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CVPR 371 Techniques II > Air Embolism Final Exam > Flashcards

Air Embolism Final Exam Flashcards

1
Q

3 types of blood borne emboli:

A
  • Cellular aggregates
  • Lipids
  • Fibrin
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2
Q

3 types of Foreign Material emboli:

A
  • Cotton Fibers
  • Plastic particles
  • metal particles
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3
Q

3 types of Gaseous emboli:

A
  • Micro gaseous GMEs
  • Visible air embolism
  • Gross air embolism
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4
Q

Out of the 284 incidents of air embolism during CPB,
which 2 has the highest occurrence?

Which has the lowest occurrence ?

A

Highest=

  • Inattention to reservoir level 104 (37%)
  • Ao root air during CPS admin 82 (29%)

Lowest =

  • Pressurized cardiotomy: 15 (5%)
  • Ruptured raceway tubing 16 (5%)
  • Unnoticed rotation of arterial pumphead 14 (5%)
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5
Q

What was the rate of air emboli occurrence as a result of a reversed LV vent line ?

A

26 (9%)

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6
Q

What was the rate of air emboli occurrence as a result of an unexpected heart beat?

A

27 (10%)

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7
Q

What are the 5 CPB air emboli safety devices?

A
  • Level Detector
  • Bubble detector
  • One way valves
  • Purge lines
  • Vent lines
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8
Q

What is the treatment for massive air embolism, which leads to a critical complication due to neurologic damage ?

A

Retrograde cerebral perfusion

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9
Q

Name 5 causes for massive air emboli ?

A
  • Sudden reduction in venous reservoir level due to large Aortopulmonary collaterals.
  • Inversion of left sided vent
  • Reversal of pump head
  • Air from cardiac chambers
  • Runaway pump head
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10
Q

How would you manage a massive air embolism?

A
  • Stop CPB immediately
  • Clamp venous line
  • Steep trendelenburg
  • Remove aortic cannula
  • Clamp out ALF if filled with air
  • De-air arterial cannulae & pump line
  • Retrograde hypothermic SVC perfusion
    30 - 40 mmHg
  • Resume antegrade CPB
  • 100% FiO2
  • Rewarm to 34 °c , no overheating
  • Induce hypertension
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11
Q

What are the parameters for Retrograde cerebral perfusion ?

Pressure:
Flow:
Temp:
Duration:

A

Pressure: 30 - 40 mmHg
Flow: 1 - 2 L/m
Temp: 20 - 24 °c
Duration: 1 - 4 min

Compression of carotid
Confirm no air in Ao cannulation site

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12
Q

What are the 3 cerebroprotectants administered in the O.R. for treatment of massive cerebral embolism ?

A
  • Methylprednisolone 30 mg/Kg
  • Mannitol 1gm/kg
  • Thiopental 20 mg/Kg
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13
Q

What are the 3 cerebroprotectants administered in the ICU for treatment of massive cerebral embolism ?

A
  • Methylprednisolone 30 mg/Kg
  • Mannitol 0.5 gm/kg Q 8hrs
  • Phenytoin 25 mg Q 12hrs
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14
Q

What is the temperature control for managing a massive cerebral emboli ?

A

Retrograde cerebral perfusion at 20 - 24°c for 1 - 4 min.

Do not rewarm completely! Rewarm to
33 - 34 °c.

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15
Q

What are the perfusionist responsibilities during a cerebral air embolism incident ?

A
  • Off CPB, clamp Venous and Arterial
  • Identify problem
  • Reprime circuit and Ao cannula
  • Retrograde SVC perfusion 1 - 2 L/m
  • Reinstitute CPB @ 22-30°c, ^ systemic pressures
  • FiO2 @ 100%
  • Off bypass @ 34°c
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16
Q

What are the Surgical responsibilities during a cerebral air embolism incident ?

A
  • Clamp and remove Ao cannula
  • Cannulate SVC or connect to SVC cannula
  • Retrieve blood/air exiting the Ao via vent.
  • When no more air is visible at aortonomy, recannulate the Ao and reinstitute bypass.
  • Bleed air from the coronaries
  • Complete surgical procedure
17
Q

What are the Surgical responsibilities during a cerebral air embolism incident ?

A
  • Steep T-burg
  • Compress carotid arteries
  • Consider administering:
    Steroids
    Mannitol
    Antiplatelet agents
    Barbituates
18
Q

Post bypass management of a cerebral air embolism ?

A
  • Ventilate with 100% FiO2
  • Slight hyperventilation
  • Rewarm to normothermia over 24hrs
  • Reverse T-Burg
  • Avoid hyperglycemia & hyponatraemia
  • Consider hyperbariac oxugen treatment
19
Q

What are the basic principles of management of massive air embolism during CPB ?

A
  • Make the diagnosis
  • Communicate the diagnosis
  • Prevent further embolism
  • Identify the source of air embolism
  • Limit organ damage
  • Clear the CPB circuit of air
  • Re-establish circulation
20
Q

Name 5 neuroprotectants used after cerebral air embolism ?

A
  • Corticosteroids
  • Antioxidants
  • Free radical scavengers
  • General anesthetic agents
  • Local anesthetics
21
Q

Perhaps retrograde cerebral perfusion is not as good as we think. Increased venous cerebral perfusion pressure is associated with destruction of the blood-brain barrier. What are the pressures suggested that will create the maximum retrograde cerebral flow with the least chance of producing increased ICP ?

A

20 - 25 mmHg

22
Q

What were the results of cerebral perfusion using india ink on the 10 pigs ?

A

Antegrade pigs intracranial artery and vnous system is completely filled with ink

Retrograde pigs - 10% of the cappilaries are filled with ink

CVPR 371 Techniques II (6 decks)

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