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Cerebral Air Embolism

Neurologic and neurocognitive deficits following cardiac surgery utilizing cardiopulmonary bypass (CPB) remain as common and severe complications with impact to patients quality of life. The etiology of these adverse outcomes is most likely multifactorial, including mainly the effects of cerebral emboli and generalized cerebral hypoperfusion next to inflammatory reactions. Cerebral emboli during CPB may present as particulate emboli released from atheromatous plaques during manipulation of the thoracic aorta or as gaseous emboli mainly entrained during open chamber procedures or generated within the CPB-circuit. High-intensity transient signals (HITS) are the ultrasonic signatures of air or solid emboli in the brain circulation as detected by transcranial Doppler (TCD). In patients undergoing open-heart surgery, most embolic signals are likely associated with air microbubbles but an unknown fraction may be represented by solid microemboli.