title: Arterial Limb Microemboli during Cardiopulmonary Bypass: Observations from a Congenital Cardiac Surgery Practice.
abstract: Gaseous microemboli (GME) are known to be delivered to the arterial circulation of patients during cardiopulmonary bypass (CPB). An increased number of GME delivered during adult CPB has been associated with brain injury and postoperative cognitive dysfunction. The GME load in children exposed to CPB and its consequences are not well characterized. We sought to establish a baseline of arterial limb emboli counts during the conduct of CPB for our population of patients requiring surgery for congenital heart disease. We used the emboli detection and counting (EDAC) device to measure GME activity in 103 consecutive patients for which an EDAC machine was available. Emboli counts for GME <40 μ and >40 μ were quantified and indexed to CPB time (minutes) and body surface area (BSA) to account for the variation in patient size and CPB times. Patients of all sizes had a similar embolic burden when indexed to bypass time and BSA. Furthermore, patients of all sizes saw a three-fold increase in the <40 μ embolic burden and a five-fold increase in the >40 μ embolic burden when regular air was noted in the venous line. The use of kinetic venous-assisted drainage did not significantly increase arterial limb GME. Efforts for early identification and mitigation of venous line air are warranted to minimize GME transmission to congenital cardiac surgery patients during CPB.
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Matte
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Connor
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Hua
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: James A
authors.initials: JA
authors.lastname: DiNardo
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Faraoni
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Frank
authors.initials: F
authors.lastname: Pigula
mesh_terms: D000328:Adult; D001830:Body Surface Area; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D004618:Embolism, Air / Q000453:epidemiology / Q000209:etiology; D004867:Equipment Design; D005121:Extremities / Q000098:blood supply*; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology
keywords: EDAC; adverse events; air embolism; cardiopulmonary bypass; congenital heart disease; gaseous microemboli