Massive air embolism during cardiopulmonary bypass

Mills, Noel L.; Ochsner, John L.

doi:10.1016/s0022-5223(19)37716-5

Cited by 262 publications

(71 citation statements)

References 14 publications

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“…Kawada et al [24] have also reported promising results with a pump in the repair of traumatic thoracic ruptures. However, the insertion of cannulae into the left atrium or descending aorta just above the anastomotic site makes the anastomosis technically more difficult to perform, and can result in air embolism [25]. PCPS does not require manipulation of the left ventricle or an atherosclerotic aorta, and may result in :fewer air embolisms.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous cardiopulmonary support in surgery for descending thoracic aortic aneurysms

Komori¹,

Kuma²,

Guo³

et al. 1998

Int J Angiol

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Section: Discussionmentioning

confidence: 99%

Percutaneous cardiopulmonary support in surgery for descending thoracic aortic aneurysms

Komori¹,

Kuma²,

Guo³

et al. 1998

Int J Angiol

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“…21 Retrograde cerebral perfusion was originally reported as a treatment for massive air embolism during cardiopulmonary bypass. 22 In 1986, Miki and Uedal utilized this method to evacuate air and to flush out the particulate for a short time before declamping the aorta during operation on the aortic arch. Thereafter, expecting an effect of brain protection, they decided to use continuous retrograde cerebral perfusion.2 Recently, retrograde cerebral perfusion is being used more frequently.…”

Section: Flow Of Retrograde Cerebral Perfusion Ismentioning

confidence: 99%

Retrograde Cerebral Perfusion with Hypothermic Blood Provides Efficient Protection of the Brain: A Neuropathological Study

Imamaki¹,

Koyanagi²,

Hashimoto³

et al. 1995

J Cardiac Surgery

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Retrograde cerebral perfusion is a method that is recently being used for protection of the brain during operations on the aortic arch. This method is useful but is said to provide a limited time for protecting the brain. We designed an experiment in dogs to investigate neuropathologically the effect of protecting the brain for 120 minutes under: (1) circulatory arrest (CA); (2) retrograde cerebral perfusion with moderately cooled blood (RCPMC); and (3) retrograde cerebral perfusion with deeply cooled blood (RCPDC). We calculated the number of the abnormal cells of 400 hippocampal neurons per dog light microscopically. The number was 199 +/- 23 (mean +/- 1 SD) in the CA group, 149 +/- 50 in the RCPMC group, and 72 +/- 33 in the RCPDC group. The difference between the CA group and the RCPMC group was not statistically significant (p < 0.05), but there was a significant difference between the RCPMC and RCPDC groups (p < 0.05). The degree of cerebral protection provided by retrograde cerebral perfusion for 120 minutes is not sufficient when using moderately cooled blood. If we use deeply cooled blood at a temperature of about 10 degrees C, we should obtain a sufficient degree of protection of the brain.

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“…RCP was first introduced as a method to wash out massive air embolism sustained during the course of cardiopulmonary bypass (CPB). 3 Retrograde perfusion under hypothermic conditions has since been utilized intermittently, and also continuously, in an attempt to supply oxygenated blood to the brain via the venous system during aortic arch surgery. 4 In some centers, hypothermic RCP is being utilized routinely in lieu of circulatory arrest, but it has generally been performed at temperatures and for durations that are believed to be "safe" even for HCA.…”

mentioning

confidence: 99%

Comparison of Retrograde Cerebral Perfusion to Antegrade Cerebral Perfusion and Hypothermic Circulatory Arrest in a Chronic Porcine Model

Midulla¹,

Gandsas²,

Sadeghi³

et al. 2008

Journal of Cardiac Surgery

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Retrograde cerebral perfusion (RCP) is a new method of cerebral protection that has been touted as an improvement over hypothermic circulatory arrest (HCA). However, RCP has been used clinically for durations and at temperatures that are “safe” for HCA alone. This study was designed to compare RCP to HCA and antegrade cerebral perfusion (ACP) deliberately exceeding “safe” limits, in order to determine unequivocally whether RCP provides better cerebral protection than HCA. Four groups of six Yorkshire pigs (20 to 30 kg) were randomly assigned to undergo 90 minutes of RCP, ACP, HCA, or HCA with heads packed in ice (HCA‐HP) at an esophageal temperature of 20°C. Arterial, mixed venous and cerebral venous oxygen, glucose and lactate contents; quantitative EEG; were monitored at baseline (37°C); at the end of cooling cardiopulmonary bypass (20°C); during rewarming (30°C); and at two and four hours post intervention. Animals were recovered and were evaluated daily using a quantitative behavioral score (0 to 9). Mean behavioral score was lower in the HCA group than in the other three groups at seven days (HCA 5.8 ± 1.1; RCP 8.5 ± 0.2; ACP 9.0 ± 0.0; HCA‐HP 8.5 ± 0.2, p < 0.05). Recovery of QEEG was better in the ACP group than in all others, but the RCP group had faster EEG recovery than HCA alone, although not better than HCA‐HP (HCA 15 ± 4; RCP 27 ± 3; ACP 78 ± 5; HCA‐HP 19 ± 3, p < 0.001). However, histopathological evidence of ischemic injury was present in 5 of 6 HCA animals and also in 4 of 6 of the HCP‐HP group, but only In 1 of 6 RCP animals and in none of the ACP group. This study demonstrates that ACP affords the best cerebral protection by all outcome measures, but RCP provides clear improvement compared to HCA. (J Card Surg 1994;9:560–575)

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Massive air embolism during cardiopulmonary bypass

Cited by 262 publications

References 14 publications

Percutaneous cardiopulmonary support in surgery for descending thoracic aortic aneurysms

Percutaneous cardiopulmonary support in surgery for descending thoracic aortic aneurysms

Retrograde Cerebral Perfusion with Hypothermic Blood Provides Efficient Protection of the Brain: A Neuropathological Study

Comparison of Retrograde Cerebral Perfusion to Antegrade Cerebral Perfusion and Hypothermic Circulatory Arrest in a Chronic Porcine Model

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