Research Article| Volume 52, ISSUE 3, P487-493, September 1962

Studies of the effects of position on the development of cerebral air embolism during open-heart surgery

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      The degree of cerebral air embolism, as measured by the volume of air collected in a bubble trap in the common carotid arteries, was determined in dogs in varying degrees of Trendelenburg positions: (a) when air was injected into the base of the aorta without extracorporeal circulation and (b) when air was introduced into the femoral artery with blood from a pump-oxygenator during total cardiopulmonary bypass.
      The following observations were made:
      • 1.
        1. The head-down position offers a statistically significant degree of protection when air is injected into the base of the aorta.
      • 2.
        2. Air has been demonstrated to remain trapped in the arch of the aorta for periods of up to 30 minutes.
      • 3.
        3. The Trendelenburg position offers some protection against air introduced by faulty extracorporeal equipment, especially if instituted during the maneuvers incidental to termination of bypass.
      • 4.
        4. Cross-clamping of the aorta or ventricular fibrillation enhances cerebral air embolism when air is introduced with the blood returned to the femoral artery during cardiopulmonary bypass.
      • 5.
        5. A portion of air added to the femoral artery return flow in extracorporeal circulation is removed by the mesenteric and celiac arteries.
      The clinical implications of these observations in open-heart surgery are apparent.
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