Massive Carbon Dioxide Gas Embolism: A Near Catastrophic Situation Averted by Use of Cardiopulmonary Bypass

Endovascular vein harvesting is used as a less invasive method when compared to the standard open surgical method of dissecting and procurement of the greater saphenous vein. The benefits include smaller incision, decreased blood loss, less pain, decreased transfusion, decreased risk of infection and enhanced epidermal cosmetics. However, endovascular vein harvesting does have a learning curve to master the technique and although endovascular vein harvesting is the preferred standard of practice over the open surgical technique, it does have inherent potential complications. During endovascular vein harvesting, there is a potential for the patient’s circulatory system to collapse which can be identified initially through hemodynamic monitoring, blood gas results, and vigilance through clinical observation. The suspected source of the crisis was confirmed when the surgeon cannulated the right atrium, where a massive gas source that (appeared pressurized) escaped upon incision of the right atrial appendage. Cardiopulmonary bypass (CPB) was utilized to support the patient and rectify the impending catastrophic event. Once full CPB was attained, we achieved hemodynamic stability and eventually all blood gases were normalized. Massive CO2 embolism is a life threatening emergency which must be identified and corrected instantaneously. CPB was the modality used to salvage this situation. Attention to the set-up of the EVH equipment, use of the transesophageal echocardiography, cerebral cximetry, vigilance and cooperation of all disciplines in the OR are definite recommendations to prevent such an occurrence. Experience gained by the perfusion team with a previous case was applied and helped to solve the immediate problems presented in this case

The Proposed Use of Performance Indices to Evaluate and Compare the “Gish Vision” Membrane Oxygenator

The objective of this investigation was to evaluate and compare the recently released Gish Vision® oxygenator with previously studied oxygenators. We utilized our previously described membrane oxygenator evaluation techniques as well as proposed the use of four new performance indices: 1) oxygen transfer index; 2) shunt fraction index; 3) pressure drop index; and 4) consistency index. We concluded that the new Gish Vision® membrane oxygenator offers the clinician the highest level of oxygen transfer “reserve” of any oxygenator we have tested. The use of our proposed performance indices enables the perfusionist to quickly and objectively compare various oxygenator performance characteristics and make a meaningful clinical comparison

CDI Blood Parameter Monitoring System 500—A New Tool for the Clinical Perfusionist

Sarns/3M Health Care has recently introduced the CDI 500 Blood Parameter Monitoring System. In addition to parameters previously available, this system now offers continuous monitoring of the patient’s oxygen consumption (VO2/min) and potassium concentration ([K+]). The purpose of this study was: (1) to compare the [K+] from the CDI 500 with the [K+] derived from our hospital’s laboratory; and (2) to compare the VO2/min from the CDI 500 with the results obtained utilizing the “gold-standard” Fick equation. The mean absolute difference in [K+] was 0.10 mEq/L with a mean percentage error of only 3.93%. The mean absolute difference in VO2/min was 18.78 ml O2/min, with a mean percentage error of 11.63%. We concluded that the [K+] correlated well and that 9.13% of the oxygen consumption percentage error was attributable to the exclusion of dissolved oxygen in the calculation used by the CDI 500, with the remaining 2.5% attributable to differences in technology. We recommended that future upgrades to the CDI 500 should include dissolved O2 when measuring oxygen consumption and consideration should be given to increasing the operating range for [K+]