Key result
Median emboli counts during cardiopulmonary bypass were 69,853 in the venous line, 3,017 before the arterial filter, and 1,251 after, predominantly associated with specific perfusionist interventions.
Why the study?
What are the frequencies and sources of emboli associated with the heart-lung machine during cardiopulmonary bypass in patients undergoing cardiothoracic surgery?
Cohort (n=100)
Single-blind
No
What are the frequencies and sources of emboli associated with the heart-lung machine during cardiopulmonary bypass in patients undergoing cardiothoracic surgery?
Emboli occur frequently during cardiopulmonary bypass and are primarily driven by specific perfusionist interventions, highlighting targets for reducing neurologic injury risk during cardiac surgery.
Emboli counts drop across the arterial filter but link strongly to perfusionist actions; hypothesis-generating for technique modifications to lower neurologic injury risk.
Neurologic injury after cardiac surgery is principally associated with emboli. Although much work has focused on surgical sources of emboli, less attention has been focused on emboli associated with the heart–lung machine. We tested whether emboli are associated with discrete processes during cardiopulmonary bypass (CPB). One hundred patients undergoing cardiothoracic surgery were enrolled between April 2008 and May 2011 at a single medical center. During each surgical procedure, emboli were counted in three CPB locations: the venous side (Channel 1), before the arterial line filter (Channel 2), and after the arterial line filter (Channel 3). We used prespecified event markers to identify perfusionist interventions. Identical circuits were used on all patients. Of the 100 patients enrolled, 62 underwent isolated coronary artery bypass grafting (CABG), 17 underwent isolated valve operations, and 21 underwent CABG plus valve. Median counts across Channels 1, 2, and 3 were 69,853, 3,017, and 1,251, respectively. The greatest contributor to emboli in Channels 1, 2, and 3, respectively, were achieving the calculated CPB flow, opening of the electronic arterial line clamp, and introducing a hemofilter. The circuit technology was efficient in reducing total emboli counts from Channels 1–2 irrespective of the size of the emboli. Nearly 71% of all emboli 30–100 mm in size were removed from the circuit between Channels 2 and 3. No significant association was found between emboli counts and S100B release. Emboli occur frequently during CPB and are predominantly associated with the initiation of bypass, operation of the electronic arterial line clamp, and the initiation of a hemofilter. Continued work to reduce the occurrence of emboli is warranted.
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DeFoe et al. (2014) conducted a cohort in Cardiothoracic surgery requiring cardiopulmonary bypass (n=100). Discrete perfusion processes during cardiopulmonary bypass was evaluated on Emboli counts in the venous line, before the arterial line filter, and after the arterial line filter. Median emboli counts during cardiopulmonary bypass were 69,853 in the venous line, 3,017 before the arterial filter, and 1,251 after, predominantly associated with specific perfusionist interventions.
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