Comparison between transcranial Doppler and Coulter counter for detection of lipid micro embolization from mediastinal shed blood reinfusion during cardiac surgery
Restricted accessResearch articleFirst published online November, 2011
Comparison between transcranial Doppler and Coulter counter for detection of lipid micro embolization from mediastinal shed blood reinfusion during cardiac surgery
Introduction: Lipid micro embolization (LME) from re-transfused shed blood has been postulated to be a potential reason for short- and long-term cognitive dysfunction after cardiac surgery. The purpose of this investigation was to evaluate if transcranial Doppler (TCD) has the capacity to detect LME.
Methods: Thirteen patients undergoing cardiopulmonary bypass surgery were investigated. Each patient’s cerebral circulation was monitored with transcranial Doppler during the first two minutes after re-transfusion of shed blood and blood was simultaneously sampled and characterised by a Coulter counter.
Results: Strong correlation was found between embolic loads, as measured by transcranial Doppler and Coulter counter (r=0.79, P<0.005).
Conclusions: This pilot study shows that non-invasive monitoring by transcranial Doppler could be a potential tool to monitor LME during cardiopulmonary bypass surgery.
BrookerRFBrownWRMoodyDM. Cardiotomy suction: a major source of brain lipid emboli during cardiopulmonary bypass. Ann Thorac Surg1998; 65(6): 1651–1655.
2.
BrondenBDenckerMAllersMPlazaIJonssonH. Differential distribution of lipid microemboli after cardiac surgery. Ann Thorac Surg2006; 81(2): 643–648.
3.
KazaAKCopeJTFiserSM. Elimination of fat microemboli during cardiopulmonary bypass. Ann Thorac Surg2003; 75(2): 555–559.
4.
EyjolfssonASciclunaSJohnssonPPeterssonFJonssonH. Characterization of lipid particles in shed mediastinal blood. Ann Thorac Surg2008; 85(3): 978–981.
MoodyDMBrownWRChallaVRStumpDAReboussinDMLegaultC. Brain microemboli associated with cardiopulmonary bypass: a histologic and magnetic resonance imaging study. Ann Thorac Surg1995; 59(5): 1304–1307.
BrucherRRussellD. Automatic online embolus detection and artifact rejection with the first multifrequency transcranial Doppler. Stroke2002; 33(8): 1969–1974.
11.
SmithJLEvansDHBellPRNaylorAR. A comparison of four methods for distinguishing Doppler signals from gaseous and particulate emboli. Stroke1998; 29(6): 1133–1138.
12.
JewellAEAkowuahEFSuvarnaSKBraidleyPHopkinsonDCooperG. A prospective randomised comparison of cardiotomy suction and cell saver for recycling shed blood during cardiac surgery. Eur J Cardiothorac Surg2003; 23(4): 633–636.
13.
AppelbladMEngstromG. Fat contamination of pericardial suction blood and its influence on in vitro capillary-pore flow properties in patients undergoing routine coronary artery bypass grafting. J Thorac Cardiovasc Surg2002; 124(2): 377–386.
14.
WikstrandVLinderNEngstromKG. Evaluation of the Doppler technique for fat emboli detection in an experimental flow model. J Extra Corpor Technol2008; 40(3): 175–183.
15.
BrondenBDenckerMBlomquistSPlazaIAllersMJonssonH. The kinetics of lipid micro-emboli during cardiac surgery studied in a porcine model. Scand Cardiovasc J2008; 42(6): 411–416.
16.
AaslidRMarkwalderTMNornesH. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg1982; 57(6): 769–774.
17.
ZangerleAKiechlSSpiegelM. Recanalization after thrombolysis in stroke patients: predictors and prognostic implications. Neurology2007; 68(1): 39–44.
18.
CarreraESchmidtJMOddoM. Transcranial Doppler ultrasound in the acute phase of aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis2009; 27(6): 579–584.
19.
KlingelhoferJConradBBeneckeRSanderDMarkakisE. Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease. J Neurol1988; 235(3): 159–162.
20.
MonteiroLMBollenCWvan HuffelenACAckerstaffRGJansenNJvan VughtAJ. Transcranial Doppler ultrasonography to confirm brain death: a meta-analysis. Intensive Care Med2006; 32(12): 1937–1944.
21.
SouteyrandGMotreffPLussonJR. Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients. Eur J Echocardiogr2006; 7(2): 147–154.
22.
RitterMAJurkKSchriekCNabaviDG. Microembolic signals on transcranial Doppler ultrasound are correlated with platelet activation markers, but not with platelet-leukocyte associates: a study in patients with acute stroke and in patients with asymptomatic carotid stenosis. Neurol Res2009; 31(1): 11–16.
23.
KingSBIIILemboNJWeintraubWS. A randomized trial comparing coronary angioplasty with coronary bypass surgery. Emory Angioplasty versus Surgery Trial (EAST). N Engl J Med1994; 331(16): 1044–1050.
24.
TelmanGKouperbergEHlebtovskyASprecherEHoffmanABeyarR. Determinants of micro-embolic signals in patients with atherosclerotic plaques of the internal carotid artery. Eur J Vasc Endovasc Surg2009; 38(2): 143–147.
25.
Al-RashidiFLandenhedMBlomquistS. Comparison of the effectiveness and safety of a new de-airing technique with a standardized carbon dioxide insufflation technique in open left heart surgery: a randomized clinical trial. J Thorac Cardiovasc Surg2011May; 141(5): 1128–3113.
26.
TimaranCHRoseroEBMartinezAEIlarrazaAModrallJGClagettGP. Atherosclerotic plaque composition assessed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. J Vasc Surg2010; 52(5): 1188–1194.
27.
EyjolfssonAPlazaIBrondenBJohnssonPDenckerMBjurstenH. Cardiorespiratory effects of venous lipid micro embolization in an experimental model of mediastinal shed blood reinfusion. J Cardiothorac Surg2009; 4: 48.
28.
KincaidEHJonesTJStumpDA. Processing scavenged blood with a cell saver reduces cerebral lipid microembolization. Ann Thorac Surg2000; 70(4): 1296–1300.
29.
EngstromKGAppelbladM. Fat reduction in pericardial suction blood by spontaneous density separation: an experimental model on human liquid fat versus soya oil. Perfusion2003; 18(1): 39–45.
30.
JonssonHHolmCNilssonAPeterssonFJohnssonPLaurellT. Particle separation using ultrasound can radically reduce embolic load to brain after cardiac surgery. Ann Thorac Surg2004; 78(5): 1572–1577.
31.
PeterssonFNilssonAHolmCJonssonHLaurellT. Separation of lipids from blood utilizing ultrasonic standing waves in microfluidic channels. Analyst2004; 129(10): 938–943.
