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Artículos de revistas sobre el tema "Deep Hypothermia Circulatory Arrest"

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Autor: Grafiati
Publicado: 4 de junio de 2021
Última modificación: 3 de febrero de 2022

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1

Svensson, Lars G., E. Stanley Crawford, Kenneth R. Hess, Joseph S. Coselli, Steven Raskin, Salwa A. Shenaq y Hazim J. Safi. "Deep hypothermia with circulatory arrest". Journal of Thoracic and Cardiovascular Surgery 106, n.º 1 (julio de 1993): 19–31. http://dx.doi.org/10.1016/s0022-5223(19)33737-7.

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2

SVENSSON, L. G., E. S. CRAWFORD, K. R. HESS, J. S. COSELLI, S. RASKIN, S. A. SHENAQ y H. J. SAFI. "Deep Hypothermia with Circulatory Arrest". Survey of Anesthesiology 38, n.º 5 (octubre de 1994): 263. http://dx.doi.org/10.1097/00132586-199410000-00014.

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3

Bakhutashvili, Zviad, Lia Janelidze, Kakhaber Beria, Simon Matikashvili y Eduard Limonjiani. "Aortic Arch Replacement without Deep Hypothermic Circulatory Arrest". Case Reports in Surgery 2021 (6 de enero de 2021): 1–3. http://dx.doi.org/10.1155/2021/8821182.

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A 60-year-old man presented with a thoracic aortic aneurysm without rupture accompanied by severe nonrheumatic aortic valve insufficiency and unstable angina. Surgery was performed and included several steps: (1) resection and reconstruction of ascending aorta and aortic arch using a tube graft, (2) replacement of aortic valve using a biological prosthesis, and (3) coronary artery bypass grafting was performed with two distal anastomoses. All of these procedures were performed with total cardiopulmonary bypass without deep hypothermic circulatory arrest under conditions of moderate hypothermia using dual concurrent cannulation of the subclavian and femoral arteries.
4

Mustonen, Caius, Hannu-Pekka Honkanen, Siri Lehtonen, Hannu Tuominen, Tuomas Mäkelä, Timo Kaakinen, Kai Kiviluoma, Vesa Anttila y Tatu Juvonen. "Moderate hypothermia with remote ischaemic preconditioning improves cerebral protection compared to deep hypothermia: a study using a surviving porcine model". European Journal of Cardio-Thoracic Surgery 58, n.º 2 (1 de abril de 2020): 269–76. http://dx.doi.org/10.1093/ejcts/ezaa065.

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Abstract OBJECTIVES The optimal temperature management of hypothermic circulatory arrest is still controversial. Moderate hypothermia preserves cerebral autoregulation and shortens cardiopulmonary bypass (CPB) duration. However, moderate hypothermia alone has inferior organ protection to deep hypothermia, so adjuncts that increase the ischaemic tolerance are needed. Thus, we hypothesized that a combination of remote ischaemic preconditioning (RIPC) and moderate hypothermia would be superior to deep hypothermia alone. METHODS Sixteen pigs were randomized to either RIPC or control groups (8 + 8). The RIPC group underwent 4 cycles of transient hind limb ischaemia. The RIPC group underwent cooling with CPB to 24°C, and the control group underwent cooling with CPB to 18°C, followed by a 30-min arrest period and subsequent rewarming to 36°C. Measurements of cerebral metabolism were made from sagittal sinus blood samples and common carotid artery blood flow. The permissible periods of hypothermic circulatory arrest were calculated based on these measurements. Neurological recovery was evaluated daily during a 7-day follow-up, and the brain was harvested for histopathological analysis. RESULTS Six pigs in the RIPC group reached normal neurological function, but none in the control group reached normal neurological function (P = 0.007). The composite neurological score of all postoperative days was higher in the RIPC group than in the control group [55 (52–58) vs 45 (39–51), P = 0.026]. At 24°C, the estimated permissible periods of hypothermic circulatory arrest were 21 (17–25) min in the RIPC group and 11 (9–13) min in the control group (P = 0.007). CONCLUSIONS RIPC combined with moderate hypothermia provides superior cerebral protection.
5

Lima, Brian, Judson B. Williams, S. Dave Bhattacharya, Asad A. Shah, Nicholas Andersen, Jeffrey G. Gaca y G. Chad Hughes. "Results of Proximal Arch Replacement Using Deep Hypothermia for Circulatory Arrest: Is Moderate Hypothermia Really Justifiable?" American Surgeon 77, n.º 11 (noviembre de 2011): 1438–44. http://dx.doi.org/10.1177/000313481107701129.

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The use of selective cerebral perfusion with warmer temperatures during circulatory arrest has been increasingly used for arch replacement over concerns regarding the safety of deep hypothermic circulatory arrest (DHCA). However, little data actually exist on outcomes after arch replacement and DHCA. This study examines modern results with DHCA for proximal arch replacement to provide a benchmark for comparison against outcomes with lesser degrees of hypothermia. Between July 2005 and June 2010, 245 proximal arch replacements (“hemiarch”) were performed using deep hypothermia; mean minimum core and nasopharyngeal temperatures were 18.0 ± 2.1°C and 14.1 ± 1.6°C, respectively. Adjunctive cerebral perfusion was used in all cases. Concomitant ascending aortic replacement was performed in 41 per cent, ascending plus aortic valve replacement in 23 per cent, and aortic root replacement in 32 per cent. Mean age was 58 ± 14 years; 36 per cent procedures were urgent/emergent. Mean duration of DHCA was 20.4 ± 6.2 minutes. Thirty-day/in-hospital mortality was 2.9 per cent. Rates of stroke, renal failure, and respiratory failure were 4.1 per cent (0.8% for elective cases), 1.2 per cent, and 0.4 per cent, respectively. Deep hypothermia with adjunctive cerebral perfusion for circulatory arrest during proximal arch replacement affords excellent neurologic as well as nonneurologic outcomes. Centers using lesser degrees of hypothermia for arch surgery, the safety of which remains unproven, should ensure comparable results.
6

Rothoerl, Ralf Dirk y Alexander Brawanski. "The history and present status of deep hypothermia and circulatory arrest in cerebrovascular surgery". Neurosurgical Focus 20, n.º 6 (junio de 2006): 1–5. http://dx.doi.org/10.3171/foc.2006.20.6.5.

