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Emboli occurrence during coronary artery bypass surgery: the influence of a new method of perfusionist blood sampling
Ld Sauren1, Ej Mooren, Ee Severdija
1Academic Hospital Maastricht, Department Cardiothoracic Surgery, Maastricht, the Netherlands. l.sauren@ctc.unimaas.nl
Abstract:
Peri-operative cerebral microemboli in cardiac surgery are associated with post-operative neurological complications. Cardiopulmonary bypass (CPB) and perfusionist interventions are important contributors of microemboli. In this study, we examined the influence of blood sampling by the perfusionist on the appearance of microembolic signals (MES) in an open and a closed CPB system. Fourteen patients underwent isolated coronary artery bypass grafting (CABG), using either an open or closed CPB system. Patients were monitored with transcranial Doppler (TCD) for the occurrence MES in both middle cerebral arteries (MCA) as well as in the arterial and venous lines of the CPB. In the closed system, two sampling methods were used, namely the "traditional" and the "E-line". In the latter, a shunt line was applied from the manifold to the cardiotomy reservoir). In the open system, one method of blood sampling was used. Blood sampling in an open system or in a closed system using the E-line resulted in 0.2 (+/-0.56) MES, which was significantly lower than the traditional method (72 (+/-69) MES). The use of a shunt line reduces MES during blood sampling in a closed CPB system.
Insights
Perfusionist blood sampling during cardiac surgery can cause cerebral microemboli. Using a shunt line in closed cardiopulmonary bypass systems significantly reduces these microembolic signals (MES), enhancing patient safety.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Biomedical Engineering
Background:
- Peri-operative cerebral microemboli are linked to neurological deficits after cardiac surgery.
- Cardiopulmonary bypass (CPB) and perfusionist actions are known sources of microemboli.
- Minimizing microemboli during CPB is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the impact of perfusionist blood sampling techniques on microembolic signals (MES) within open and closed CPB systems.
- To compare the efficacy of different blood sampling methods in reducing MES during coronary artery bypass grafting (CABG).
Main Methods:
- Fourteen patients undergoing isolated CABG were monitored using transcranial Doppler (TCD) for MES.
- MES were detected in middle cerebral arteries (MCAs) and CPB lines.
- Blood sampling was performed using a traditional method and an "E-line" shunt method in a closed CPB system, and one method in an open system.
Main Results:
- Blood sampling in an open system or the "E-line" method in a closed system yielded significantly fewer MES (0.2 +/-0.56) compared to the traditional method (72 +/-69).
- The "E-line" shunt method demonstrated a substantial reduction in MES during blood sampling in closed CPB.
- TCD monitoring confirmed the reduction of MES with specific sampling techniques.
Conclusions:
- The "E-line" shunt method for blood sampling in closed CPB systems effectively minimizes microembolic signals.
- Implementing shunt lines during perfusionist interventions can reduce the risk of peri-operative neurological complications.
- Optimizing blood sampling techniques is vital for enhancing safety in cardiac surgery patients undergoing CPB.
