dc.contributorGiraldo Bustamante, Juan Camilo
dc.creatorQuintero López, Olga Lucía
dc.date.accessioned2018-10-22T14:15:55Z
dc.date.available2018-10-22T14:15:55Z
dc.date.created2018-10-22T14:15:55Z
dc.date.issued2018
dc.identifierhttp://repository.urosario.edu.co/handle/10336/18644
dc.identifierhttps://doi.org/10.48713/10336_18644
dc.description.abstractBackground: Massive cerebral air embolism during cardiopulmonary bypass (CPB) is catastrophic and in some instances, has the potential to lead to fatal outcomes. Its incidence is around 0.1% to 0.2% % (1) and secuelae of it can be devastating and in some instances fatal (2,3). There is not an evidence-based algorithm for the diagnosis and intraoperative management of this complication (4). Methodology: Qualitative systematic review and meta-analysis. PRISMA-P guidelines will be followed for the elaboration, redaction, and publication of the protocol (5). Results: Two thousand and sixty six articles were identified. Of these, 135 possible articles were considered for analysis of title and abstract. Thirty-three articles were retrieved for full text review. Of these, two articles were excluded since they did not met inclusion criteria. Two articles were included for meta-analysis and 29 case reports and series were included for description. Conclusion: The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected.
dc.languagespa
dc.publisherUniversidad del Rosario
dc.publisherEspecialización en Anestesia Cardiotorácica
dc.publisherFacultad de Medicina
dc.rightshttp://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.rightsinfo:eu-repo/semantics/openAccess
dc.rightsAbierto (Texto Completo)
dc.rightsEL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. Para el correcto ejercicio de mi derecho de habeas data cuento con la cuenta de correo habeasdata@urosario.edu.co, donde previa identificación podré solicitar la consulta, corrección y supresión de mis datos.
dc.rightsAtribución-NoComercial-SinDerivadas 2.5 Colombia
dc.sourceSahu MK, Ingole PR, Bisoi AK, Venugopal P. Successful management of a case of massive air embolism from cardiopulmonary bypass with retrograde cerebral perfusion in a child. J Cardiothorac Vasc Anesth. 2006;20(1):80–1.
dc.sourceLou S, Ji B, Liu J, Yu K, Long C. Generation, detection and prevention of gaseous microemboli during cardiopulmonary bypass procedure. Int J Artif Organs. 2011;34(11):1039–51.
dc.sourceNiyibizi E, Kembi GE, Lae C, Pignel R, Sologashvili T. Delayed hyperbaric oxygen therapy for air emboli after open heart surgery: case report and review of a success story. J Cardiothorac Surg [Internet]. 2016 Dec 5 [cited 2018 Jun 18];11(1):167. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27919270
dc.sourceGuy TS, Kelly MP, Cason B, Tseng E. Retrograde cerebral perfusion and delayed hyperbaric oxygen for massive air embolism during cardiac surgery. Interact Cardiovasc Thorac Surg [Internet]. 2009 Dec 12 [cited 2018 Jun 18];8(April):382–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19064584
dc.sourceMoher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev [Internet]. 2015;4(1):1–9. Available from: http://dx.doi.org/10.1186/2046-4053-4- 1%5Cnhttp://www.systematicreviewsjournal.com/content/4/1/1%5CnAll Papers/M/Moher et al. 2015 - Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.pdf
dc.sourcevan der Zee MP, Koene BM, Mariani MA. Fatal air embolism during cardiopulmonary bypass: analysis of an incident and prevention measures. Interact Cardiovasc Thorac Surg. 2014;19(5):875–7.
dc.sourceKlein KU, Engelhard K. Perioperative neuroprotection. Best Pract Res Clin Anaesthesiol. 2010;24(4):535–49.
dc.sourceFischer GW, Stone ME. Cerebral air embolism recognized by cerebral oximetry. Semin Cardiothorac Vasc Anesth. 2009;13(1):56–9.
