Microemboli generated during extracorporeal circulation (ECC) are likely to induce neurological sequelae. This study examines whether the choice of a distinct type of ECC can reduce intracerebral emboli counts. Middle cerebral artery blood flow during coronary artery bypass grafting was monitored continuously by transcranial Doppler ultrasound in 45 patients. The ECC systems used were a roller pump (n = 16), a centrifugal pump (n = 18) and a combination of centrifugal pump and heparin-coated ECC system (n = 11). Patients’ characteristics as well as surgical and anesthesiological procedure did not differ between the groups. Total counts did not differ significantly between the three groups. Intraoperative events in individual patients may lead to massive embolus generation overcoming positive properties of a distinct ECC system.

Libman RB, Wirkowski E, Neystat M, Barr W, Gelb S, Graver M: Stroke associated with cardiac surgery. Arch Neurol 1997;54:83–87.
Blauth CI: Macroemboli and microemboli during cardiopulmonary bypass. Ann Thorac Surg 1995;59:1300–1303.
Blauth CI, Arnold JV, Schulenberg WE, McCartney AC, Taylor KM: Cerebral microembolism during cardiopulmonary bypass. Retinal microvascular studies in vivo with fluorescin angiography. J Thorac Cardiovasc Surg 1988;95:668–678.
Moody DM, Brown WR, Challa VR, Stump DA, Reboussin DM, Legault C: Brain microemboli associated with cardiopulmonary bypass: A histologic and magnetic resonance imaging study. Ann Thorac Surg 1995;59:1304–1307.
Bruggemans EF, van Dijk JG, Huysmans HA: Residual cognitive dysfunctioning at 6 months following coronary artery bypass graft surgery. Eur J Cardiothorac Surg 1995;9:636–643.
Utley JR: Pathophysiology of cardiopulmonary bypass: Current issues. J Cardiac Surg 1990;5:177–189.
Waaben J, Sorensen HR, Andersen ULS, et al: Arterial line filtration protects brain microcirculation during cardiopulmonary bypass in the pig. J Thorac Cardiovasc Surg 1994;107:1030–1035.
Baker AJ, Naser B, Benaroia M, Mazer CD: Cerebral microemboli during coronary artery bypass using different cardioplegia techniques. Ann Thorac Surg 1995;59:1187–1181.
Johnston WE, Stump DA, DeWitt DS, et al: Significance of gaseous microemboli in the cerebral circulation during cardiopulmonary bypass in dogs. Circulation 1993;88:II319–329.
Bashein G, Townes D, Nessly ML, et al: A randomized study of carbon dioxide management during hypothermic cardiopulmonary bypass. Anaesthesiology 1990;71:7–15.
Markus HS, Harrison MJ: Microembolic signal detection using ultrasound. Stroke 1995;26:1517–1519.
Nevin M: Blood gas management; in Smith PL, Taylor KM (eds): Cardiac Surgery and the Brain. London, Edward Arnold, 1993, pp 197–214.
Consensus Committee of the 9th International Cerebral Hemodynamics Symposium: Basic identification criteria of Doppler microembolic signals. Stroke 1994;25:1123.
Pugsley W, Klinger L, Paschalis C, Treasure T, Harrison M, Newman S: The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke 1994;25:1393–1399.
Braekken SG, Russell D, Brucher R, Abdelnoor M, Svennevig J: Cerebral microembolic signals during cardiopulmonary bypass surgery: Frequency, time of occurrence, and association with patient and surgical characteristics. Stroke 1997;28:1988–1992.
Trivedi UH, Turtle MRJ, Abboud S, Venn GE, Chambers DJ: Differences in microemboli production between roller pump and centrifugal pump during cardiopulmonary bypass. Abstract from Pathophysiology and Techniques of Cardiopulmonary Bypass, San Diego 1996.
Bunegin L, Wahl H, Albin MS: Detection and volume estimation of embolic air in the middle cerebral artery using transcranial Doppler sonography. Stroke 1994;25:593–600.
Clark RE, Brillman J, Davis DA, Lovell MR, Price TRP, Magovern GJ: Microemboli during coronary artery bypass grafting. J Thorac Cardiovasc Surg 1995;109:249–258.
Georgiadis D, Mackay TG, Kelman AW, Grosset DG, Wheatley DJ, Lees KR: Differentiation between gaseous and formed embolic material in vivo. Application in prosthetic heart valve patients. Stroke 1994;25:1559–1563.
Markus HS, Brown MM: Differentiation between different pathological cerebral embolic materials using transcranial Doppler in an in vitro model. Stroke 1993;24:1–5.
Gerraty RP, Bowser DN, Infeld B, Mitchell PJ, Davis SM: Microemboli during carotid angiography. Stroke 1996;27:1543–1547.
Moody DM, Brown WR, Challa VR, Stump DA, Reboussin DM, Legault C: Brain microemboli associated with cardiopulmonary bypass: A histologic and magnetic resonance imaging study. Ann Thorac Surg 1995;59:1304–1307.
Ring HG, David NJ: Experimental air embolism. Studies with fluorescein cinematography. Arch Ophthalmol 1969;81:830–836.
Stump DA, Tegeler CH, Rogers AT, et al: Neuropsychological deficits are associated with the number of emboli detected during cardiac surgery (abstract). Stroke 1995;26:509.
Barbut D, Yao FS, Hager DN, Kavanaugh P, Trifiletti RR, Gold JP: Comparison of transcranial Doppler ultrasonography and transesophagial echocardiography to monitor emboli during coronary artery bypass surgery. Stroke 1996;27:87–90.
Van der Linden J, Casimir-Ahn H: When do cerebral emboli appear during open heart operations? A transcranial Doppler study. Ann Thorac Surg 1991;51:237–241.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.