Microemboli in our bypass circuits: a contemporary audit

Cardiopulmonary bypass (CPB) may introduce microemboli into the patient's arterial circulation. These may arise from the CPB circuit. Most relevant studies have been performed in vitro; there are relatively few clinical studies. We used the Emboli Detection and Classification quantifier (EDAC) (Luna Innovations, Roanoke, VA) in a prospective clinical audit of emboli in a contemporary CPB circuit. Following ethics approval, standard clinical CPB circuits in patients undergoing CPB were instrumented with three EDAC system probes placed on the venous line, outlet of the hard-shell venous reservoir (HSVR), and distal to the arterial line filter. This was synchronized with the perfusion data management system and emboli number and volume were recorded at 30-second intervals. Recorded observations and combined data from both the EDAC and data management system were analyzed. We report data from the first 12 patients (24.5 hours of CPB) of a larger series currently being performed. The mean total emboli count per minute was significantly greater downstream of the HSVR than in the venous line and significantly less downstream of the arterial line filter than either of the above. The total count downstream of both the HSVR and the arterial line filter was greater when the vent pump was on vs. off. Despite the significant increase in emboli count downstream of the reservoir during vent operation there was a significant reduction in the total volume of emboli in this position compared with the venous line. This was further reduced by the arterial line filter. Nevertheless, the total embolic volume was greater downstream of the HSVR and the arterial filter with the vent on vs. off. The two overwhelming sources of emboli emanating from our CPB circuit were the use of the left ventricular vent and air entrained from the venous line. Such audit enables refinement of CPB management and potential component redesign which may make CPB safer and improve patient outcome.