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How effective are cardiopulmonary bypass circuits at removing gaseous microemboli?
Timothy J Jones1, Dwight D Deal, Jason C Vernon
1Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA.
Abstract:
An association has been demonstrated between intravascular microemboli and organ injury during cardiopulmonary bypass (CPB). Air may be inadvertently introduced into the venous line during CPB resulting in the formation of gaseous microemboli (GME). We studied the ability of CPB circuits, from five different manufacturers, to remove GME originating from the introduction of air into the venous line. Using an in vitro model of adult CPB, 60 ml of air was introduced into the venous line and the progression of GME through the circuit components was monitored at 5 locations. In all circuits GME were detected in the arterial line following the introduction of air into the venous line. There was a wide variation between manufacturers in the ability of the circuit to remove GME. Air introduced into the venous line during CPB results in the formation of GME that are able to pass through all the circuit components including the arterial filter. The quantity of GME detected in the arterial line is influenced by the design of the circuit components and varies between manufacturers. Air in the venous line should be avoided and if present it must be dealt with promptly.
Insights
Gaseous microemboli (GME) from air in cardiopulmonary bypass (CPB) venous lines can reach the arterial line, potentially causing organ injury. CPB circuit designs vary significantly in their ability to remove these dangerous GME.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Medical Device Technology
Background:
- Intravascular microemboli are linked to organ injury during cardiopulmonary bypass (CPB).
- Accidental air introduction into the CPB venous line can create gaseous microemboli (GME).
Purpose of the Study:
- To evaluate the efficacy of different cardiopulmonary bypass (CPB) circuits in removing gaseous microemboli (GME).
- To assess the progression of GME through CPB circuits from five manufacturers.
Main Methods:
- An in vitro adult CPB model was utilized.
- 60 ml of air was introduced into the venous line.
- GME progression was monitored at five locations within the circuit.
Main Results:
- Gaseous microemboli (GME) were detected in the arterial line of all tested CPB circuits after air introduction.
- Significant variation exists among manufacturers regarding GME removal capability.
- GME passed through all circuit components, including arterial filters, in all tested systems.
Conclusions:
- Air introduced into the venous line during CPB generates GME that can traverse the entire circuit.
- CPB circuit design significantly impacts GME filtration efficiency.
- Prompt management of air in the venous line during CPB is crucial to prevent GME transmission.