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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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Received: February 13, 1962
☆Supported in part by grants from the American Heart Association and the United States Public Health Service.
© 1962 Published by Elsevier Inc.