Does the venous cannulation method affect gaseous embolic load to the patient during extracorporeal circulation?

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Anesthesiology

Background:

• Cardiopulmonary bypass (CPB) is critical for cardiac surgery but carries risks, notably gaseous microemboli (GME).
• The prevalence of GME during CPB and its impact on stroke risk are not fully understood.
• Minimizing GME is crucial for improving patient outcomes in open-heart surgery.

Purpose of the Study:

• To quantitatively compare GME incidence in the arterial line between cavoatrial and bicaval cannulation techniques during open-heart surgery.
• To explore the influence of venous reservoir volume on GME.
• To assess the correlation between GME in the venous and arterial lines.

Main Methods:

• A single-center randomized controlled trial involving 39 adult patients undergoing cardiac surgery.
• Patients were assigned to either cavoatrial or bicaval cannulation and randomized to different venous reservoir volumes (≥300 mL vs. 200-300 mL).
• Gaseous microemboli were detected using GAMPT BCC300 probes throughout the CPB circuit.

Main Results:

• No significant differences in arterial GME count or volume were found between cavoatrial and bicaval cannulation (p=.444 and p=.967, respectively).
• Venous reservoir volume did not significantly impact GME levels (p=.074 for count, p=.166 for volume).
• No significant correlation was observed between GME in the venous and arterial lines (p=.492 and p=.750).

Conclusions:

• Cannulation strategy (cavoatrial vs. bicaval) does not significantly affect arterial GME during CPB.
• The effectiveness of the CPB circuit in removing GME (99.14%) highlights the role of modern oxygenators and filters.
• No adverse events were reported, suggesting the safety of current CPB systems in managing GME.