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✓ After the development of deep hypothermia and circulatory arrest for cardiothoracic procedures in the late 1950s, this technique was adopted by several neurosurgeons as an aid to complex cranial surgery. Woodhall and colleagues described its first use for a neurosurgical procedure in 1960. Although their case did not involve a cerebrovascular procedure, the technique was subsequently used for the surgical treatment of cerebrovascular lesions, especially complex and giant aneurysms as well as large and solid hemangioblastomas. At the beginning, incorporation of this technique into common neurosurgical practice was impeded by several factors. For example, postbypass coagulopathy had been a serious source of morbidity. Furthermore, the need for cooperation among multiple subspecialities and the requirements for expensive equipment had further limited the availability of this technique. Subsequent improvements in the technique and advances in the equipment designed for cardiopulmonary bypass have led to its more widespread use starting in the 1980s. Hypothermic circulatory arrest has been described in several reports as a safe and useful tool in the treatment of large and giant aneurysms. Nevertheless, improvements in endovascular procedures and further refinement in skull base surgical techniques have limited the indications for circulatory arrest and deep hypothermia. The authors describe the history of hypothermia and circulatory arrest, its implementation in cerebrovascular surgery, and the changes in indications for and results of its use over time.
7

Levit, A., T. Buldakova, Y. Petrishchev, O. Korkin y K. Nikitin. "Is deep hypothermia necessary during circulatory arrest?" European Journal of Anaesthesiology 23, Supplement 38 (mayo de 2006): 10. http://dx.doi.org/10.1097/00003643-200605001-00027.

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8

Dorotta, Ihab, Penny Kimball-Jones y Richard Applegate. "Deep Hypothermia and Circulatory Arrest in Adults". Seminars in Cardiothoracic and Vascular Anesthesia 11, n.º 1 (marzo de 2007): 66–76. http://dx.doi.org/10.1177/1089253206297482.

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9

DeLeon, Serafin, Michel Ilbawi, Rene Arcilla, Anthony Cutilletta, Robert Egel, Alfonso Wong, Jose Quinones et al. "Choreoathetosis after deep hypothermia without circulatory arrest". Annals of Thoracic Surgery 50, n.º 5 (noviembre de 1990): 714–19. http://dx.doi.org/10.1016/0003-4975(90)90668-v.

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10

LEY, O. y Y. BAYAZITOGLU. "BRAIN TEMPERATURE DISTRIBUTION DURING DEEP HYPOTHERMIC CIRCULATORY ARREST IN HUMANS". Journal of Mechanics in Medicine and Biology 04, n.º 02 (junio de 2004): 197–212. http://dx.doi.org/10.1142/s0219519404000977.

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This paper analyzes the effect of different cooling and rewarming strategies on the brain temperature distribution before and after circulatory arrest in adults and children. The temperature variations during systemic cooling, circulatory arrest, and rewarming are calculated using a thermal model that incorporates physiological parameters. The calculations presented here explain why sometimes hypothermia does not show the expected neuroprotective effect.This work shows the importance of departing from a steady temperature distribution when using deep hypothermic circulatory arrest. In the calculations, the external cooling conditions of the head are varied, and it is observed that hypothermic cardiopulmonary bypass (CPB) together with external head cooling help reduce the temperature gradients within the head during periods of reduced blood flow, and reduces the temperature increase in the deep tissue produced by the residual cerebral metabolic activity. The results presented here agree with previous experimental observations1–3regarding the duration of systemic cooling using CPB.
11

Vekstein, Andrew M., Babtunde A. Yerokun, Oliver K. Jawitz, Julie W. Doberne, Jatin Anand, Jorn Karhausen, David N. Ranney et al. "Does deeper hypothermia reduce the risk of acute kidney injury after circulatory arrest for aortic arch surgery?" European Journal of Cardio-Thoracic Surgery 60, n.º 2 (24 de febrero de 2021): 314–21. http://dx.doi.org/10.1093/ejcts/ezab044.

