To compare the efficiency of 20 and 40 µm arterial line filters during cardiopulmonary bypass for the removal of emboli from the extracorporeal circuit.
Methods:
Twenty-four adult patients undergoing surgery were perfused using a cardiopulmonary bypass circuit containing either a 20 µm or 40 µm arterial filter (n = 12 in both groups). The Emboli Detection and Classification system was used to count emboli upstream and downstream of the filter throughout cardiopulmonary bypass. The mean proportion of emboli removed by the filter was compared between the groups.
Results:
The 20 µm filter removed a significantly greater proportion of incoming emboli (0.621) than the 40 µm filter (0.334) (p=0.029). The superiority of the 20 µm filter persisted across all size groups of emboli larger than the pore size of the 40 µm filter.
Conclusion:
The 20 µm filter removed substantially more emboli than the 40 µm filter during cardiopulmonary bypass in this comparison.
WillcoxTMitchellSJ. Microemboli in our bypass circuits: a contemporary audit. J Extra Corpor Technol2009; 41: 31–37.
2.
LynchJEWellsCAkersT, et al. Monitoring microemboli during cardiopulmonary bypass with the EDAC quantifier. J Extra Corpor Technol2010; 42: 212–218.
3.
WhitakerDCNewmanSPStygallJHope-WynneCHarrisonMJWalesbyRK. The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery. Eur J Cardiothorac Surg2004; 25: 267–274.
4.
PugsleyWKlingerLPaschalisCTreasureTHarrisonMNewmanSP. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke1994; 25: 1393–1399.
5.
MitchellSJ. From trash to leucocytes: what are we filtering and why?J Extra Corpor Technol2006; 38: 58–63.
6.
De SomerFMVetranoMRVan BeekJPVan NootenGJ. Extracorporeal bubbles: a word of caution. Interact Cardiovasc Thorac Surg2010; 10: 995–1001.
7.
PadayacheeTSParsonsSTheoboldRGoslingRGDeverallPB. The effect of arterial filtration on reduction of gaseous microemboli in the middle cerebral artery during cardiopulmonary bypass. Ann Thoac Surg1988; 45: 647–649.
8.
MitchellSJGormanDF. The pathophysiology of cerebral arterial gas embolism. J Extra Corpor Technol2002; 34: 18–23.
MitchellSJWillcoxTGormanDF. Bubble generation and venous air filtration by hard-shell venous reservoirs: a comparative study. Perfusion1997; 12: 325–333.
11.
TaylorRLBorgerMAWeiselRDFedorkoLFeindelCM. Cerebral microemboli during cardiopulmonary bypass: increased emboli during perfusionist interventions. Ann Thorac Surg1999; 68: 89–93.
12.
SilbertBEveredLScottDA. Cognitive decline in the elderly: is anaesthesia implicated?Best Pract Res Clin Anaesthesiol2011; 25: 379–393.
13.
KruisRWVlasveldFAVan DijkD. The (un)importance of cerebral microemboli. Semin Cardiothorac Vasc Anesth2010; 14: 111–118.
14.
StumpDATegelerCHRogersAT, et al. Neuropsychological deficits are associated with the number of emboli detected during cardiac surgery. Stroke1993; 3: 509.
15.
ClarkREBrillmanJDavisDALovellMRPriceTRMacgovernGJ. Microemboli during coronary artery bypass grafting. Genesis and effect on outcome. J Thorac Cardiovasc Surg1995; 109: 249–257.
16.
StumpDAFedorkoLBrookerRHilbawiHKonNAHammonJW. Biochemical markers of brain injury, embolic load, bypass time and neurobehavioural deficits after CABG surgery: is there a relationship. Ann Thorac Surg1997; 64: 920.
17.
ArrowsmithJEStygallJTimberlakeN, et al. Correlation between middle cerebral artery microemboli and neuropsychological deficits following cardiopulmonary bypass with a membrane oxygenator. Ann Thorac Surg1997; 64: 924.
18.
HammonJWStumpDAKinND, et al. Risk factors and solutions for the development of neurobehavioral changes after coronary artery bypass grafting. Ann Thorac Surg1997; 63: 1613–1618.
19.
HillsBAJamesPB. Microbubble damage to the blood-brain barrier: relevance to decompression sickness. Undersea Biomed Res1991; 18: 111–116.
20.
HelpsSCMeyer-WittingMReillyPLGormanDF. Increasing doses of intracarotid air and cerebral blood flow in rabbits. Stroke1990; 21: 1340–1345.
21.
CantaisELougePSuppiniAFosterPPParmierB. Right-to-left shunt and risk of decompression illness with cochleovestibular and cerebral symptoms in divers: case control study in 101 consecutive dive accidents. Crit Care Med2003; 31: 84–88.
22.
HillsBAButlerBD. Size distribution of intravascular air emboli produced by decompression. Undersea Biomed Res1981; 8: 163–170.
23.
MitchellSJDooletteDJ. Selective vulnerability of the inner ear to decompression sickness in divers with right-to-left shunt: the role of tissue gas supersaturation. J Appl Physiol2009; 106: 298–301.
24.
ChristinFBouffardYRossiRDelafosseB. Paradoxical symptomatic air embolism after saline contrast transesophageal echocardiography. Echocardiography2007; 24: 867–869.
25.
SastrySMacNabADalyKRaySMcCollumC. Is transcranial Doppler for the detection of venous-to-arterial circulation shunts reproducible?Cerebrovasc Dis2007; 23: 424–429.
