Management of potential gas embolus during closure of an atrial septal defect                 in a three-year-old

Johnson, Charles E.; Faulkner, Sherry C.; Schmitz, Michael L.; Drummond-Webb, Jonathan J.

doi:10.1191/0267659103pf687oa

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…Other sources of venous gas can occur such as air entrainment from vascular cannulation or operative sites. 2 In Case 1, gas most likely entered the venous circulation from the bronchial venous system, as well as mediastinal and intercostal veins that were disrupted as a result of the pulmonary barotrauma. The second case we describe manifested venous gas emboli without such a clear association with ventilation-related trauma.…”

Section: Discussionmentioning

confidence: 99%

Management of continuous venous gas emboli during extracorporeal life support utilizing the Kolobow gas trap

et al. 2004

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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 patients may develop a continuous release of gas into the venous circulation from multiple sources. Two pediatric ECLS cases are presented with continuous venous gas embolism. A 'gas trap' was devised by creating a column of fluid erected vertically on the venous line. This allowed gas to rise within the column, separating it from the ECLS circuit, thus, preventing gas from lodging in the membrane.

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Section: Discussionmentioning

confidence: 99%

Management of continuous venous gas emboli during extracorporeal life support utilizing the Kolobow gas trap

et al. 2004

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“…1,22 Although its use is not standardized, case reports have suggested administering RCP for 1 to 2 minutes at 28°C and with a pressure ranging from 20 to 40 mm Hg in the arterial line of the CPB circuit. [22][23][24][25] Other authors have reported that RCP should be administered for 5 minutes with a flow of 300 to 500 mL/min while maintaining jugular venous pressure <25 mm Hg. 26 In our case, it was decided to titrate flow according to pressure in the arterial line in order to maintain pressure between 40 and 45 mm Hg and avoiding any increase above this range to prevent cerebral edema.…”

Section: Restore the Oxygen Supply-demand Balancementioning

confidence: 99%

Successful Management of Massive Air Embolism During Cardiopulmonary Bypass Using Multimodal Neuroprotection Strategies

Quintero

Giraldo

Sandoval

2018

Semin Cardiothorac Vasc Anesth

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Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team. All caregivers involved in this event must synchronize their responses quickly, harmoniously, and in such a way that all interventions lead to minimizing the impact of this complication. Its occurrence leaves important lessons to the surgical team that faces it. The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected. It is the duty of each surgical team to determine and clearly organize which strategies will be followed. The purpose of this case study was to demonstrate that a massive air embolism can be rapidly detected using near-infrared spectroscopy monitoring and can be successfully corrected with a multimodal neuroprotection strategy.

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“…In the case of gross air embolism, these efforts have been highly successful, but occasional case reports continue to appear. 4 However, elimination of GME from conventional CPB has proved more difficult.…”

Section: Introductionmentioning

confidence: 99%

Bubbles and bypass: an update

Kurusz

Butler

2004

Perfusion

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Bubbles in the bloodstream are not a normal condition--yet they remain a fact of cardiopulmonary bypass (CPB), having been extensively studied and documented since its inception some 50 years ago. While detectable levels of gaseous microemboli (GME) have decreased significantly in recent years and gross air embolism has been nearly eliminated due to increased awareness of etiologies and technological advances, methods of use of current perfusion systems continue to elicit concerns over how best to totally eliminate GME during open-heart procedures. A few studies have correlated adverse neurocognitive manifestations associated with excessive quantities of GME. Newer techniques currently in vogue, such as vacuum-assisted venous drainage, low-prime perfusion circuits, and carbon dioxide flooding of the operative field, have, in some instances, exacerbated the problem of gas embolism or engendered secondary complications in the safe conduct of CPB. Doppler monitoring (circuit or transcranial) primarily remains a research tool to detect GME emanating from the circuit or passing into the patients' cerebral vasculature. Newer developments not yet widely available, such as multiple-frequency harmonics, may finally provide a tool to distinguish particulate microemboli from GME and further delineate the clinical significance of GME.

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Management of potential gas embolus during closure of an atrial septal defect in a three-year-old

Cited by 6 publications

References 11 publications

Management of continuous venous gas emboli during extracorporeal life support utilizing the Kolobow gas trap

Management of continuous venous gas emboli during extracorporeal life support utilizing the Kolobow gas trap

Successful Management of Massive Air Embolism During Cardiopulmonary Bypass Using Multimodal Neuroprotection Strategies

Bubbles and bypass: an update

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