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The detection and prevention of gaseous microemboli (GME) during cardiopulmonary bypass has generated considerable interest within the cardiac surgical community. There have been several landmark papers that have used Transcranial Doppler devices during cardiopulmonary bypass to detect gaseous microemboli activity in the patients middle cerebral artery during perfusionist interventions. To determine if this source of emboli could be prevented, a shunt was developed between the oxygenators sampling manifold and the oxygenators venous line. This shunt bypassed the venous line and emptied into the oxygenators integral cardiotomy. An in vitro experiment was then performed using three open system oxygenators (Sorin Synthesis, Sorin PrimeOx2 and Terumo Capiox SX25) to compare post arterial filter emboli detection using the Hatteland CMD20 Microbubble Detector under tightly controlled conditions. After injection of air through the sampling manifold, the PrimeOx2 and the Synthesis oxygenators had statistically significant fewer GME with the shunt employed, than when the shunt was not employed. Using a shunt in the sampling manifold during perfusionist interventions will dramatically reduce or eliminate gaseous microemboli transmission to the patient during bypass, with both the PrimeOx2 and Synthesis oxygenators. However, results indicate that further investigation of GME handling with all oxygenators integral cardiotomies is warranted.
The detection and prevention of gaseous microemboli (GME) during cardiopulmonary bypass has generated considerable interest within the cardiac surgical community. There have been several landmark papers that have used Transcranial Doppler devices during cardiopulmonary bypass to detect gaseous microemboli activity in the patients middle cerebral artery during perfusionist interventions. To determine if this source of emboli could be prevented, a shunt was developed between the oxygenators sampling manifold and the oxygenators venous line. This shunt bypassed the venous line and emptied into the oxygenators integral cardiotomy. An in vitro experiment was then performed using three open system oxygenators (Sorin Synthesis, Sorin PrimeOx2 and Terumo Capiox SX25) to compare post arterial filter emboli detection using the Hatteland CMD20 Microbubble Detector under tightly controlled conditions. After injection of air through the sampling manifold, the PrimeOx2 and the Synthesis oxygenators had statistically significant fewer GME with the shunt employed, than when the shunt was not employed. Using a shunt in the sampling manifold during perfusionist interventions will dramatically reduce or eliminate gaseous microemboli transmission to the patient during bypass, with both the PrimeOx2 and Synthesis oxygenators. However, results indicate that further investigation of GME handling with all oxygenators integral cardiotomies is warranted.
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