Massive air embolism in a Fontan patient

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Pediatric Cardiology

Background:

• Cardiopulmonary bypass commonly utilizes integrated hard shell cardiotomy and venous reservoirs for congenital heart disease (CHD) patients.
• Proper venting of these reservoirs is critical to prevent system pressurization, which can lead to complications.

Observation:

• A case of air embolism occurred due to retrograde air propulsion through the venous line.
• This event was secondary to a pressurized cardiotomy reservoir in a patient with Fontan circulation.

Findings:

• Pressurized sealed cardiotomy events have been linked to vacuum-assisted venous drainage system issues and general improper venting.
• The study describes the specific mechanism of cardiotomy reservoir pressurization.
• The reported scenario was successfully simulated using a mock circuit to understand the pathophysiology.

Implications:

• Highlights the critical importance of adequate venting in cardiotomy reservoirs during cardiopulmonary bypass for CHD.
• Underscores the potential for severe complications like air embolism in Fontan patients if reservoirs are not properly managed.
• Provides insights for refining safety protocols and equipment design in pediatric cardiac surgery.