dc.sourceSmith M. Shedding light on the adult brain: a review of the clinical applications of near-infrared spectroscopy. Philos Trans R Soc A Math Phys Eng Sci. 2011
dc.sourceScheeren TWL, Schober P, Schwarte LA. Monitoring tissue oxygenation by near infrared spectroscopy (NIRS): background and current applications. J Clin Monit Comput [Internet]. 2012;26(4):279–87. Available from: http://link.springer.com/10.1007/s10877-012-9348-y
dc.sourceMurkin JM. NIRS: a standard of care for CPB vs. an evolving standard for selective cerebral perfusion? J Extra Corpor Technol [Internet]. 2009;41(1):11–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19361034%0Ahttp://www.pubmedcentral.nih. gov/articlerender.fcgi?artid=PMC4680225
dc.sourceHaydin S, Onan B, Onan IS, Ozturk E, Iyigun M, Yeniterzi M, et al. Cerebral Perfusion During Cardiopulmonary Bypass in Children: Correlations Between Near- Infrared Spectroscopy, Temperature, Lactate, Pump Flow, and Blood Pressure. Artif Organs. 2013;37(1):87–91.
dc.sourceQing M, Shim JK, Grocott HP, Sheng H, Mathew JP, MacKensen GB. The effect of blood pressure on cerebral outcome in a rat model of cerebral air embolism during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2011;142(2):424–9.
dc.sourceGao W, Chen SR, Wu MY, Gao K, Li YL, Wang HY, et al. Methylprednisolone exerts neuroprotective effects by regulating autophagy and apoptosis. Neural Regen Res. 2016;11(5):823–8.
dc.sourceShum-Tim D, Tchervenkov CI, Jamal AM, Nimeh T, Luo CY, Chedrawy E, et al. Systemic steroid pretreatment improves cerebral protection after circulatory arrest. Ann Thorac Surg. 2001;72(5):1465–72.
dc.sourceSchmitt KRL, Kern C, Berger F, Ullrich O, Hendrix S, Abdul-Khaliq H. Methylprednisolone attenuates hypothermia- and rewarming-induced cytotoxicity and IL-6 release in isolated primary astrocytes, neurons and BV-2 microglia cells. Neurosci Lett. 2006;404(3):309–14.
dc.sourceMukherji J, Hood RR, Edelstein SB. Overcoming challenges in the management of critical events during cardiopulmonary bypass. Semin Cardiothorac Vasc Anesth. 2014;18(2):190–207.
dc.sourceWeiner MM, Wicker J, Fischer GW, Adams DH, Bronster D, Evans AS, et al. Early detection and treatment of an air embolism during cardiac surgery. J Cardiothorac Vasc Anesth. 2015;29(3):791–6.
dc.sourceJohnson CE, Faulkner SC, Schmitz ML, Drummond-Webb JJ. Management of potential gas embolus during closure of an atrial septal defect in a three-year-old. Perfusion. 2003;18(6):381–4.
dc.sourceGregoric ID, Myers TJ, Kar B, Loyalka P, Reverdin S, La Francesca S, et al. Management of air embolism during HeartMate XVE exchange. Texas Hear Inst J [Internet]. 2007 [cited 2018 May 29];34(1):19–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17420788
dc.sourceYerlioglu ME, Wolfe D, Mezrow CK, Weisz DJ, Midulla PS, Zhang N, et al. The effect of retrograde cerebral perfusion after particulate embolization to the brain. J Thorac Cardiovasc Surg. 1995;110(5):1470–85.
dc.sourceShrinivas VG, Sankarkumar R, Rupa S, Rupa S. Retrograde Cerebral Perfusion for Treatment of Air Embolism After Valve Surgery. Asian Cardiovasc Thorac Ann [Internet]. 2004 Mar 25 [cited 2018 Jun 21];12(1):81–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14977750
dc.sourceSanabria A, Rigau D, Rotaeche R, Selva A, Marzo-castillejo M. Sistema GRADE : metodología para la realización de recomendaciones para la práctica clínica. 2015;47(9):48–55.
dc.sourceGuyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force. Chest [Internet]. 2006 Jan [cited 2012 Jul 23];129(1):174–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16424429
dc.sourceAsociación Médica Mundial. Declaración de Helsinki de la AMM - Principios éticos paralas investigaciones médicas en seres humanos [Internet]. 2017. Available from: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios- eticos-para-las-investigaciones-medicas-en-seres-humanos/
dc.sourceMinisterio de Salud. Resolución 8430 de 1993. Minist Salud y Protección Soc República Colomb. 1993;1993(Octubre 4):1–19.
