Japanese Journal of Cardiovascular Surgery Vol48,No1

“De-airing” in Open Heart Surgery―Report on a Nation-Wide Survey Prior to a CVSAP:Symposium and Literature Review
Kazumasa Orihashi* Toshihiko Ueda**

(Second Department of Surgery, Kochi Medical School*, Nankoku, Japan, and Division of Cardiovascular Surgery, Tokai University Hachioji Hospital**, Hachioji, Tokyo, Japan)

Since the beginning of cardiac surgery, retained intracardiac air has been one of the important problems to be solved. While transesophageal echocardiography enabled visualization of the air, and de-airing procedures have been routinely carried out, they appear to vary much among institutions and are not necessarily based on firm scientific evidence. Thus, “de-airing” was chosen as the theme of the 2016 CVSAP(Cardiovascular surgery and Anesthesia and Perfusion)Symposium and a nation-wide questionnaire survey was carried out prior to it. This paper reports the results of this survey and illustrates “the best de-airing” at present, based on the literature review. The collection rate of the questionnaire survey was high:77.9%(278/357)and 83.3%(85/102)from major institutions of surgeons and anesthesiologists, respectively, indicating a high level of interest. More than 90% of both considered de-airing as important since adverse events related to air embolism were actually encountered, including some critical ones. Most routinely performed de-airing procedures are posture change, lung inflation and aspiration through the vent cannulae. Direct aspiration of air is carried out in only one-third of institutions. Carbon dioxide insufflation is performed in 82.5% of institutions, mostly at a rate of 2~3L/min. However, not a few surgeons are skeptical of its significance. While many surgeons are grateful for collaboration by anesthesiologists, some expect more information sharing between them. They also expect better comprehension of “de-airing” and timely manipulation of extracorporeal circulation system by clinical engineers to avoid undesirable events. Some surgeons expressed a wish for a convenient device for de-airing. Furthermore, some questions to be solved in the future were raised, including how meticulously the bubbles should be removed or how efficient carbon dioxide insufflation is.

 

Jpn. J. Cardiovasc. Surg. 48:25-34(2019)

Keywords:cardiac surgery;retained air;air embolism


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