title: Endogenous gas formation--an in vitro study with relevance to gas microemboli during cardiopulmonary bypass.
abstract: Gas embolism is an identified problem during cardiopulmonary bypass (CPB). Our aim was to analyze the potential influence from gas solubility based on simple physical laws, here called endogenous gas embolism. Gas solubility decreases at higher temperature and gas bubbles are presumably formed at CPB warming. An experimental model to measure gas release was designed. Medium (water or blood retrieved from mediastinal drains, 14.6 mL) was incubated and equilibrated with gas (air, 100% oxygen, or 5% carbon dioxide in air) at low temperature (10 degrees C or 23 degrees C). At warming to 37 degrees C, gas release was digitally measured. Also, the effect of fluid motion was evaluated. At warming, the medium became oversaturated with dissolved gas. When fluid motion was applied, gas was released to form bubbles. This was exemplified by a gas release of .45% (.31/.54, medians and quartile range, volume percent, p = .007) and 1.26% (1.14/ 1.33, p = .003) when blood was warmed from 23 degrees C or 10 degrees C to 37 degrees C, respectively (carbon dioxide 5% in air). Consistent findings were seen for water and with the other types of gas exposure. The theory of endogenous gas embolization was confirmed with gas being released at warming. The endogenous gas formation demonstrated a dynamic pattern with oversaturation and with rapid gas released at fluid motion. The gas release at warming was substantial, in particular when the results were extrapolated to full-scale CPB conditions. The interference from endogenous gas formation should be considered in parallel to external sources of gas microemboli.
  
  
  BACKGROUND
  cardiopulmonary bypass, gas embolization, microemboli, gas solubility, temperature.
authors.affiliation: Heart Centre, Cardiothoracic Surgery, Department of Surgery and Perioperative Sciences, University of Umeå, Umeå, Sweden. lena.e.lindholm@vll.se
authors.forename: Lena
authors.initials: L
authors.lastname: Lindholm
authors.forename: Karl Gunnar
authors.initials: KG
authors.lastname: Engström
mesh_terms: D032701:Biomimetics / Q000379:methods*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001810:Blood Volume; D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003198:Computer Simulation; D004618:Embolism, Air / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008955:Models, Cardiovascular