Reply

Abstract

To the Editor: We appreciate the opportunity to respond to the letter by Dr Dye regarding our article. As pointed out in the article and by Dr Dye's discussion, we did design this experimental model to address the efficacy of preventing injury in massive macroscopic air embolism. However, like Dr Dye, we believe that neurologic injury and dysfunction secondary to microemboli is as important, and far more common, than macroemboli in the post–cardiopulmonary bypass patient population. We also share Dr Dye's concern that nitrogen bubbles may occur during all periods of cardiopulmonary bypass, secondary to systemic rewarming. As such, we are of a like mind with Dr Dye in the conclusion that the use of perfluorocarbons may have a much greater role in routine cardiopulmonary bypass than outlined in our article in which a massive air embolism was the mechanism. We have performed and are in the process of analyzing further studies delineating the role of perfluorocarbon emulsion as a prophylactic measure, and have also examined the dose effect. In addition, at the present time clinical trials are underway for the establishment of the safety of this modality in cardiopulmonary bypass patients. We appreciate the opportunity to respond to Dr Dye's comments and share his hopes that perfluorocarbons may have a much wider utilization in cardiopulmonary bypass in the future for the prevention of both major and minor neurologic injuries.