Microemboli detection and classification during pediatric cardiopulmonary bypass

Area of Science:

• Cardiovascular Surgery
• Neurology
• Biomedical Engineering

Background:

• Postoperative neurological morbidity is a concern in cardiac surgery.
• Transcranial Doppler has limitations in detecting small microemboli.
• Improved microemboli detection could enhance patient outcomes.

Purpose of the Study:

• To evaluate the Emboli Detection and Classification (EDAC) Quantifier for microemboli monitoring.
• To assess microemboli presence and characteristics in pediatric cardiopulmonary bypass circuits.
• To identify potential sources and timing of microemboli generation.

Main Methods:

• Utilized the Emboli Detection and Classification (EDAC) Quantifier.
• Monitored microemboli in the cardiopulmonary bypass circuit during 33 pediatric heart operations.
• Analyzed microemboli quantity, size, and location (venous vs. arterial lines).

Main Results:

• Significantly more microemboli detected in the venous line (median 11,830) compared to the arterial line (1298).
• Venous microemboli were larger (>40 μm) in 59% of cases, versus 7% in arterial lines.
• Increased microemboli counts observed at bypass onset and with clamp removal; venous lines showed higher counts.

Conclusions:

• The EDAC Quantifier offers enhanced sensitivity for microemboli detection (10 μm).
• Thousands of microemboli, many <40 μm, are transmitted to pediatric patients during heart surgery.
• Initiation of bypass, potentially due to venous line air, may be a significant source of microemboli, warranting further investigation to improve neurological outcomes.