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Abstract OBJECTIVES The impact of hypothermic circulatory arrest (HCA) temperature on postoperative acute kidney injury (AKI) has not been evaluated. This study examined the association between circulatory arrest temperatures and AKI in patients undergoing proximal aortic surgery with HCA. METHODS A total of 759 consecutive patients who underwent proximal aortic surgery (ascending ± valve ± root) including arch replacement requiring HCA between July 2005 and December 2016 were identified from a prospectively maintained institutional aortic surgery database. The primary outcome was AKI as defined by Risk, Injury, Failure, Loss, End Stage Renal Disease (ESRD) criteria. The association between minimum nasopharyngeal (NP) and bladder temperatures during HCA and postoperative AKI was assessed, adjusting for patient-level factors using multivariable logistic regression. RESULTS A total of 85% (n = 645) of patients underwent deep hypothermia (14.1–20.0°C), 11% (n = 83) low-moderate hypothermia (20.1–24.0°C) and 4% (n = 31) high-moderate hypothermia (24.1–28.0°C) as classified by NP temperature. When analysed by bladder temperature, 59% (n = 447) underwent deep hypothermia, 22% (n = 170) low-moderate, 16% (n = 118) high-moderate and 3% mild (n = 24) (28.1–34.0°C) hypothermia. The median systemic circulatory arrest time was 17 min. The incidence of AKI did not differ between hypothermia groups, whether analysed using minimum NP or bladder temperature. In the multivariable analysis, the association between degree of hypothermia and AKI remained non-significant whether analysed as a categorical variable (hypothermia group) or as a continuous variable (minimum NP or bladder temperature) (all P > 0.05). CONCLUSIONS In patients undergoing proximal aortic surgery including arch replacement requiring HCA, degree of systemic hypothermia was not associated with the risk of AKI. These data suggest that moderate hypothermia does not confer increased risk of AKI for patients requiring circulatory arrest, although additional prospective data are needed.
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Li, Yong, Xiaogang Sun, Xiuhui Zhang, Yuchun Zhang, Guanghui Pang y Hongliang Ma. "A modified procedure in aortic arch replacement with no deep hypothermic circulatory arrest". Perfusion 33, n.º 8 (2 de julio de 2018): 663–66. http://dx.doi.org/10.1177/0267659118781649.

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Deep hypothermia or circulation arrest is widely used during total aortic arch replacement. However, conventional procedures have high morbidity and mortality.1 We use the “branch-first” technique2,3 combined with clamping the distal aorta, incorporating a stented elephant trunk to avoid deep hypothermia and circulation arrest. This technique brings us closer to the goal of arch surgery without cerebral or visceral circulatory arrest and the morbidity of deep hypothermia. Early results are encouraging.
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McHugh, Michael, Brian Conway, Marcos Nores y Sotiris Stamou. "Role of Moderate Hypothermia and Antegrade Cerebral Perfusion during Repair of Type A Aortic Dissection". International Journal of Angiology 27, n.º 04 (29 de octubre de 2018): 190–95. http://dx.doi.org/10.1055/s-0038-1675204.

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The goal of this study was to compare early postoperative outcomes and actuarial survival between patients who underwent repair of acute type A aortic dissection with deep or moderate hypothermia.A total of 132 consecutive patients from a single academic medical center underwent repair of acute type A aortic dissection between January 2000 and June 2014. Of those, 105 patients were repaired under deep hypothermia (< 24 C°), while 27 patients were repaired under moderate hypothermia (≥24 C°). Median ages were 62 years (range: 27–86) and 59 years (range: 35–83) for patients repaired under deep hypothermia compared with patients repaired under moderate hypothermia, respectively (p = 0.451). Major morbidity, operative mortality, and 10-year actuarial survival were compared between groups.Operative mortality was 17.1 and 7.4% in the deep and moderate hypothermia groups, respectively (p = 0.208). Incidence of permanent stroke was 12.4% in the deep hypothermic circulatory arrest group and 0% in the moderate hypothermia group (p = 0.054). Actuarial 5- and 10-year survival demonstrated a trend for lower long-term mortality with moderate hypothermia compared with deep hypothermia (69% 5-year and 54% 10-year for deep hypothermia vs. 79% 5-year and 10-year for moderate hypothermia, log-rank p = 0.161).Moderate hypothermia is a safe and efficient alternative to deep hypothermia and may have protective benefits. Stroke rate was lower with moderate hypothermia.
14

Conolly, Sarah, Joseph E. Arrowsmith y Andrew A. Klein. "Deep hypothermic circulatory arrest". Continuing Education in Anaesthesia Critical Care & Pain 10, n.º 5 (octubre de 2010): 138–42. http://dx.doi.org/10.1093/bjaceaccp/mkq024.

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15

Zhurav, Larisa y Troy S. Wildes. "Pro: Topical Hypothermia Should Be Used During Deep Hypothermic Circulatory Arrest". Journal of Cardiothoracic and Vascular Anesthesia 26, n.º 2 (abril de 2012): 333–36. http://dx.doi.org/10.1053/j.jvca.2011.12.002.

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16

Chiba, Yukio, Ryusuke Muraoka, Tetsuya Kimura, Masayuki Nara, Hiroyuki Niwa, Akio Ihaya, Kouichi Morioka, Takahiko Uesaka, Katsuhiko Matsuyama y Takeshi Tsuda. "Deep Hypothermic Intermittent Circulatory Arrest". Japanese Circulation Journal 62, n.º 2 (1998): 106–10. http://dx.doi.org/10.1253/jcj.62.106.

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17

Liu, Yang, Zining Wu, Lu Dai, Haiyang Li, Ming Gong, Feng Lan, Xinliang Guan y Hongjia Zhang. "Deep Hypothermic Circulatory Arrest Does Not Show Better Protection for Vital Organs Compared with Moderate Hypothermic Circulatory Arrest in Pig Model". BioMed Research International 2019 (17 de abril de 2019): 1–11. http://dx.doi.org/10.1155/2019/1420216.