dc.sourceShah J, Jiwa N, Mamdani N, Hill D. Venous and arterial air embolism: a rare phenomenon with fatal consequences. BMJ Case Rep [Internet]. 2016 Dec 5 [cited 2018 Jun 18];2016:bcr2016217550. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27920021
dc.sourceMaddali M, Thomas E, Malik M. Air embolism during fontan operation. Ann Card Anaesth [Internet]. 2014 [cited 2018 Jun 18];17(3):229. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24994734
dc.sourceFouilloux V, Davey L, Van Arsdell GS, Honjo O. Foam formation and acute air emboli with the maquet paediatric Quadrox I: A word of caution. Interact Cardiovasc Thorac Surg [Internet]. 2014 Jul [cited 2018 Jun 18];19(1):163–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24706171
dc.sourceMatte GS, Kussman BD, Wagner JW, Boyle SL, Howe RJ, Pigula FA, et al. Massive air embolism in a Fontan patient. J Extra Corpor Technol [Internet]. 2011 Jun [cited 2018 Jun 18];43(2):79–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21848177
dc.sourceBrito T, Pithan N, Martins G, Jessen B, Assumpção C, Porto T, et al. Case reports: hyperbaric oxygen therapy for the treatment of cerebral air embolism. Undersea Hyperb Med. 2011;38(3):207–12.
dc.sourceGibson AJ, Davis FM. Hyperbaric oxygen therapy in the treatment of post cardiac surgical strokes - A case series and review of the literature. Anaesth Intensive Care. 2010;38(1):175–84.
dc.sourceFrenkel G, Birk E, Vidne B, Shukrun G, Bachar O, Katz Y, et al. A word of caution: Cerebral air emboli caused by tubing elastic recoil while performing low-flow antegrade cerebral perfusion in a low-birth-weight neonate. J Thorac Cardiovasc Surg [Internet]. 2010 Feb [cited 2018 Jun 18];139(2):e25–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19660303
dc.sourceNewcomb A, Frawley G, Fock A, Bennett M, d’Udekem Y. Hyperbaric Oxygenation in the Management of Cerebral Arterial Gas Embolism During Cavopulmonary Connection Surgery. J Cardiothorac Vasc Anesth. 2008;22(4):576–80.
dc.sourceNeema PK, Pathak S, Varma PK, Manikandan S, Rathod RC, Tempe DK, et al. Systemic Air Embolization After Termination of Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2007;21(2):288–97.
dc.sourceVillacorta J, Kerbaul F, Collart F, Guidon C, Bonnet M, Guillen JC, et al. Perioperative cerebral ischaemia in cardiac surgery and BIS. Anaesth Intensive Care. 2005;33(4):514–7.
dc.sourceKin N, Konstadt SN, Sato K, Hanaoka K. Reduction of Bispectral Index Value Associated with Clinically Significant Cerebral Air Embolism. J Cardiothorac Vasc Anesth. 2004;
dc.sourceGomes WJ, Strisiver DA, Penco AJF, Rampersad K, Angelini GD. Successful treatment of accidental air embolism in warm heart surgery. Asian Cardiovasc Thorac Ann. 2003;11(1):68–9.
dc.sourceYeh T, Austin EH, Sehic A, Edmonds HL. Rapid recognition and treatment of cerebral air embolism: The role of neuromonitoring. J Thorac Cardiovasc Surg. 2003;126(2):589–91.
dc.sourceHuber S, Rigler B, Mächler HE, Metzler H, Smolle-Jüttner FM. Successful treatment of massive arterial air embolism during open heart surgery. Ann Thorac Surg [Internet]. 2000;69(3):931–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10750789
dc.sourceZiser A, Adir Y, Lavon H, Shupak A. Hyperbaric oxygen therapy for massive arterial air embolism during cardiac operations. J Thorac Cardiovasc Surg. 1999;117(4):818–21.
dc.sourceJones N, Howell C. Massive arterial air embolism during cardiopulmonary bypass: antegrade blood cardioplegia delivered by the pump: an accident waiting to happen. Perfusion. 1996;11:157–61.
dc.sourceRozanski J, Szufladowicz M. Successful treatment of massive air embolism. J Card Surg [Internet]. 1994;9(4):430–2. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt= Citation&list_uids=7949671
dc.sourceKol S, Ammar R, Weisz G, Melamed Y. Hyperbaric oxygenation for arterial air embolism during cardiopulmonary bypass. Ann Thorac Surg. 1993;55(2):401–3.
