Comparison of the effectiveness and safety of a new de-airing technique with a standardized carbon dioxide insufflation technique in open left heart surgery: a randomized clinical trial.

Comparison of the effectiveness and safety of a new de-airing technique with a standardized carbon dioxide insufflation technique in open left heart surgery: a randomized clinical trial.

MedLine Citation:	PMID: 20817209 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	OBJECTIVE: We have compared the effectiveness, time required for de-airing, and safety of a newly developed de-airing technique for open left heart surgery (Lund technique) with a standardized carbon dioxide insufflation technique. METHODS: Twenty patients undergoing elective open aortic valve surgery were randomized prospectively to the Lund technique (Lund group, n = 10) or the carbon dioxide insufflation technique (carbon dioxide group, n = 10). Both groups were monitored intraoperatively during de-airing and for 10 minutes after weaning from cardiopulmonary bypass by transesophageal echocardiography and online transcranial Doppler for the severity and the number of gas emboli, respectively. The systemic arterial partial pressure of carbon dioxide and pH were also monitored in both groups before, during, and after cardiopulmonary bypass. RESULTS: The severity of gas emboli observed on transesophageal echocardiography and the number of microembolic signals recorded by transcranial Doppler were significantly lower in the Lund group during the de-airing procedure (P = .00634) and in the first 10 minutes after weaning from cardiopulmonary bypass (P = .000377). Furthermore, the de-airing time was significantly shorter in the Lund group (9 vs 15 minutes, P = .001). The arterial pH during the cooling phase of cardiopulmonary bypass was significantly lower in the carbon dioxide group (P = .00351), corresponding to significantly higher arterial partial pressure of carbon dioxide (P = .005196) despite significantly higher gas flows (P = .0398) in the oxygenator throughout the entire period of cardiopulmonary bypass. CONCLUSIONS: The Lund de-airing technique is safer, simpler, and more effective compared with the carbon dioxide insufflation technique. The technique is also more cost-effective because the de-airing time is shorter and no extra expenses are incurred.

Authors:	Faleh Al-Rashidi; Maya Landenhed; Sten Blomquist; Peter Höglund; Per-Axel Karlsson; Leif Pierre; Bansi Koul
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Publication Detail:	Type: Comparative Study; Journal Article; Randomized Controlled Trial Date: 2010-09-03
Journal Detail:	Title: The Journal of thoracic and cardiovascular surgery Volume: 141 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2011 May
Date Detail:	Created Date: 2011-04-18 Completed Date: 2011-06-17 Revised Date: 2011-11-28
Medline Journal Info:	Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States
Other Details:	Languages: eng Pagination: 1128-33 Citation Subset: AIM; IM
Copyright Information:	Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:	Department of Cardiothoracic Surgery, Skane University Hospital in Lund, University of Lund, Sweden.
Data Bank Information
Bank Name/Acc. No.:	ClinicalTrials.gov/NCT00934596
Export Citation:	APA/MLA Format Download EndNote Download BibTex
MeSH Terms
Descriptor/Qualifier:	Aged Aortic Valve / surgery* Blood Gas Analysis Carbon Dioxide* / economics Cardiac Surgical Procedures* Cardiopulmonary Bypass Cost-Benefit Analysis Echocardiography, Transesophageal Embolism, Air / blood, etiology, prevention & control, ultrasonography Female Hospital Costs Humans Insufflation / adverse effects, economics, methods Male Middle Aged Monitoring, Intraoperative Prospective Studies Registries Severity of Illness Index Sweden Time Factors Treatment Outcome Ultrasonography, Doppler, Transcranial
Chemical
Reg. No./Substance:	124-38-9/Carbon Dioxide
Comments/Corrections
Comment In:	J Thorac Cardiovasc Surg. 2011 Nov;142(5):1285; author reply 1285-6 [PMID: 22014347 ]

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