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Does CO 2 flushing of the empty CPB circuit decrease the number of gaseous emboli in the prime?

Karolinska Institutet, Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden, Jesper.nyman{at}karolinska.se

C. Rundby

Karolinska Institutet, Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden

P. Svenarud

Karolinska Institutet, Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden

J. van der Linden

Karolinska Institutet, Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden

Twenty (20) CPB-circuits were randomized to a CO₂ group or a control group. In the CO ₂ group, each circuit was flushed with CO₂ (10L/min) at the top of the venous reservoir for 5 minutes, after which priming fluid was added without interruption of the CO₂ inflow. Control group circuits were not flushed and contained air. A perfusionist, blinded to the study, started the pump (5L/min), ventilated the oxygenator (3L O₂/min), and knocked on the oxygenator 20 times during the first and 14^th minutes. Arterial line microemboli counts were registered with a Doppler for 15 minutes. In both groups, the median number of microemboli was highest during the first minute, 380.5 (288.75/422.25, 25^th/75^th percentile) counts in the control group versus 264.5 (171.75/422.25) counts in the CO ₂ group (p=0.01). Throughout the experiment, the median microembolic count minute by minute in the CO₂ group remained lower (p 0 .004) than in the control group. Knocking on the reservoir (14^th minute) increased the microemboli counts in both groups (p<0.01). The median values during the 15^th minute were 15.5 and 0.5 in the control and the CO₂ groups, respectively, which were 9% (15.5/173) and 0.5% (0.5/87), respectively, of the values registered after 14 minutes. In conclusion, CO ₂ flushing of the empty circuit decreases the number of gaseous emboli in the prime compared with a conventional circuit that contains air before being primed with fluid. Knocking of the oxygenator releases gaseous emboli and the duration of re-circulating the circuit with prime influences the number of microemboli.

Key Words: Surgery • extracorporeal circulation • air • emboli • Doppler.

This version was published on July 1, 2009

Perfusion, Vol. 24, No. 4, 249-255 (2009)
DOI: 10.1177/0267659109350241


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