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Background. Continued debates exist regarding the optimal temperature during hypothermic circulatory arrest in aortic arch repair for patients with type A aortic dissection. This study seeks to examine whether the use of moderate hypothermic circulatory arrest in a pig model provides comparable vital organ protection outcomes to the use of deep hypothermic circulatory arrest. Methods. Thirteen pigs were randomly assigned to 30 minutes of hypothermic circulatory arrest without cerebral perfusion at 15°C (n = 5), 25°C (n = 5), and a control group (n = 3). The changes in standard laboratory tests and capacity for protection against apoptosis in different vital organs were monitored with different temperatures of hypothermic circulatory arrest management in pig model to determine which temperature was optimal for hypothermic circulatory arrest. Results. There were no significant differences in the capacity for protection against apoptosis in vital organs between 2 groups (p > 0.05, respectively). Compared with the moderate hypothermic circulatory arrest group, the deep hypothermic circulatory arrest group had no significant advantages in terms of the biologic parameters of any other organs (p > 0.05). Conclusions. Compared with deep hypothermic circulatory arrest, moderate hypothermic circulatory arrest is a moderate technique that has similar advantages with regard to the levels of biomarkers of injury and capacity for protection against apoptosis in vital organs.
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Chang, Jack H. T., Joseph S. Janik, John D. Burrington, David R. Clark, David N. Campbell y George Pappas. "Extensive tumor resection under deep hypothermia and circulatory arrest". Journal of Pediatric Surgery 23, n.º 3 (marzo de 1988): 254–58. http://dx.doi.org/10.1016/s0022-3468(88)80734-6.

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19

Mossad, Emad B., Sandra Machado y John Apostolakis. "Bleeding Following Deep Hypothermia and Circulatory Arrest in Children". Seminars in Cardiothoracic and Vascular Anesthesia 11, n.º 1 (marzo de 2007): 34–46. http://dx.doi.org/10.1177/1089253206297413.

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20

Yang, Wei, Qing Ma, G. Burkhard Mackensen y Wulf Paschen. "Deep Hypothermia Markedly Activates the Small Ubiquitin-Like Modifier Conjugation Pathway; Implications for the Fate of Cells Exposed to Transient Deep Hypothermic Cardiopulmonary Bypass". Journal of Cerebral Blood Flow & Metabolism 29, n.º 5 (25 de febrero de 2009): 886–90. http://dx.doi.org/10.1038/jcbfm.2009.16.

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Various cardiovascular operations are performed during conditions of deep hypothermic circulatory arrest. Here we investigated the effects of deep hypothermia on the small ubiquitin-like modifier (SUMO) conjugation pathway using a clinically relevant animal model of deep hypothermic cardiopulmonary bypass (DHCPB). Deep hypothermic cardiopulmonary bypass induced a marked activation of the SUMO conjugation pathway and triggered a nuclear translocation of SUMO2/3-conjugated proteins. Furthermore, DHCBP significantly modified gene expression. Activation of the SUMO conjugation pathway is believed to protect neurons from damage caused by low blood flow. This pathway may, therefore, play a key role in defining the outcome of cells exposed to DHCPB.
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Mack, William J., Andrew F. Ducruet, Peter D. Angevine, Ricardo J. Komotar, Debra B. Shrebnick, Niloo M. Edwards, Craig R. Smith et al. "Deep Hypothermic Circulatory Arrest for Complex Cerebral Aneurysms: Lessons Learned". Neurosurgery 60, n.º 5 (1 de mayo de 2007): 815–27. http://dx.doi.org/10.1227/01.neu.0000255452.20602.c9.

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AbstractOBJECTIVEDeep hypothermic circulatory arrest is a useful adjunct for treating complex aneurysms. Decreased cerebral metabolism and resultant ischemic tolerance create an environment suitable for devascularizing high-risk lesions. However, the advent of modern imaging modalities, innovative cerebral revascularization strategies, and the emergence of endovascular stenting and coiling limit the number of aneurysms requiring this surgical intervention. We present 66 patients with intracranial aneurysms who underwent surgical clipping under deep hypothermic arrest and attempt to identify patients well-suited for this procedure.METHODSThis study was conducted during a 15-year period and examined patients with aneurysms of the anterior and posterior cerebral circulation. Demographics, aneurysm characteristics, and surgical factors were evaluated as predictors of functional outcome.RESULTSPatient age and the duration of cardiac arrest were independent predictors of early clinical outcome (P &lt; 0.05). Our experience suggests that the ideal patient is younger than 60 years old and harbors few medical comorbidities. Individuals with large aneurysms of the anterior communicating artery, internal carotid artery bifurcation, posterior inferior cerebellar artery, midbasilar, or vertebral arteries and with an absence of thrombosis and calcium may be most likely to experience favorable outcomes. Circulatory arrest should not exceed 30 minutes. Postoperative computed tomographic scanning and timely anesthetic emergence allow for early detection of hemorrhage. Complete dissection of the aneurysm before bypass and avoiding extreme hypothermia yield a low incidence of life-threatening postoperative hematomas.CONCLUSIONHypothermic circulatory arrest is a useful technique for neuroprotection during the clipping of complex cerebral aneurysms. This procedure, however, has several associated risks. Patient factors, pathoanatomic characteristics, and surgical parameters may be used to guide patient selection.
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Gocoł, Radosław, Damian Hudziak, Jarosław Bis, Konrad Mendrala, Łukasz Morkisz, Paweł Podsiadło, Sylweriusz Kosiński, Jacek Piątek y Tomasz Darocha. "The Role of Deep Hypothermia in Cardiac Surgery". International Journal of Environmental Research and Public Health 18, n.º 13 (1 de julio de 2021): 7061. http://dx.doi.org/10.3390/ijerph18137061.

