“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