Safety InformationJaSECT Safety Committee (May,2016)

Measures to Prevent Recurrence of Air Embolism Accidents
from Selective Cerebral Perfusion Circuit
In May 2009, Safety Information on the risk of drawing air from the oxygenator during selective cerebral
perfusion was issued. This issue will be presenting measures to prevent recurrence of such an incident, in which
air was mistakenly drawn in from the hemofiltration circuit, causing air to be erroneously drawn into the selective
cerebral perfusion circuit. Clarify the precautions for separate cerebral perfusion procedure at each facility andconsider specific countermeasures to ensure safe extracorporeal circulation.

【Circuit configuration of the air misfeed case】
Using centrifugal pump, the hemofiltration circuit and the separate cerebral perfusion circuit were branched fromthe oxygenator outlet, and the hemofiltration circuit was circulated with the main circuit’s perfusion pressure.

Hemofilter
血液濃縮器
CerebralPump
CerebralReservReservoir

脳送血Cerebral Circulation
Oxygenator

Systemic Circulation
体送血Arterial Pump

【Occurrence of air misfeed】
Due to a bending of the hemofiltration circuit before the junction between the hemofiltration circuit and theseparate cerebral perfusion circuit for some reason, blood from the oxygenator could not be pumped fromthe cerebral pump, and air was drawn into the separate cerebral perfusion circuit through thehemofiltration circuit connected to the reservoir.
Air drawn from the Reservoir

Hemofilter
血液濃縮器Reservoir
貯血槽

脳送血ポンプ
Cerebral
Pump
Cerebral Circulation
脳送血
Oxygenator

Arterial Pump

体送血
Systemic Circulation

Points to note
• Separate cerebral perfusion circuits are often complex and may have multiple branches from a single circuit.
• Branch circuits from the main circuit often use circuits with small diameter tubings, which may result in
low tubing strength to maintain its shape.

Handling
If in case air is drawn into the separate cerebral perfusion circuit, stop the circulation immediately, place
the patient in Trendelenburg position for air elimination, and eliminate the air by removing the cerebral
perfusion cannula. Perform retrograde perfusion with cooling.

Countermeasures• When circulating the hemofiltration circuit with the perfusion pressure of the main circuit, it is possible tomake it as one circuit by branching from the outlet of the arterial pump and circulating to the reservoir.
• Install a bubble detector to the separate cerebral perfusion circuit. It is safer to have a function that
automatically stops the cerebral pump in addition to the audible alarm when bubbles are detected.
• It is also effective to install a bubble trap or an arterial line filter in the separate cerebral perfusion circuit.

BubbleReservoir

Bubble Trap or Arterial

Control

Hemofilter

Line Filter

Cerebral Pump
Cerebral Perfusion

Bubble Detector
Systemic circulation

Arterial Pump• A method of sending blood by branching the arterial line without using a pump in the selective cerebral
perfusion circuit.
FlowReservoir

Bubble Trap orPress

Hemofilter

Arterial Line Filter
Roller Clamp toadjust Pressure

Cerebral Perfusion
Flow Meter

Arterial Pump

Reference１）JaSECT Safety Information (May, 2009)

Systemic Circulation