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Hypothermia is defined as a decrease in body core temperature to below 35 °C. In cardiac surgery, four stages of hypothermia are distinguished: mild, moderate, deep, and profound. The organ protection offered by deep hypothermia (DH) enables safe circulatory arrest as a prerequisite to carrying out cardiac surgical intervention. In adult cardiac surgery, DH is mainly used in aortic arch surgery, surgical treatment of pulmonary embolism, and acute type-A aortic dissection interventions. In surgery treating congenital defects, DH is used to assist aortic arch reconstructions, hypoplastic left heart syndrome interventions, and for multi-stage treatment of infants with a single heart ventricle during the neonatal period. However, it should be noted that a safe duration of circulatory arrest in DH for the central nervous system is 30 to 40 min at most and should not be exceeded to prevent severe neurological adverse events. Personalized therapy for the patient and adequate blood temperature monitoring, glycemia, hematocrit, pH, and cerebral oxygenation is a prerequisite and indispensable part of DH.
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Olsen, R. W., L. J. Hayes, E. H. Wissler, H. Nikaidoh y R. C. Eberhart. "Influence of Hypothermia and Circulatory Arrest on Cerebral Temperature Distributions". Journal of Biomechanical Engineering 107, n.º 4 (1 de noviembre de 1985): 354–60. http://dx.doi.org/10.1115/1.3138569.

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A finite element model of the bioheat transfer equation has been developed to simulate the temperature distribution in the head of a subhuman primate. Simulations were made of the induction of deep hypothermia and of subsequent hypothermic circulatory arrest (HCA). Simulations of the circulatory arrest phase were performed with different values of surface heat transfer coefficient and tissue metabolic heat generation. Numerical results were compared with experimental data for the same procedure. The simulations indicate the brain cools rapidly to a near isothermal condition in response to an infusion of cold arterial blood. However, extracerebral structures cool much more slowly. The bulk of heat gain by the brain during HCA is due to heat transfer from these warmer extra-cerebral tissues. These results suggest extended cooling by cardiopulmonary bypass (CPB) combined with surface cooling pads should reduce or even prevent the rise of brain temperatures during HCA.
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Jacobs, Marshall L. "Recent innovations in the Norwood sequence of operations". Cardiology in the Young 14, S1 (febrero de 2004): 47–51. http://dx.doi.org/10.1017/s1047951104006298.

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Although Norwood's first stage palliative procedure has been adopted by most proponents of reconstructive surgery for hypoplastic left heart syndrome, several technical modifications have recently been introduced. Some are intended primarily to minimize the adverse effects of cardiopulmonary bypass, hypothermic circulatory arrest, or both. Some are intended to simplify the technical performance of the initial palliative procedure. As the number of patients surviving staged reconstructive surgery for hypoplastic left heart syndrome grows steadily, there is a shift in emphasis toward investigation of methods to minimize morbidity. Specifically, the quality of life after staged reconstructive surgery may be affected by the potential for neurologic injury associated with bypass, deep hypothermia, and circulatory arrest. The pathology of cerebral injury includes ischemic cerebral necrosis, periventricular leukomalacia, necrosis of the brain stem, and intracranial hemorrhage. Neurologic injury associated with cardiac surgery during infancy is undoubtedly multi-factorial, and as yet is poorly and incompletely understood. Several surgical teams, nonetheless, have revised the technical aspects of the palliative operations with a goal of minimizing the duration of hypothermic circulatory arrest.
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DeCampli, William M. "Laboratory studies regarding regional low-flow perfusion for neonatal cardiac surgery". Cardiology in the Young 15, S1 (febrero de 2005): 134–41. http://dx.doi.org/10.1017/s1047951105001174.

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As the overall mortality declines following repair of complex congenital cardiac malformations, attention has focused on reducing the lasting morbidity of these interventions, particularly the observed neurodevelopmental deficiencies. Both cardiopulmonary bypass and deep hypothermic circulatory arrest produce transient alterations in cerebral hemodynamics and metabolism. In studies performed in animals, deep hypothermic circulatory arrest, as compared to cardiopulmonary bypass alone, has been shown to produce excess injury to, and death of, neuronal and glial cells.1 In neonates, deep hypothermic circulatory arrest of greater duration than one hour is a risk factor for early post-operative seizures, and for subsequent neurodevelopmental deficits.2 The Boston Circulatory Arrest Study suggests that, at follow-up of eight years, infants subjected to greater than 41 minutes of deep hypothermic circulatory arrest had excess deficits in full-scale, verbal and performance intelligence quotient, the Mayo apraxia test, and grooved pegboard testing.3 The independent adverse effects of deep hypothermic circulatory arrest have encouraged clinicians to develop the alternative technique of intermittent global perfusion, or continuous regional perfusion at low flow perfusion, in an attempt to reduce the degree of injury to the central nervous system.4–7
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Azevedo, Ruben, Wolfram Beierlein, Hans P. Wendel, Klaus Dietz, Gerhard Ziemer y Andreas Straub. "Glycoprotein IIb/IIIa inhibition reduces prothrombotic events under conditions of deep hypothermic circulatory arrest". Thrombosis and Haemostasis 94, n.º 07 (2005): 115–22. http://dx.doi.org/10.1160/th04-10-0641.

