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Detection and elimination of microemboli related to cardiopulmonary bypass

Robert C Groom1, Reed D Quinn, Paul Lennon

  • 1Cardiac Surgery and the Department of Anesthesia, Maine Medical Center, Portland, ME 04102, USA. groomr@mmc.org

Circulation. Cardiovascular Quality and Outcomes
|December 25, 2009
PubMed

Insights

Implementing evidence-based changes in cardiopulmonary bypass (CPB) techniques and circuit components significantly reduced cerebral microemboli during coronary artery bypass grafting surgery, decreasing emboli by over 75%.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Biomedical Engineering

Background:

  • Neurobehavioral impairment is a frequent complication following coronary bypass surgery.
  • Cerebral microemboli during cardiopulmonary bypass (CPB) are a primary cause of cognitive injury.
  • Understanding and mitigating cerebral microemboli during CPB is crucial for patient outcomes.

Purpose of the Study:

  • To investigate the occurrence of cerebral embolism during CPB.
  • To assess the effectiveness of evidence-based modifications in CPB circuit components and processes.
  • To quantify the reduction in patient exposure to emboli through these changes.

Main Methods:

  • M-Mode Doppler utilized to detect microemboli in the CPB circuit (inflow/outflow) and cerebral arteries (middle cerebral arteries).
  • Real-time association of clinical techniques with emboli detection by merging Doppler signals.
  • Study included 169 isolated coronary artery bypass grafting (CABG) patients between 2002 and 2008, divided into four phases.

Main Results:

  • No significant difference in microemboli detected in the CPB circuit inflow across phases (P=0.96).
  • Significant reduction in microemboli detected in the CPB circuit outflow (87.9% decrease, P<0.001) and in the brain (77.2% decrease, P<0.001) across phases.
  • Changes in CPB circuit components and techniques correlated with substantial emboli reduction.

Conclusions:

  • Modifications to CPB techniques and circuit components, such as filter size and pump type, are effective.
  • These evidence-based changes led to a greater than 75% reduction in cerebral microemboli.
  • Optimizing CPB management can significantly decrease the risk of neurological injury.
Abstract

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