Safe Cerebral Protection: How to Handle Dangerous Sternal Reentry

This video details how to enter the sternum when patients have undergone previous sternotomy. This patient was having his fourth sternal reentry and the CT scan showed the aorta was right next to the back of the sternum. 

First, the femoral vessels were cannulated. Most importantly, the carotid artery was accessed and a 14 Fr pediatric arterial cannula was placed into this vessel. The circuit was run to the carotid artery at one liter per minute. 

The logic of this approach is that no matter how much air there is from aortic entry, no air will get into the cerebral vessels. At one liter per minute, blood will travel retrograde down the other carotid artery and no air can enter the brain. This is a very safe technique when done correctly.

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