Cerebral air embolism is a known complication of open‐heart surgery with devastating consequences. Neurologic injury after CPB can be divided into 2 types:Type I: Focal injury.Type II: Intellectual deterioration/neurocognitive impairment (up to 53% at the time of hospital discharge and 42% could be impaired for up to 5 years). Increasing evidence points to cerebral embolization as the principal culprit. Since the early days of modern cardiac surgery, surgeons have attempted to limits its damage by various means. One of the early techniques propounded was carbon dioxide insufflation of the pericardial cavity. Carbon dioxide, was uniquely positioned for this, being denser than air, more soluble than air, and easily managed perioperatively if the blood levels were to go up beyond physiological ranges. The technique gradually went into disuse, since there was no instrumentation, in the early days of CPB to measure and establish its impact on the actual outcomes. Secondly, the devices, through which CO2 was delivered, were not effective.There has been increasing enthusiasm for the technique but no consensus on the technical considerations or on the actual benefits of the practice.Our li
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