microemboli during cardiac surgery has been linked to the increased incidence of postoperative renal failure, right ventricular dysfunction, and hemodynamic instability. The objective of this study is to determine whether the embolic load is associated with hemodynamic instability during cardiopulmonary bypass (CPB) separation and postoperative complications. Methods A retrospective single-centre cohort study of 354 patients undergoing cardiac surgery between December 2015 and March 2020 was conducted. Patients were divided in tertiles, where 117 patients had a low quantity of embolic material (LEM), 119 patients have a medium quantity of microemboli (MEM) and 118 patients who have a high quantity of embolic material (HEM). The primary endpoint was a difficult CPB separation. Multivariate logistic regression was used to determine the potential association between a difficult CPB separation and the number of embolic materials. Results Patients who had a difficult CPB separation had more HITS compared to patients who had a successful CPB separation (p < 0.001). In the multivariate analysis, patients with MEM decreased their odds of having a difficult CPB weaning compared to patients in the HEM group (OR = 0.253, CI 0.111–0.593; p = 0.001). In the postoperative period patients in the HEM group have a higher Time of Persistent Organ Dysfunction (TPOD), a longer stay in the ICU, a longer duration under vasopressor drugs and a higher mortality rate compared to those in the MEM and LEM groups. Conclusion The result of this study suggests that a high quantity of cerebral embolic material increases the odds of having a difficult CPB separation. Also, it seems to be associated to more complex surgery, a longer CPB time, a higher TPOD and a longer stay in the ICU. Six out of eight patients who died in this cohort were in the HEM group.

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Section: Discussionmentioning

confidence: 99%

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Jarry,

Couture,

Beaubien-Souligny

et al. 2024

J Cardiothorac Surg

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“…Control of air inlet was accomplished by opening and closing the Luer-Lok cap. This method of introducing air is previously described (10).…”

Section: Interventionmentioning

confidence: 99%

Can the Oxygenator Screen Filter Reduce Gaseous Microemboli?

Johagen,

Appelblad,

Svenmarker

2014

J Extra Corpor Technol

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Gaseous microemboli (GME) define small bubbles as <200 μm in size. GME are reported to increase morbidity after cardiopulmonary bypass (CPB) and cardiac surgery. To prevent intrusion of GME into the systemic circulation during CPB, arterial line filtration is generally recommended. New trends in oxygenator design promote location of arterial filtration as an integral part of the oxygenator housing. The present experimental study aimed to evaluate the GME removal properties of an integrated arterial screen filter in a standard microporous oxygenator. The GME properties of Terumo Capiox® FX25 with an integrated arterial screen filter was assessed in an experimental setup and compared with Capiox® RX25, in which no arterial screen filter is present. A blood analog prime solution was recirculated using a roller pump at 4 and 6 L per minute flow rate, respectively, through a customized CPB circuit comprising oxygenator, reservoir, and connecting tubing. A controlled volume of air was introduced into the circuit. The GME activity was measured and computed using a Gampt BCC200® ultrasonic device placing one probe at the venous inlet and one other at the arterial outlet of the oxygenator. Transmembrane delta values of GME activity were used to calculate the removal efficacy based on counts and volume of GME. Use of screen filtration reduced the GME volume by 99.1% ± .1% compared with 98.0% ± .1% for controls at 4 L/min flow rate (p < .001). At 6 L/min, the reduction was 97.9% ± .1% compared with 97.0% ± .1% (p < .001). In contrast, the reduction of GME counts was less effective after screen filtration compared with controls: 89.6 ± .6% versus 91.4 ± .4% at 4 L/min and 55.6% ± 1.6% versus 76.0% ± 1.4% at 6 L/min, respectively (p < .001). The tested oxygenator with incorporated arterial screen filter reduced GME activity based on the calculated volume at the same time as counts of GME increased.

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The bypass plan

Matte

2015

Perfusion for Congenital Heart Surgery

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The perfusionist must be familiar with the patient's original diagnosis, catheterization lab interventions, previous surgeries, and current needs when developing the bypass plan. The following are major considerations for management of the patient during cardiopulmonary bypass. Please refer to Chapter 6 for defect-specific considerations.The care team must have a reasonably standardized communication plan for the bypass run [1][2][3]. This includes standardizing to closed-loop communication for certain anesthesia, surgical, and cardiopulmonary bypass (CPB) commands, notifications, and/or concerns. Each communication should be verbally acknowledged per the team standard (either repeated back or with another affirmation) to ensure the information is properly delivered and handled. This technique is essential for bypass safety and is used at most centers to announce checkpoints during the case.Common bypass-related checkpoints where closedloop communication among the team is essential include the following: • Heparin in • ACT running • Bypass lines clamped and ready for division at the field • Pump suckers on (with suckers and vent line tested under saline at field)

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Vacuum Assist: Angel or Demon CON

Cited by 9 publications

References 45 publications

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Can the Oxygenator Screen Filter Reduce Gaseous Microemboli?

The bypass plan

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