Detection and elimination of microemboli related to cardiopulmonary bypass.
Circ Cardiovasc Qual Outcomes
Adult, Aged, Aged, 80 and over, Cardiopulmonary Bypass, Coronary Artery Bypass, Coronary Artery Disease, Evidence-Based Medicine, Female, Humans, Intracranial Embolism, Intraoperative Complications, Male, Middle Aged, Middle Cerebral Artery, Monitoring, Intraoperative, Ultrasonography, Doppler
BACKGROUND: Neurobehavioral impairment is a common complication of coronary bypass surgery. Cerebral microemboli during cardiopulmonary bypass (CPB) are a principal mechanism of cognitive injury. The aim of this work was to study the occurrence of cerebral embolism during CPB and to evaluate the effectiveness of evidence-based CPB circuit component and process changes on the exposure of the patient to emboli.
METHODS AND RESULTS: M-Mode Doppler was used to detect emboli in the inflow and outflow of cardiopulmonary circuit and in the right and left middle cerebral arteries. Doppler signals were merged into a single display to allow real-time associations between discrete clinical techniques and emboli detection. One hundred sixty-nine isolated coronary artery bypass grafting (CABG) patients were studied between 2002 and 2008. There was no statistical difference in median microemboli detected in the inflow of the CPB circuit, (Phase I, 931; Phase II, 1214; Phase III, 1253; Phase IV, 1125; F [3,158]=0.8, P=0.96). Significant changes occurred in median microemboli detected in the outflow of the CPB circuit across phases, (Phase I, 702; Phase II, 572; Phase III, 596; Phase IV, 85; F [3,157]=13.1, P
CONCLUSIONS: Changes in CPB techniques and circuit components, including filter size and type of pump, resulted in a reduction in more than 75% of cerebral microemboli.
Groom, Robert C; Quinn, Reed D; Lennon, Paul; Donegan, Desmond J; Braxton, John H; Kramer, Robert S; Weldner, Paul W; Russo, Louis; Blank, Seth D; Christie, Angus A; Taenzer, Andreas H; Forest, Richard J; Clark, Cantwell; Welch, Janine; Ross, Cathy S; O'Connor, Gerald T; Likosky, Donald S; and Northern New England Cardiovascular Disease Study Group, "Detection and elimination of microemboli related to cardiopulmonary bypass." (2009). Maine Medical Center. 893.