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SummaryDeep Hypothermic Circulatory Arrest (DHCA) is employed during thoracic aortic and congenital heart surgery, and can induce postoperative neurological damage probably caused by microthrombembolism. Hypothermia has been reported to induce platelet activation and aggregation. The platelet activation marker P-selectin mediates binding of platelets to leukocytes. Tirofiban and eptifibatide, short-acting inhibitors of the platelet fibrinogen receptor GP IIb/IIIa, have recently been shown to protect platelet function without increasing bleeding during heart surgery using cardiopulmonary bypass. The aim of this study was to investigate the effect of tirofiban and eptifibatide on platelets and platelet-leukocyte interaction under DHCA conditions in vitro.Platelet aggregation, binding of the GP IIb/IIIa activation specific antibody PAC-1, P-selectin expression as well as monocyte and granulocyte content of aggregates were investigated in un-stimulated and ADP-stimulated samples using flow cytometry. Tirofiban and eptifibatide inhibited massive platelet aggregation and PAC-1 binding which were induced by DHCA conditions. P-selectin expression was inhibited by tirofiban but increased by eptifibatide at hypothermia. Platelet-bound leukocytes were present in all samples. Eptifibatide increased granulocyte content of aggregates at hypothermia in ADP-stimulated samples. We conclude that under conditions of DHCA both tirofiban and eptifibatide inhibit platelet aggregation but have different effects on platelet P-selectin expression and platelet-leukocyte interaction. Application of a short-acting and non-activating GP IIb/IIIa inhibitor should be considered during DHCA in vivo to prevent occlusion of the microvasculature and subsequent organ damage.
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Solomon, Robert A., Craig R. Smith, Eric C. Raps, William L. Young, Gilbert J. Stone y Matthew E. Fink. "Deep Hypothermic Circulatory Arrest for the Management of Complex Anterior and Posterior Circulation Aneurysms". Neurosurgery 29, n.º 5 (1 de noviembre de 1991): 732–38. http://dx.doi.org/10.1227/00006123-199111000-00015.

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Abstract Giant aneurysm surgery continues to be a technically difficult task with high operative morbidity. Recent advances in cardiac surgery have fueled interest in the technique of deep hypothermic circulatory arrest for the treatment of giant and complex intracranial aneurysms. Fourteen patients with giant intracranial aneurysms operated on with the technique of deep hypothermic circulatory arrest are presented. All 14 aneurysms were successfully treated. There were 2 intraoperative strokes: 1 resulted in severe disability and 1 resulted in mild disability. No significant neurological complications were related to the technique of cardiopulmonary bypass with deep hypothermic circulatory arrest. This initial experience indicates that patients with giant and complex intracranial aneurysms might benefit from a surgical approach that included the use of deep hypothermic circulatory arrest.
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Wernovsky, Gil, Richard A. Jonas, Paul R. Hickey, Adré J. du Plessis y Jane W. Newburger. "Clinical neurologic and developmental studies after cardiac surgery utilizing hypothermic circulatory arrest and cardiopulmonary bypass". Cardiology in the Young 3, n.º 3 (julio de 1993): 308–16. http://dx.doi.org/10.1017/s1047951100001712.

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The dramatic reduction in surgical mortality associated with repair of congenital heart anomalies in recent decades has been accompanied by a growing recognition of adverse neurologic sequels in some of the survivors. Abnormalities of the central nervous system may be a function of coexisting cerebral abnormalities or acquired events unrelated to surgical management (such as paradoxical embolus, cerebral infection, or effects of chronic cyanosis), but insults to the central nervous system appear to occur most frequently during or immediately after surgery. In particular, techniques of support used during neonatal and infant cardiac surgery—cardiopulmonary bypass, profound hypothermia and circulatory arrest—have been implicated as important causes of cerebral injury. This paper will review the effects of bypass and deep hypothermic circulatory arrest on neurodevelopmental outcome.
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Mavroudis, Constantine D., Michael Karlsson, Tiffany Ko, Marco Hefti, Javier I. Gentile, Ryan W. Morgan, Ross Plyler et al. "Cerebral mitochondrial dysfunction associated with deep hypothermic circulatory arrest in neonatal swine†". European Journal of Cardio-Thoracic Surgery 54, n.º 1 (15 de enero de 2018): 162–68. http://dx.doi.org/10.1093/ejcts/ezx467.

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Abstract OBJECTIVES Controversy remains regarding the use of deep hypothermic circulatory arrest (DHCA) in neonatal cardiac surgery. Alterations in cerebral mitochondrial bioenergetics are thought to contribute to ischaemia–reperfusion injury in DHCA. The purpose of this study was to compare cerebral mitochondrial bioenergetics for DHCA with deep hypothermic continuous perfusion using a neonatal swine model. METHODS Twenty-four piglets (mean weight 3.8 kg) were placed on cardiopulmonary bypass (CPB): 10 underwent 40-min DHCA, following cooling to 18°C, 10 underwent 40 min DHCA and 10 remained at deep hypothermia for 40 min; animals were subsequently rewarmed to normothermia. 4 remained on normothermic CPB throughout. Fresh brain tissue was harvested while on CPB and assessed for mitochondrial respiration and reactive oxygen species generation. Cerebral microdialysis samples were collected throughout the analysis. RESULTS DHCA animals had significantly decreased mitochondrial complex I respiration, maximal oxidative phosphorylation, respiratory control ratio and significantly increased mitochondrial reactive oxygen species (P &lt; 0.05 for all). DHCA animals also had significantly increased cerebral microdialysis indicators of cerebral ischaemia (lactate/pyruvate ratio) and neuronal death (glycerol) during and after rewarming. CONCLUSIONS DHCA is associated with disruption of mitochondrial bioenergetics compared with deep hypothermic continuous perfusion. Preserving mitochondrial health may mitigate brain injury in cardiac surgical patients. Further studies are needed to better understand the mechanisms of neurological injury in neonatal cardiac surgery and correlate mitochondrial dysfunction with neurological outcomes.
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Levati, Anna, Concezione Tommasino, Maria Pia Moretti, Roberto Paino, Giuseppe D??Aliberti, Francesco Santoro, Stefania Meregalli, Sergio Vesconi y Massimo Collice. "Giant Intracranial Aneurysms Treated With Deep Hypothermia and Circulatory Arrest". Journal of Neurosurgical Anesthesiology 19, n.º 1 (enero de 2007): 25–30. http://dx.doi.org/10.1097/01.ana.0000211022.96054.4d.

