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J Thorac Cardiovasc Surg 1998;115:1393
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Air embolism with intraaortic balloon counterpulsation during cardiopulmonary bypass

To the Editor:

The recommendation in the recent letter by Mulay and associates ¹ to maintain intraaortic balloon (IAB) counterpulsation during the entire period of cardiopulmonary bypass (CPB) should be qualified with a word of caution: cases of significant air embolism have been reported if the aorta is opened (as it is for cannulation) at the onset of IAB deflation. ^2,3 In their letter, the authors noted that they temporarily stop the IAB pump when clamping or unclamping the aorta; on the basis of the previously reported cases, we believe the IAB should also be turned off with any aortotomy or when the arterial perfusion or cardioplegia cannulas or vents are being inserted or removed. It is particularly important to turn the IAB off if a period of circulatory arrest is used, as noted by Mills and Morris. ⁴ The generally accepted technique of momentarily lowering CPB blood flow when applying the aortic crossclamp or removing the cardioplegia cannula or ascending aortic vent will lower blood pressure in the aorta and may favor air entry with IAB deflation. Although this mechanism of arterial air embolism may be rare, the potential for sucking a relatively large volume (up to 40 cc) of room air into the ascending aorta during CPB is real and can be minimized by stopping the IAB when surgical maneuvers require that the aorta be opened. This word of caution should not detract from the message in the excellent letter of Mulay and associates ¹ outlining the benefits of pulsatility during CPB.

Department of SurgeryDivision of Cardiothoracic SurgeryThe University of Texas Medical Branch, Galveston, TX 77555-052812/8/89286

References

1. Mulay AV, Zacharias S, Hansbro SC, Catchpole RW, Nair RU. Should intraaortic balloon counterpulsation be continued during cardiopulmonary bypass? [letter]. J Thorac Cardiovasc Surg 1997;114:1128-9.[Free Full Text]
   
2. Kurusz M, Conti VR, Arens JF, Brown JP, Faulkner SC, Manning JV Jr. Perfusion accident survey. Proc Am Acad Cardiovasc Perfusion 1986;7:57-65.
   
3. Coughlan DWS, Diehl JT, Rice TW, et al. Ascending aortic insertion of the intra-aortic balloon catheter: the potential for air embolism. Proc Am Acad Cardiovasc Perfusion 1986;7:161-2.
   
4. Mills NL, Morris JM. Air embolism associated with cardiopulmonary bypass. In: Waldhausen JA, Orringer MB, editors. Complications in cardiothoracic surgery. St Louis: Mosby; 1991. p. 60-7.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Scott D. Lick Vincent R. Conti Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kurusz, M. Articles by Conti, V. R. Search for Related Content PubMed PubMed Citation Articles by Kurusz, M. Articles by Conti, V. R.