TITLE

Effect of perfusionist technique on cerebral embolization during cardiopulmonary bypass

AUTHOR(S)
Rodriguez, Rosendo A.; Williams, Kathryn A.; Babaev, Andrei; Rubens, Fraser; Nathan, Howard J.
PUB. DATE
January 2005
SOURCE
Perfusion;Jan2005, Vol. 20 Issue 1, p3
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: To determine the association between high intensity transient signals (HITS) and perfusionist interventions, purging techniques, pump flows and venous reservoir blood volume levels during cardiopulmonary bypass. Methods: Transcranial Doppler was used to detect HITS in the middle cerebral artery during the period of aortic crossclamping in patients undergoing coronary artery bypass grafting. Perfusionist-related interventions were recorded and included blood sampling (including the number of times that the oxygenator sampling manifold was purged), drug bolus injections and infusions (vasopressors, crystalloid and mannitol). Pump flows and venous reservoir volume levels were also documented. Results: There were 534 interventions in 90 patients [median number of interventions per patient: 6 (quartiles: 4, 8)]. The median total HITS count from all interventions was 17 (5, 37). This represented 38% of the total HITS counts during aortic crossclamping. Factors contributing to differences in the HITS count included type of intervention (p<0.0001) and perfusionist (p=0.0012). Blood sampling (p<0.001) and drug bolus injections (p=0.06) had higher HITS counts per patient than infusions. Repetitive purging significantly increased HITS counts (r=0.74; p<0.001). Purging perfusionists (purging: 1–10 times) had higher HITS counts per patient [5 HITS (1, 15) than nonpurgers [0 HITS (0, 1) p <0.0001]. HITS counts were significantly correlated with reservoir volumes (r= -0.20, p=0.017) and pump flow rates (r=0.21, p=0.008). Reservoir volume levels ≤800 mL were associated with higher HITS counts per intervention [11 HITS (2, 27)] during blood sampling compared with higher volume levels [3 HITS (1, 10), p=0.001]. Conclusions: Cerebral emboli associated with perfusionist interventions can be minimized by not purging the sampling manifold, using continuous infusions rather than bolus injections, and maintaining high blood-volume levels ( >800 mL) in the venous reservoir.
ACCESSION #
16235813

 

Related Articles

  • Evaluation of an alternative S100b assay for use in cardiac surgery: relationship with microemboli and neuropsychological outcome. Whitaker, D. C.; Green, A. J. E.; Stygall, J.; Harrison, M. J. G.; Newman, S. P. // Perfusion;Jul2007, Vol. 22 Issue 4, p267 

    Introduction. The aim of the study was to investigate the relationship between S100b release, neuropsychological outcome and cerebral microemboli. Peri-operative assay of the astroglial cell protein S100b has been used as a marker of cerebral damage after cardiac surgery but potential assay...

  • Effects of protective and conventional mechanical ventilation on pulmonary function and systemic cytokine release after cardiopulmonary bypass. Koner, Ozge; Celebi, Serdar; Balci, Huriye; Cetin, Gurkan; Karaoglu, Kamil; Cakar, Nahit // Intensive Care Medicine;Apr2004, Vol. 30 Issue 4, p620 

    Objective: To evaluate the effects of protective and conventional ventilation with or without positive end-expiratory pressure (PEEP), on systemic tumor necrosis factor-alpha, interleukin-6 levels and pulmonary function during open heart surgery.Design: Prospective,...

  • Management of continuous venous gas emboli during extracorporeal life support utilizing the Kolobow gas trap. Faulkner, Sherry C.; Johnson, Charles E.; Tucker, Juan; Schmitz, Michael L.; Drummond-Webb, Jonathan J. // Perfusion;Sep2004, Vol. 19 Issue 5, p301 

    Extracorporeal life support (ECLS) with a roller pump system uses a closed cardiopulmonary bypass (CPB) circuit not equipped with a venous reservoir. Hence, gas emboli cannot escape the ECLS circuit, predisposing to clot formation, membrane failure and potential gas embolism. Rarely, some...

  • ULTRASONIC RADIATION FORCE FOR EMBOLI REMOVAL FROM BLOOD. Campbell, C. A.; Hinders, M. K. // AIP Conference Proceedings;2/22/2010, Vol. 1211 Issue 1, p1551 

    In this work we investigate the removal of emboli from cardiopulmonary bypass circuits via acoustic radiation force. Unless removed, emboli can be a significant source of cognitive deficit after cardiac surgery. We have implemented both inviscid linear and viscous non-linear models for radiation...

  • Factor VIIa treatment of DIC as a clinical manifestation of amniotic fluid embolism in a patient with fetal demise. Kahyaoglu, Inci; Kahyaoglu, Serkan; Mollamahmutoglu, Leyla // Archives of Gynecology & Obstetrics;Jul2009, Vol. 280 Issue 1, p127 

    Introduction: A pregnant patient, with term intrauterine fetal demise, who developed cardiopulmonary arrest during labor, followed by disseminated intravascular coagulation (DIC) secondary to amniotic fluid embolism (AFE) that was treated with Recombinant Factor VIIa, is...

  • cardiopulmonary bypass. Peters, Michael // BMA A-Z Family Medical Encyclopedia;2004, p145 

    An encyclopedia entry for "cardiopulmonary bypass" is presented. It refers to a procedure commonly used during heart surgery by which the circulation of blood around the body is maintained while the heart is stopped during surgery. To maintain the supply of oxygenated blood to the body tissues,...

  • Emerging Technologies in Biocompatible Surface Modifying Additives: Quest for Physiologic Cardiopulmonary Bypass. Gunaydin, Serdar // Current Medicinal Chemistry - Cardiovascular & Hematological Age;Oct2004, Vol. 2 Issue 4, p295 

    Modification of polymer surfaces to achieve a surface with enhanced compatibility is an important means of obtaining improved biomaterials. The molecular design of the novel technologies is carried out with attention to create a biomembrane-mimicking surface on medical devices. This review...

  • O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management? de Somer, Filip; Mulholland, John W.; Bryan, Megan R.; Aloisio, Tommaso; Van Nooten, Guido J.; Ranucci, Marco // Critical Care;2011, Vol. 15 Issue 4, p1 

    Introduction: Acute kidney injury (AKI) is common after cardiac operations. There are different risk factors or determinants of AKI, and some are related to cardiopulmonary bypass (CPB). In this study, we explored the association between metabolic parameters (oxygen delivery (DO2) and carbon...

  • Renal function and cardiopulmonary bypass in pediatric cardiac surgical patients. Lema, Guillermo; Vogel, Andrea; Canessa, Roberto; Jalil, Roberto; Carvajal, Claudia; Becker, Pedro; Jaque, Maria; Fajardo, Christian; Urzua, Jorge // Pediatric Nephrology;Oct2006, Vol. 21 Issue 10, p1446 

    We studied prospectively the perioperative changes of renal function in nine children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured with inulin and 131I-hippuran clearances before CPB, during...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics