Proceedings

A Battle Plan in the Event of Massive Air Embolism during Open Heart Surgery

The Department of Cardiac Surgery, Kaiser Foundation Hospital, Los Angeles, CA

^* Direct communications to: William I. Brenner, M.D., Department of Cardiac Surgery, 1526 North Edgemont St., Los Angeles, CA 90027

Abstract

After nearly 30 years of clinical open-heart surgery, air embolism to the coronary and cerebral arterial circulations during cardiopulmonary bypass procedures still remains a persistent hazard. The true incidence of morbidity and mortality related to air embolism is difficult to determine because of a wide spectrum of clinical presentations. The major manifestations of coronary air embolism are arrhythmia and/or reduced cardiac output. Those of cerebral air embolism are frank stroke, confusion or postoperative psychosis. A “battle plan” is proposed to outline a rational course of action in the event of massive air embolism recognized in the course of an open heart operation. If followed, the damage to the patient can be minimized, and full recovery can result. This “battle plan” represents the synthesis of the cardiac surgical literature on the prevention, recognition and treatment of air embolism occurring during open heart surgery.