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Gerstein NS, Panikkath PV, Mirrakhimov AE, Lewis AE, Ram H. Cardiopulmonary Bypass Emergencies and Intraoperative Issues. J Cardiothorac Vasc Anesth 2022; 36:4505-4522. [PMID: 36100499 DOI: 10.1053/j.jvca.2022.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/29/2022] [Accepted: 07/10/2022] [Indexed: 11/11/2022]
Abstract
Cardiopulmonary bypass (CPB) is a complex biomechanical engineering undertaking and an essential component of cardiac surgery. However, similar to all complex bioengineering systems, CPB activities are prone to a variety of safety and biomechanical issues. In this narrative review article, the authors discuss the preventative and intraoperative management strategies for a number of intraoperative CPB emergencies, including cannulation complications (dissection, malposition, gas embolism), CPB equipment issues (heater-cooler failure, oxygenator issues, electrical failure, and tubing rupture), CPB circuit thrombosis, medication issues, awareness during CPB, and CPB issues during transcatheter aortic valve replacement.
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Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Pramod V Panikkath
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Aibek E Mirrakhimov
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Alexander E Lewis
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Harish Ram
- Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL
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2
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Izzat MB. Effective handling of substantial arterial air embolization during extracorporeal perfusion. Clin Case Rep 2019; 7:2568-2570. [PMID: 31893101 PMCID: PMC6935650 DOI: 10.1002/ccr3.2510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 11/05/2022] Open
Abstract
This report highlights the need for a coordinated approach to substantial arterial air embolization, considering the high risk of neurologic injury. Appropriate management may involve systemic hypothermia, hyperoxia, and retrograde cerebral perfusion.
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Ma P, Wang S, Guan R, Hu L, Wang X, Ge A, Zhu J, Du W, Liu BF. An integrated microfluidic device for studying controllable gas embolism induced cellular responses. Talanta 2019; 208:120484. [PMID: 31816727 DOI: 10.1016/j.talanta.2019.120484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/15/2019] [Accepted: 10/18/2019] [Indexed: 01/05/2023]
Abstract
Gas embolism is the abnormal emergence of bubble in the vascular system, which can induce local ischemic symptoms. For studying the mechanism underlying gas embolism and revealing local ischemic diseases information, novel technique for analyzing cells response to bubble contact with high controllability is highly desired. In this paper, we present an integrated microfluidic device for the precise generation and control of microbubble based on the gas permeability of polydimethysiloxane (PDMS) to study the effect of bubble's mechanical contact on cells. Cell viability analysis demonstrated that short-term (<15 min) bubble contact was generally non-lethal to cultured endothelial cells. The significant increase in intracellular calcium of the microbubble-contacted cells and cell-to-cell propagation of calcium signal in the adjacent cells were observed during the process of bubble expansion. In addition, the analysis of intercellular calcium signal in the cells treated with suramin and octanol revealed that cell-released small nucleotides and gap junction played an important role in regulating the propagation of calcium wave triggered by bubble contact. Thus, our microfluidic method provides an effective platform for studying the effect of gas embolism on cultured adherent cells and can be further needed for anti-embolism drugs test.
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Affiliation(s)
- Peng Ma
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Shanshan Wang
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; BGI Education Center, University of Chinese Academy of Sciences, Shenzhen 518083, China
| | - Ruixue Guan
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Liang Hu
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; School of Ophthalmology & Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Xixian Wang
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; Single Cell Center, CAS Key Laboratory of Biofuels and Shandong Key Laboratory of Energy Genetics, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, Qingdao 266101, China
| | - Anle Ge
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; Single Cell Center, CAS Key Laboratory of Biofuels and Shandong Key Laboratory of Energy Genetics, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, Qingdao 266101, China
| | - Jinchi Zhu
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Wei Du
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
| | - Bi-Feng Liu
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
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Quintero OL, Giraldo JC, Sandoval NF. Successful Management of Massive Air Embolism During Cardiopulmonary Bypass Using Multimodal Neuroprotection Strategies. Semin Cardiothorac Vasc Anesth 2018; 23:324-332. [DOI: 10.1177/1089253218819782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team. All caregivers involved in this event must synchronize their responses quickly, harmoniously, and in such a way that all interventions lead to minimizing the impact of this complication. Its occurrence leaves important lessons to the surgical team that faces it. The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected. It is the duty of each surgical team to determine and clearly organize which strategies will be followed. The purpose of this case study was to demonstrate that a massive air embolism can be rapidly detected using near-infrared spectroscopy monitoring and can be successfully corrected with a multimodal neuroprotection strategy.
