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Chapter 9 - Considerations for Operations Involving Deep Hypothermic Circulatory Arrest

Published online by Cambridge University Press:  24 October 2022

By
Pingping Song  and
Joseph E Arrowsmith
Edited by
Florian Falter ,
Albert C. Perrino, Jr  and
Robert A. Baker
Florian Falter
Affiliation:
Royal Papworth Hospital, Cambridge
Albert C. Perrino, Jr
Affiliation:
Yale University Medical Center, Connecticut
Robert A. Baker
Affiliation:
Flinders Medical Centre, Adelaide
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Summary

Deep hypothermic circulatory arrest (DHCA), either alone or in combination with other perfusion strategies, has become the mainstay of vital organ protection for a variety of pathologies and surgical procedures that necessitate the complete cessation of blood flow. DHCA provides a near blood-less operating field, albeit of limited duration, while ameliorating the major adverse consequences of vital organ ischemia.Cooling of the brain – the organ at greatest ischemic risk – reduces cerebral metabolic rate, extending the period of "safe" ischemia from 3-4 minutes at normothermia to >20 minutes.

Keywords

Indications for DHCAPhysiology of DHCASurgical Considerations for DHCAPerfusion Considerations for DHCAHemodilutionCirculatory ArrestRewarmingNeuroprotection;Spinal Cord ProtectionPulmonary Thrombendarterectomy
Type
Chapter
Information
Cardiopulmonary Bypass , pp. 80 - 91
Publisher: Cambridge University Press
Print publication year: 2022

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References

Suggested Further Reading

Arrowsmith, JE, Ganugapenta, MSSR. Intraoperative brain monitoring in cardiac surgery. In Bonser, R, Pagano, D, Haverich, A (Eds.). Brain Protection in Cardiac Surgery. London: Springer-Verlag. 2011. pp.83–111.Google Scholar
Chan, MJ, Chung, T, Glassford, NJ et al. Near-Infrared spectroscopy in adult cardiac surgery patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2017; 31(4): 1155–1165.CrossRefGoogle ScholarPubMed
Ghadimi, K, Gutsche, JT, Setegne, SL et al. Severity and duration of metabolic acidosis after deep hypothermic circulatory arrest for thoracic aortic surgery. J Cardiothorac Vasc Anesth 2015; 29(6): 1432–1440.CrossRefGoogle ScholarPubMed
James, ML, Anderson, MD, Swaminathan, M et al. Predictors of electrocerebral inactivity with deep hypothermia. J Thorac Cardiovasc Surg 2014; 147(3): 1002–1007.CrossRefGoogle ScholarPubMed
Krüger, T, Hoffmann, I, Blettner, M et al. Intraoperative neuroprotective drugs without beneficial effects? Results of the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2013; 44(5): 939–946.CrossRefGoogle Scholar
Misfeld, M, Leontyev, S, Borger, MA et al. What is the best strategy for brain protection in patients undergoing aortic arch surgery? A single center experience of 636 patients. Ann Thorac Surg 2012; 93(5): 1502–1508.CrossRefGoogle ScholarPubMed
Scheeren, TWL, Kuizenga, MH, Maurer, H et al. Electroencephalography and brain oxygenation monitoring in the perioperative period. Anesth Analg 2019; 128(2): 265–277.CrossRefGoogle ScholarPubMed
Steppan, J, Hogue, CW Jr. Cerebral and tissue oximetry. Best Pract Res Clin Anaesthesiol 2014; 28(4): 429–439.CrossRefGoogle ScholarPubMed
Vuylsteke, A, Sharples, L, Charman, G et al. Circulatory arrest versus cerebral perfusion during pulmonary endarterectomy surgery (PEACOG): a randomized controlled trial. Lancet 2011; 378(9800): 1379–1387.CrossRefGoogle Scholar
Etz CD, , Weigang E, , Hartert M, et al.Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery, European Journal of Cardio-Thoracic Surgery, 2015, 47(6): 943–957.Google Scholar

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