Cerebral Protection during Cardiopulmonary Bypass: Devices and Techniques to Prevent Air Embolism
The subject of optimum cerebral protection during cardiopulmonary bypass is far from resolved . However, in recent years important strides have been made in understanding which devices and techniques protect best. Air, or gas embolism (massive or micro) from the extracorporeal circuit has been implicated in neurologic dysfunction in patients following cardiopulmonary bypass (CPB). Prevention of air embolism has been the focus of surgeons and perfusionists since the advent of open-heart surgery in the 1950s. The dangers and consequences of air embolism, however, have been reported in the literature many centuries prior to the advent of open-heart surgery. The manifestations may be subtle or gross, transient or permanent, depending on several factors including volume and type of gas, rate of infusion, and methods of treatment used when air embolism is recognized. Technique considerations for minimizing gaseous microemboli include choice of circuit components and methods of their operation. Use of arterial filters and membrane oxygenators has been suggested for decreasing gaseous microemboli. In cases of air embolism, safety devices on the CPB circuit may limit the extent of patient injury.
KeywordsCardiopulmonary Bypass Safety Device Extracorporeal Circuit Cerebral Protection Pressure Relief Valve
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