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Affiliation(s)
- Olga L. Quintero
- Universidad del Rosario, Bogotá, Colombia
- Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
| | - Juan C. Giraldo
- Universidad del Rosario, Bogotá, Colombia
- Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
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Malik N, Claus PL, Illman JE, Kligerman SJ, Moynagh MR, Levin DL, Woodrum DA, Arani A, Arunachalam SP, Araoz PA. Air embolism: diagnosis and management. Future Cardiol 2017. [DOI: 10.2217/fca-2017-0015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Air embolism is an uncommon, but potentially life-threatening event for which prompt diagnosis and management can result in significantly improved patient outcomes. Most air emboli are iatrogenic. Arterial air emboli may occur as a complication from lung biopsy, arterial catheterization or cardiopulmonary bypass. Immediate management includes placing the patient on high-flow oxygen and in the right lateral decubitus position. Venous air emboli may occur during pressurized venous infusions, or catheter manipulation. Immediate management includes placement of the patient on high-flow oxygen and in the left lateral decubitus and/or Trendelenburg position. Hyperbaric oxygen therapy is the definitive treatment which may decrease the size of air emboli by facilitating gas reabsorption, while also improving tissue oxygenation and reducing ischemic reperfusion injury.
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Affiliation(s)
- Neera Malik
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Paul L Claus
- Department of Hyperbaric & Altitude Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jeffery E Illman
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Seth J Kligerman
- Department of Radiology & Nuclear Medicine, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201, USA
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - David L Levin
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - David A Woodrum
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | | | - Philip A Araoz
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
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Inci K, Koutouzi G, Chernoray V, Jeppsson A, Nilsson H, Falkenberg M. Air bubbles are released by thoracic endograft deployment: An in vitro experimental study. SAGE Open Med 2016; 4:2050312116682130. [PMID: 27994872 PMCID: PMC5153025 DOI: 10.1177/2050312116682130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/09/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose: Embolic stroke is a dreaded complication of thoracic endovascular aortic repair. The prevailing theory about its cause is that particulate debris from atherosclerotic lesions in the aortic wall are dislodged by endovascular instruments and embolize to the brain. An alternative source of embolism might be air trapped in the endograft delivery system. The aim of this experimental study was to determine whether air is released during deployment of a thoracic endograft. Methods: In an experimental benchtop study, eight thoracic endografts (five Medtronic Valiant Thoracic and three Gore TAG) were deployed in a water-filled transparent container drained from air. Endografts were prepared and deployed according to their instructions for use. Deployment was filmed and the volume of air released was collected and measured in a calibrated syringe. Results: Air was released from all the endografts examined. Air volumes ranged from 0.1 to 0.3 mL for Medtronic Valiant Thoracic and from <0.025 to 0.04 mL for Gore TAG. The largest bubbles had a diameter of approximately 3 mm and came from the proximal end of the Medtronic Valiant device. Conclusion: Air bubbles are released from thoracic endografts during deployment. Air embolism may be an alternative cause of stroke during thoracic endovascular aortic repair.
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Affiliation(s)
- Kamuran Inci
- Department of Surgery, Varberg Hospital, Varberg, Sweden
| | - Giasemi Koutouzi
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Valery Chernoray
- Department of Applied Mechanics, Chalmers University of Technology, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Thoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Håkan Nilsson
- Department of Applied Mechanics, Chalmers University of Technology, Gothenburg, Sweden
| | - Mårten Falkenberg
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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