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Hanley, Frank L. "Religion, politics…deep hypothermic circulatory arrest". Journal of Thoracic and Cardiovascular Surgery 130, n.º 5 (noviembre de 2005): 1236.e1–1236.e8. http://dx.doi.org/10.1016/j.jtcvs.2005.07.047.

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Smith, Craig R. y Talia B. Spanier. "Aprotinin in deep hypothermic circulatory arrest". Annals of Thoracic Surgery 68, n.º 1 (julio de 1999): 278–86. http://dx.doi.org/10.1016/s0003-4975(99)00518-4.

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Mason, Linda J. y Michelle L. Schlunt. "Update on Deep Hypothermic Circulatory Arrest". Seminars in Cardiothoracic and Vascular Anesthesia 11, n.º 1 (marzo de 2007): 5. http://dx.doi.org/10.1177/1089253206297408.

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Habertheuer, Andreas, Dominik Wiedemann, Alfred Kocher, Guenther Laufer y Prashanth Vallabhajosyula. "How to Perfuse: Concepts of Cerebral Protection during Arch Replacement". BioMed Research International 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/981813.

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Arch surgery remains undoubtedly among the most technically and strategically challenging endeavors in cardiovascular surgery. Surgical interventions of thoracic aneurysms involving the aortic arch require complete circulatory arrest in deep hypothermia (DHCA) or elaborate cerebral perfusion strategies with varying degrees of hypothermia to achieve satisfactory protection of the brain from ischemic insults, that is, unilateral/bilateral antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP). Despite sophisticated and increasingly individualized surgical approaches for complex aortic pathologies, there remains a lack of consensus regarding the optimal method of cerebral protection and circulatory management during the time of arch exclusion. Many recent studies argue in favor of ACP with various degrees of hypothermic arrest during arch reconstruction and its advantages have been widely demonstrated. In fact ACP with more moderate degrees of hypothermia represents a paradigm shift in the cardiac surgery community and is widely adopted as an emergent strategy; however, many centers continue to report good results using other perfusion strategies. Amidst this important discussion we review currently available surgical strategies of cerebral protection management and compare the results of recent European multicenter and single-center data.
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Kajimoto, Masaki, Dolena R. Ledee, Aaron K. Olson, Nancy G. Isern, Isabelle Robillard-Frayne, Christine Des Rosiers y Michael A. Portman. "Selective cerebral perfusion prevents abnormalities in glutamate cycling and neuronal apoptosis in a model of infant deep hypothermic circulatory arrest and reperfusion". Journal of Cerebral Blood Flow & Metabolism 36, n.º 11 (1 de octubre de 2016): 1992–2004. http://dx.doi.org/10.1177/0271678x16666846.

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Deep hypothermic circulatory arrest is often required for the repair of complex congenital cardiac defects in infants. However, deep hypothermic circulatory arrest induces neuroapoptosis associated with later development of neurocognitive abnormalities. Selective cerebral perfusion theoretically provides superior neural protection possibly through modifications in cerebral substrate oxidation and closely integrated glutamate cycling. We tested the hypothesis that selective cerebral perfusion modulates glucose utilization, and ameliorates abnormalities in glutamate flux, which occur in association with neuroapoptosis during deep hypothermic circulatory arrest. Eighteen infant male Yorkshire piglets were assigned randomly to two groups of seven (deep hypothermic circulatory arrest or deep hypothermic circulatory arrest with selective cerebral perfusion for 60 minutes at 18℃) and four control pigs without cardiopulmonary bypass support. Carbon-13-labeled glucose as a metabolic tracer was infused, and gas chromatography–mass spectrometry and nuclear magnetic resonance were used for metabolic analysis in the frontal cortex. Following 2.5 h of cerebral reperfusion, we observed similar cerebral adenosine triphosphate levels, absolute levels of lactate and citric acid cycle intermediates, and carbon-13 enrichment among three groups. However, deep hypothermic circulatory arrest induced significant abnormalities in glutamate cycling resulting in reduced glutamate/glutamine and elevated γ-aminobutyric acid/glutamate along with neuroapoptosis, which were all prevented by selective cerebral perfusion. The data suggest that selective cerebral perfusion prevents these modifications in glutamate/glutamine/γ-aminobutyric acid cycling and protects the cerebral cortex from apoptosis.
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Shuhaiber, Jeffrey H. "Evaluating the Quality of Trials of Hypothermic Circulatory Arrest Aortic Surgery". Asian Cardiovascular and Thoracic Annals 15, n.º 5 (octubre de 2007): 449–52. http://dx.doi.org/10.1177/021849230701500521.

