This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rodriguez, R. A Articles by Nathan, H. J Search for Related Content PubMed PubMed Citation Articles by Rodriguez, R. A Articles by Nathan, H. J Social Bookmarking                   What's this?

Effect of perfusionist technique on cerebral embolization during cardiopulmonary bypass

Department of Anesthesiology, Cardiac Division, University of Ottawa Heart Institute, Ottawa, Ontario, Canada, Rrodriguez{at}Ottawaheart.ca

Kathryn A Williams

Department of Epidemiology and Community Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Andrei Babaev

Department of Perfusion, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Fraser Rubens

Department of Surgery, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Howard J Nathan

Department of Anesthesiology, Cardiac Division, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

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.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. Dittrich and E. B. Ringelstein Occurrence and Clinical Impact of Microembolic Signals During or After Cardiosurgical Procedures Stroke, February 1, 2008; 39(2): 503 - 511. [Abstract] [Full Text] [PDF]

				M. Boodhwani, F. Rubens, D. Wozny, R. Rodriguez, and H. J. Nathan Effects of sustained mild hypothermia on neurocognitive function after coronary artery bypass surgery: A randomized, double-blind study. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1443 - 1452.e1. [Abstract] [Full Text] [PDF]

				M. Perthel, L. El-Ayoubi, A. Bendisch, J. Laas, and M. Gerigk Clinical advantages of using mini-bypass systems in terms of blood product use, postoperative bleeding and air entrainment: an in vivo clinical perspective Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1070 - 1075. [Abstract] [Full Text] [PDF]

				R. A Rodriguez and D. Belway Comparison of two different extracorporeal circuits on cerebral embolization during cardiopulmonary bypass in children Perfusion, September 1, 2006; 21(5): 247 - 253. [Abstract] [PDF]

				R. A. Rodriguez, F. Rubens, D. Belway, and H. J. Nathan Residual air in the venous cannula increases cerebral embolization at the onset of cardiopulmonary bypass Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 175 - 180. [Abstract] [Full Text] [PDF]

				J. L Rudolph, D. Tilahun, P. R Treanor, V. E Pochay, M. A Mahendrakar, P. Sagar, and V. L Babikian Use of a large bore syringe creates significantly fewer high intensity transient signals (HITS) into a cardiopulmonary bypass system than a small bore syringe Perfusion, January 1, 2006; 21(1): 67 - 71. [Abstract] [PDF]