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Abstract
One of the largest postoperative complications of cardiopulmonary bypass during cardiac surgery is neurocognitive impairment. Studies have shown that up to 50% to 70% of Coronary Artery Bypass Graft [CABG] patients present with neurocognitive impairment one-week post-procedure. Most of these deficits have been attributed to gaseous microemboli transfer during CPB at times such as cannulation and perfusionist interventions involving drug administration and blood gas sampling. Although microemboli transfer has significantly improved over the years, it still remains the responsibility of the perfusionist to implement techniques to try and minimize the amount of gaseous microemboli transfer to the patient.
In this study, a cardiopulmonary bypass circuit comprised of two different cardioplegia systems was constructed in order to test the mechanical efficacy of microemboli removal in each. For each, a 1 mL bolus of air was introduced to the circuit pre-cardioplegia and microemboli were measured both pre-cardioplegia and postcardioplegia using the Emboli Detection and Classification [EDAC] quantifier from Luna Innovations. Additionally, each cardioplegia unit was exposed to two different temperature conditions, normothermia and hypothermia, in order to test whether the solubility impacted microemboli transfer through the systems.
The results of this study showed that the Quest MPS® Myocardial Protection System removed a greater number, and volume, of microemboli than did the Avecor Myotherm [p is less than 0.05]. However, no impact of temperature was detected. The results of this study demonstrate that selection of cardioplegia setup is a crucial step in attempt on the part of the perfusionists to minimize gaseous microemboli transfer to the patient.