Massive arterial air embolism during cardiopulmonary bypass: antegrade blood cardioplegia delivered by the pump - an accident waiting to happen

Of the many possible causes of air embolism occurring in patients undergoing cardiopulmonary bypass (CPB), human error due to the perfusionist or the surgeon accounts for the vast majority. This case, however, presents a previously unreported, but recognized, cause of air embolism, due to a technical problem encountered during the administration of blood cardioplegia. The nature of some of the older CPB pumps allows the administration of cardioplegia at a time when the main CPB pump is not rotating. A situation may then arise whereby air may be entrained and delivered to the patient. The management of massive air embolism is discussed, and recommendations are made to prevent such an occurrence happening in the future.