Optimizing CO₂ field flooding during sternotomy: In vitro confirmation of the Karolinska studies

by Mira Puthettu, Stijn Vandenberghe, Spyros Balafas, Clelia Di Serio, Geni Singjeli, Alberto Pagnamenta, Stefanos Demertzis

Although CO₂ field-flooding was first used during cardiac surgery more than 60 years ago, its efficacy is still disputed. The invisible nature of the gas and the difficulty in determining the “safe” quantity to protect the patient are two of the main obstacles to overcome for its validation. Moreover, CO₂ concentration in the chest cavity is highly sensitive to procedural aspects, such suction and hand movements. Based on our review of the existing literature, we identified four major factors that influence the intra-cavity CO₂ concentration during open-heart surgery: type of delivery device (diffuser), delivery CO₂ flow rate, diffuser position around the wound cavity, and its orientation inside the cavity. In this initial study, only steady state conditions were considered to establish a basic understanding on the effect of the four above-mentioned factors. Transient factors, such as suction or hand movements, will be reported separately.