dc.sourceBayindir O, Paker T, Akpinar B, Bilal M, Nolens I, Wijers T, et al. A 58-Year-Old Man Had a Massive Air Embolism During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 1991;5(6):627–34.
dc.sourceKumar AS, Jayalakshmi TS, Kale SC, Saxena BK, Singh V, Paul SJ. Management of massive air embolism during open heart surgery. Int J Cardiol. 1985;9(4):413–6.
dc.sourceWinter PM, Alvis HJ, Gage AA. Hyperbaric treatment of cerebral air embolism during cardiopulmonary bypass. Jama. 1971;215(11):1786–8.
dc.sourceLeach RM, Rees PJ, Wilmshurst P. Hyperbaric oxygen therapy Dangers of hyperbaric oxygen. Br Med J. 1998;317(0831):1140–3.
dc.sourceAntonelli C, Franchi F, Della Marta ME, Carinci A, Sbrana G, Tanasi P, et al. Guiding principles in choosing a therapeutic table for DCI hyperbaric therapy. Minerva Anestesiol. 2009;75(3):151–61.
dc.sourceMartens S, Neumann K, Sodemann C, Deschka H, Wimmer-Greinecker G, Moritz A. Carbon Dioxide Field Flooding Reduces Neurologic Impairment After Open Heart Surgery. Ann Thorac Surg. 2008;85(2):543–7.
dc.sourceMartens S, Dietrich M, Wals S, Steffen S, Wimmer-greinecker G, Moritz A. Conventional carbon dioxide application does not reduce cerebral or myocardial damage in open heart surgery. Ann Thorac Surg. 2001;72:1940–4.
dc.sourceMurkin JM, Newman SP, Stump DA, Blumenthal JA. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg. 1995;59(5):1289–95.
dc.sourceTovar EA, Del Campo C, Borsari A, Webb RP, Dell JR, Weinstein PB. Postoperative management of cerebral air embolism: gas physiology for surgeons. Ann Thorac Surg [Internet]. 1995;60(4):1138–42. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt= Citation&list_uids=7574975
dc.sourceKurusz M, Butler BD, Katz J, Conti VR. Air embolism during cardiopulmonary bypass. Perfusion [Internet]. 1995 Nov [cited 2018 Jun 21];10(6):361–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8747895
dc.sourceMuth CM, Shank E. Gas embolism. N Engl J Med. 2000;342(7):476–82.
dc.sourceMittnacht AC, Rodriguez-Diaz C. Multimodal neuromonitoring in pediatric cardiac anesthesia. Ann Card Anaesth [Internet]. 2014 [cited 2018 Sep 28];17(1):25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24401298
dc.sourceSaidi N, Murkin JM. Applied Neuromonitoring in Cardiac Surgery: Patient Specific Management. Semin Cardiothorac Vasc Anesth [Internet]. 2005 Mar 17 [cited 2018 Sep 28];9(1):17–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15735841
dc.sourceMurkin JM. Applied Neuromonitoring and Improving CNS Outcomes. Semin Cardiothorac Vasc Anesth [Internet]. 2005 Jun 17 [cited 2018 Sep 28];9(2):139–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15920638
dc.sourceMoerman A, Meert F, De Hert S. Cerebral near-infrared spectroscopy in the care of patients during cardiological procedures: a summary of the clinical evidence. J Clin Monit Comput [Internet]. 2016 Dec 8 [cited 2018 Jun 19];30(6):901–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26449691
dc.sourceTaillefer M-C, Denault AY. Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Can J Anesth Can d’anesthésie [Internet]. 2005 Jan [cited 2018 Jun 19];52(1):79–87. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15625262
dc.sourceUrbanski PP, Lenos A, Kolowca M, Bougioukakis P, Keller G, Zacher M, et al. Near-infrared spectroscopy for neuromonitoring of unilateral cerebral perfusion. Eur J Cardio-thoracic Surg. 2013;43(6):1140–4.
