R. Segal, P. Mezzavia, R. Krieser, Shienny Sampurno, M. Taylor, R. Ramsay, Michael Kluger, Keat Lee, F. Loh, J. Tatoulis, Michael O’Keefe, Yinwei Chen, Teresa Sindoni, Irene Ng
{"title":"Warm humidified CO2 insufflation improves pericardial integrity for cardiac surgery. A randomized control study.","authors":"R. Segal, P. Mezzavia, R. Krieser, Shienny Sampurno, M. Taylor, R. Ramsay, Michael Kluger, Keat Lee, F. Loh, J. Tatoulis, Michael O’Keefe, Yinwei Chen, Teresa Sindoni, Irene Ng","doi":"10.23736/S0021-9509.22.12004-5","DOIUrl":null,"url":null,"abstract":"BACKGROUND\nFlooding the surgical field with dry cold CO2 during open-chamber cardiac surgery has been used to mitigate air entrainment into the systemic circulation. However, exposing epithelial surfaces to cold, dry gas causes tissue desiccation. This randomised controlled study was designed to investigate whether the use of humidified warm CO2 insufflation into the cardiac cavity could reduce pericardial tissue damage and the incidence of micro-emboli when compared to dry cold CO2 insufflation.\n\n\nMETHODS\nForty adult patients requiring elective open-chamber cardiac surgery were randomised to have either dry cold CO2 insufflation via a standard catheter or humidified warm CO2 insufflation via the HumiGard device. The primary endpoint was biopsied pericardial tissue damage, assessed using electron microscopy. We assessed the percentage of microvilli and mesothelial damage, using a damage severity score (DSS) system. We compared the proportion of patients who had less damage, defined as DSS < 2. Secondary endpoints included the severity of micro-emboli, by visual assessment of bubble load on transoesophageal echocardiogram; lowest near infrared spectroscopy; total de-airing time; highest cardio-pulmonary bypass sweep speed; hospital length of stay and complications.\n\n\nRESULTS\nA higher proportion of patients in the humidified warm CO2 group displayed conserved microvilli (47% vs 11%, p=0.03) and preserved mesothelium (42% vs 5%, p=0.02) compared to the control group. There were no differences in the secondary outcomes.\n\n\nCONCLUSIONS\nHumidified warm CO2 insufflation significantly reduced pericardial epithelial damage when compared to dry cold CO2 insufflation in open-chamber cardiac surgery. Further studies are warranted to look into its potential clinical benefits.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of cardiovascular surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.23736/S0021-9509.22.12004-5","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
BACKGROUND
Flooding the surgical field with dry cold CO2 during open-chamber cardiac surgery has been used to mitigate air entrainment into the systemic circulation. However, exposing epithelial surfaces to cold, dry gas causes tissue desiccation. This randomised controlled study was designed to investigate whether the use of humidified warm CO2 insufflation into the cardiac cavity could reduce pericardial tissue damage and the incidence of micro-emboli when compared to dry cold CO2 insufflation.
METHODS
Forty adult patients requiring elective open-chamber cardiac surgery were randomised to have either dry cold CO2 insufflation via a standard catheter or humidified warm CO2 insufflation via the HumiGard device. The primary endpoint was biopsied pericardial tissue damage, assessed using electron microscopy. We assessed the percentage of microvilli and mesothelial damage, using a damage severity score (DSS) system. We compared the proportion of patients who had less damage, defined as DSS < 2. Secondary endpoints included the severity of micro-emboli, by visual assessment of bubble load on transoesophageal echocardiogram; lowest near infrared spectroscopy; total de-airing time; highest cardio-pulmonary bypass sweep speed; hospital length of stay and complications.
RESULTS
A higher proportion of patients in the humidified warm CO2 group displayed conserved microvilli (47% vs 11%, p=0.03) and preserved mesothelium (42% vs 5%, p=0.02) compared to the control group. There were no differences in the secondary outcomes.
CONCLUSIONS
Humidified warm CO2 insufflation significantly reduced pericardial epithelial damage when compared to dry cold CO2 insufflation in open-chamber cardiac surgery. Further studies are warranted to look into its potential clinical benefits.
背景:在开腹心脏手术中,用干冷的CO2注入手术场可以减少空气夹带进入体循环。然而,将上皮表面暴露在寒冷、干燥的气体中会导致组织干燥。这项随机对照研究旨在调查与干冷CO2注入相比,使用加湿的温暖CO2注入心腔是否可以减少心包组织损伤和微栓塞的发生率。方法40例需要择期开室心脏手术的成年患者随机分为两组,一组通过标准导管进行干冷CO2注入,另一组通过HumiGard装置进行湿式暖CO2注入。主要终点是活检心包组织损伤,用电子显微镜评估。我们使用损伤严重程度评分(DSS)系统评估微绒毛和间皮损伤的百分比。我们比较了损伤较小(定义为DSS < 2)的患者比例。次要终点包括微栓子的严重程度,通过经食管超声心动图对气泡负荷的视觉评估;最低近红外光谱;总去风时间;最高心肺旁路扫描速度;住院时间和并发症。结果湿化暖CO2组微绒毛保存率(47% vs 11%, p=0.03)和间皮保存率(42% vs 5%, p=0.02)高于对照组。次要结果没有差异。结论与干冷CO2灌注相比,湿化暖CO2灌注可显著减少心包上皮损伤。有必要进一步研究其潜在的临床益处。