Does CO(2) flushing of the empty CPB circuit decrease the number of gaseous emboli in the prime?
Twenty (20) CPB-circuits were randomized to a CO(2) group or a control group. In the CO( 2) group, each circuit was flushed with CO(2) (10L/min) at the top of the venous reservoir for 5 minutes, after which priming fluid was added without interruption of the CO(2) 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 O(2)/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 CO(2) group remained lower (p < or = 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 CO(2) 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.
Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden. Jesper.nyman@karolinska.se
J
J
Nyman
C
C
Rundby
P
P
Svenarud
J
J
van der Linden
D002245:Carbon Dioxide / Q000737:chemistry*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D004618:Embolism, Air / Q000209:etiology / Q000517:prevention & control*; D006353:Heart-Assist Devices; D006801:Humans; D066298:In Vitro Techniques; D010107:Oxygenators, Membrane
D002245:Carbon Dioxide