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Ann Thorac Surg 1983;36:433-436
© 1983 The Society of Thoracic Surgeons

Articles

The Effectiveness of Venoarterial Perfusion in Treatment of Arterial Air Embolism during Cardiopulmonary Bypass

Frans F.A. Hendriks, Ph.D., Ad J. J.C. Bogers, M.D., Aart Brutel de la Rivière, M.D., Hans A. Huysmans, M.D.*, Gerard A. Brom, M.D.

Department of Cardiothoracic Surgery, University Medical Center, Leiden, The Netherlands

Accepted for publication October 19, 1982.

* Address reprint requests to Dr. Huysmans, Department of Cardiothoracic Surgery, University Medical Center, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands

In an experimental study using 6 pigs, the clinical situation of accidental air embolism was mimicked by introducing a known amount of pure nitrogen into the aortic perfusion line during standard hypothermic cardiopulmonary bypass. The treatment after embolization consisted of 15 minutes of perfusion flow reversal. A special device was built to enable quantitative assessment of the amount of gas that escaped through the aortic cannula during venoarterial perfusion. This showed that only 47% of the injected gas bolus could be removed from the circulation. However, microscopic and histological examinations of the brain of each pig one week postoperatively did not reveal trapped gas or ischemic tissue damage.

It is concluded that hyperbaric treatment after a clinical accident involving air embolism should be used if the embolus has reached the periphery before flow reversal can be effected. Since over 50% of the amount of gas introduced into the vasculature may remain behind even after prolonged venoarterial perfusion, ischemic damage of organs is still possible.




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