dc.sourceChan MJ, Chung T, Glassford NJ, Bellomo R. Near-Infrared Spectroscopy in Adult Cardiac Surgery Patients: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth [Internet]. 2017 Aug [cited 2018 Jun 20];31(4):1155–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28800981
dc.sourceGrocott HP. Pharmacologic neuroprotection: the search continues. J Extra Corpor Technol [Internet]. 2007;39(4):296–301. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18293824%5Cnhttp://www.pubmedcentral.nih .gov/articlerender.fcgi?artid=PMC4680702
dc.sourceDemir T, Demir H, Tansel T, Kalko Y, Tireli E, Dayioglu E, et al. Influence of Methylprednisolone on Levels of Neuron-Specific Enolase in Cardiac Surgery: A Corticosteroid Derivative to Decrease Possible Neuronal Damage. J Card Surg [Internet]. 2009 Jul [cited 2018 Jul 27];24(4):397–403. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19583607
dc.sourceKrüger T, Hoffmann I, Blettner M, Borger MA, Schlensak C, Weigang E. Intraoperative neuroprotective drugs without beneficial effects? Results of the german registry for acute aortic dissection type a (GERAADA). Eur J Cardio- thoracic Surg. 2013;44(5):939–46.
dc.sourceNussmeier NA, Arlund C, Slogoff S. Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology [Internet]. 1986 Feb [cited 2018 Sep 21];64(2):165–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3946803
dc.sourceZhou R, Yang Z, Tang X, Tan Y, Wu X, Liu F. Propofol protects against focal cerebral ischemia via inhibition of microglia-mediated proinflammatory cytokines in a rat model of experimental stroke. PLoS One. 2013;8(12):1–12.
dc.sourceAdembri C, Venturi L, Pellegrini-Giampietro DE. Neuroprotective effects of propofol in acute cerebral injury. CNS Drug Rev. 2007;13(1080–563X (Print)):333– 51.
dc.sourceSalameh A, Dhein S, Dähnert I, Klein N. Neuroprotective strategies during cardiac surgery with cardiopulmonary bypass. Int J Mol Sci. 2016;17(11).
dc.sourceGrogan K, Stearns J, Hogue CW. Brain protection in cardiac surgery. Anesth Clin [Internet]. 2008;26(3):521–38. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2607116/pdf/nihms71288.pdf
dc.sourceNathan HJ, Wells GA, Munson JL, Wozny D. Neuroprotective Effect of Mild Hypothermia in Patients Undergoing Coronary Artery Surgery With Cardiopulmonary Bypass. Circulation [Internet]. 2001;104(suppl 1):I-85-I-91. Available from: http://circ.ahajournals.org/lookup/doi/10.1161/hc37t1.094710
dc.sourceBergeron EJ, Mosca MS, Aftab M, Justison G, Reece TB. Neuroprotection strategies in aortic surgery. Cardiol Clin. 2017;35(3):453–65.
dc.sourceMalik N, Claus PL, Illman JE, Kligerman SJ, Moynagh MR, Levin DL, et al. Air embolism: diagnosis and management. Future Cardiol [Internet]. 2017 Jul [cited 2018 Jun 21];13(4):365–78. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28644058
dc.sourceThom SR. Functional inhibition of leukocyte B2 integrins by hyperbaric oxygen in carbon monoxide-mediated brain injury in rats [Internet]. Vol. 123, Toxicology and Applied Pharmacology. 1993. p. 248–56. Available from: http://www.scopus.com/inward/record.url?eid=2-s2.0- 0027521312&partnerID=40&md5=43526ab5537edb3c2d34ca8837a09614
dc.sourceBlanc P, Boussuges A, Henriette K, Sainty J, Deleflie M. Iatrogenic cerebral air embolism: Importance of an early hyperbaric oxygenation. Intensive Care Med. 2002;28(5):559–63.
dc.sourceinstname:Universidad del Rosario
dc.sourcereponame:Repositorio Institucional EdocUR
dc.subjectEmbolismo aéreo
dc.subjectProcedimiento quirúrgico cardíaco
dc.subjectBypass cardiopulmonar
dc.subjectCirculación extracorporeal
dc.subjectCirculación cerebrovascular
dc.subjectNeuroprotección
dc.subjectEmbolismo intracranial.
dc.titleImpacto de intervenciones para el manejo del embolismo aéreo cerebral masivo en cirugía de bypass cardiopulmonar
dc.typemasterThesis


Este ítem pertenece a la siguiente institución