“De-airing” in Open Heart Surgery—Report on a Nation-Wide Survey Prior to a CVSAP : Symposium and Literature Review
- VernacularTitle:開心術における 『心内空気除去』： CVSAP シンポジウムにおける全国集計の報告および文献的考察
- Author:
Kazumasa ORIHASHI
1
;
Toshihiko UEDA
2
Author Information
- Keywords: cardiac surgery; retained air; air embolism
- From:Japanese Journal of Cardiovascular Surgery 2019;48(1):25-34
- CountryJapan
- Language:Japanese
- Abstract: 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∼3 L/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.
