In open heart surgery is there a role for the use of carbon dioxide field flooding techniques to reduce the level of post-operative gaseous emboli?

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether there is any benefit to the use of carbon dioxide (CO(2)) field flooding techniques in open heart surgery in order to reduce post-operative gaseous emboli. Altogether 103 papers were found using the reported search, of which 3 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that there is no large clinical study to prove that there is a neurocognitive benefit to the use of CO(2) field flooding. However, experimental evidence shows that the solubility of CO(2) emboli justifies efforts to replace intracavital air with CO(2) in open heart surgery to reduce gaseous emboli but that caution is warranted as use of excessive cardiotomy suction may result in hypercarbia.