Dear Benjamin,

Your comments submitted "Oxygent may be helpful in removing unwanted air bubbles that are created when cardiopulmonary bypass (CPB) is used for coronary artery bypass grafting (CABG) procedures. These bubbles can block small blood vessels and thereby deprive parts of the brain and other critical organs of oxygen".

This made me really think before responding back to this thread.

First let’s get this strait up front and open in front of everyone so that the lay people that don't understand the intricacies of Cardiovascular Surgery are not lead astray by such comments !

Air bubbles are a catastrophic event that Very Rarely Ever Happens in cardiac surgery and if and when it does occur there are practiced measures that are utilized to reverse and eliminate any air bubbles that might get systemic when CPB is used!

Micro-air on the other hand, is a newer phenomenon that has really emerged in awareness with the advent of so called Mini or Micro Circuits that industry has tried to thrust upon cardiac surgery to try and reduce some of the hemodilution associated with CPB. These circuits have little or no reservoir to trap venous line air, and there is no hold up time for the out-gasing of bubbles and air.

By streamlining these circuits to try and reduce the crystalloid priming volumes they have made it so there is less transit time for Micro-Air and less reaction time for the Perfusionist. They have not caught on because of the obvious added stress, shortcomings and costs, and because almost all perfusionists have learned to safely condense there circuits and RAP (auto prime) their circuits for free without giving up the safety and familiarity of their trusted circuits for their patients.

Reducing hemodilution is a multi-disciplinary multimodality approach that must be practiced by all members that have direct contact with the patient, from the first I.V. upon arrival, to Cath Lab, OR, ICU, Step down and all the way to discharge, everyone must be held responsible.

Perfusionists can not be the only ones held accountable to avoiding hemodilution and giving blood products by shrinking their primes to safe and trusted levels in Cardiac surgery. We are, in most cases out on limb pushing the border of safety trying to reduce hemodilution. We already have the CPB procedure honed to a fairly safe and trusted science without going to more expense and extremes to try to reduce priming volumes and jeopardize patient safety especially when we can auto prime the condensed circuits (for free) economically.

Air in the bloodstream is not normal and is extremely dangerous with morbidity and mortality associated with it. Your submitted comments were passé and would lead lay people to believe that this was a natural occurrence when CPB is used and this is simply not the truth!

I am both a seasoned Cardiovascular Perfusionist and advocate of serious blood conservation and management, and feel the need to defend the profession and the use of CPB which is STILL the “Gold Standard” by which all other off shoots (Angioplasty, Drug eluding Stents, Off -Pump surgery etc) attempt to compare themselves with because of the superior and long term results for treating Coronary Artery and Disease.

__________________
Keith A. Samolyk CCP, LCP
Global Blood Resources LLC
P.O. Box 383 Somers CT. 06071
Tel (800) - 942 - 9243
Fax (860) - 285 - 0289
www.mybloodfirst.com

I really appreciate your responding to Benjamin's post. It is certainly a good idea to accurately inform persons not in the health care field about the real risks and benefits of various blood-avoidance procedures. It appears, on reading his post, that his information was extracted from some other source, was a quotation, and was no doubt contributed by Benjamin with the intent of sharing what he felt was some beneficial information. The additional clarification is the sort of response NoBlood editors appreciate, since your depth of knowledge can take the information and "flesh it out" in a way that benefits both medically and non-medically knowledgeable readers, including Benjamin himself.
In fact, I hope you have already taken the opportunity to visit our Wiki site and use some of your knowledge to "flesh out" some of the information there. If not, I heartily invite you to do so. We have a growing amount of information on the Wiki that needs tending to by our more medically knowledgeable members. Thanks again! And thank you, Benjamin, for contributing to the Forum!

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Jan Grossberg, RN, BSN
Editorial Team