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The quality of level 1 evidence in reports on deep hypothermic circulatory arrest was assessed, and the confounding factors in surgical management and study design that can prevent meta-analysis formulation were determined. A systematic search of the literature was conducted using categorized nomenclature for randomized controlled trials in adult patients undergoing deep hypothermic circulatory arrest in the last 40 years. Twelve randomized controlled trials (2.3%) were found among 504 publications on deep hypothermic circulatory arrest listed on Medline from 1960; only 4 of them related to adults. One adequately powered study demonstrated reduced blood loss in deep hypothermic circulatory arrest using aprotinin. Three studies comparing retrograde and antegrade perfusion were underpowered. The median CONSORT score was 14 (range, 13–15). There were no consistent measures of similar outcomes (neuropsychometric, neurocognitive). No explanation was provided for the difference in reported ranges of neurological deficits in nonrandomized (5%–70%) and randomized (3%–9%) studies. Existing studies of deep hypothermic circulatory arrest are insufficient and inconsistent in the outcome measured, which explains the lack of a meta-analysis. Neurological injury remains high, and an appropriately powered study of interventions that can optimize cerebral perfusion is necessary.
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Kondo, Mamiko, Yusuke Yoshikawa, Hirofumi Terada y Michiaki Yamakage. "Anesthetic Management of Total Aortic Arch Replacement in a Myasthenia Gravis Patient under Deep Hypothermic Circulatory Arrest". Case Reports in Anesthesiology 2019 (4 de julio de 2019): 1–2. http://dx.doi.org/10.1155/2019/3278147.

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The anesthetic management of myasthenia gravis patients undergoing cardiac or aortic surgery under cardiopulmonary bypass, especially with deep hypothermic circulatory arrest, is challenging. We describe a case of successful anesthetic management of a myasthenia gravis patient undergoing total arch replacement with deep hypothermic circulatory arrest under neuromuscular monitoring and complete reversal of the action of neuromuscular blocking drugs by sugammadex. The present case suggests that patients with well-controlled myasthenia gravis might be safely managed in cardiac or aortic surgery under cardiopulmonary bypass with deep hypothermic circulatory arrest.
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Stone, Gilbert J., William L. Young, Craig R. Smith, Robert A. Solomon, Alvin Wald, Noeleen Ostapkovich y Debra B. Shrebnick. "Do Standard Monitoring Sites Reflect True Brain Temperature When Profound Hypothermia Is Rapidly Induced and Reversed?" Anesthesiology 82, n.º 2 (1 de febrero de 1995): 344–51. http://dx.doi.org/10.1097/00000542-199502000-00004.

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Background Brain temperature is closely approximated by most body temperature measurements under normal anesthetic conditions. However, when thermal autoregulation is overridden, large temperature gradients may prevail. This study sought to determine which of the standard temperature monitoring sites best approximates brain temperature when deep hypothermia is rapidly induced and reversed during cardiopulmonary bypass. Methods Twenty-seven patients underwent cardiopulmonary bypass and deep hypothermic circulatory arrest in order for each to have a giant cerebral aneurysm surgically clipped. Brain temperatures were measured directly with a thermocouple embedded in the cerebral cortex. Eight other body temperatures were monitored simultaneously with less invasive sensors at standard sites. Results Brain temperature decreased from 32.6 +/- 1.4 degrees C (mean +/- SD) to 16.7 +/- 1.7 degrees C in 28 +/- 7 min, for an average cerebral cooling rate of 0.59 +/- 0.15 degrees C/min. Circulatory arrest lasted 24 +/- 15 min and was followed by 63 +/- 17 min of rewarming at 0.31 +/- 0.09 degrees C/min. None of the monitored sites tracked cerebral temperature well throughout the entire hypothermic period. During rapid temperature change, nasopharyngeal, esophageal, and pulmonary artery temperatures corresponded to brain temperature with smaller mean differences than did those of the tympanic membrane, bladder, rectum, axilla, and sole of the foot. At circulatory arrest, nasopharyngeal, esophageal, and pulmonary artery mean temperatures were within 1 degree C of brain temperature, even though individual patients frequently exhibited disparate values at those sites. Conclusions When profound hypothermia is rapidly induced and reversed, temperature measurements made at standard monitoring sites may not reflect cerebral temperature. Measurements from the nasopharynx, esophagus, and pulmonary artery tend to match brain temperature best but only with an array of data can one feel comfortable disregarding discordant readings.
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Buchnieva, Olha Volodymyrivna. "PROTECTION OF CENTRAL AND PERIPHERAL ORGANS IN AORTIC SURGERY". International Medical Journal, n.º 3 (2020): 19–23. http://dx.doi.org/10.37436/2308-5274-2019-3-3.

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The introduction into clinical practice of hypothermic circulatory arrest, both in the non−perfusion version and with an artificial circulation, was the beginning of active use of systemic hypothermia as an effective element of cerebral and visceral protection during combined cardiac surgeries, including in aorta pathology. To evaluate ways of protecting visceral organs and spinal cord, namely the "no perfusion" technique with drainage of cerebrospinal fluid, lateral aortic compression, left−atrial−femoral bypass, deep hypothermia with cardiac arrest, i.e. hypothermic circulatory arest, bypass grafting, artificial blood circulation and moderate hypothermia in surgery for acute aortic syndrome the results of treatment of the patients with acute bundle aortic aortic abdominal localization were analyzed. There was characterized the proposed and implemented in practice original method of protection, consisting in an access to aorta, which is pressed above the aneurysm at the level of bifurcation, and selective perfusion into the mouth of vessels supplying the internal organs with a custodiol solution with a temperature of 3−4°. All the patients with combined occlusion−stenotic lesions of different arterial pools have aortic prostheses with the inclusion of visceral arteries into bloodstream in different variants. The tendency of the more favorable post−surgery period in the patients to whom the implemented methods of protection were applied. Key words: aortic aneurysm, surgical treatment, organ protection.
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Wu, YanWen, LiQiong Xiao, Ting Yang, Lei Wang y Xin Chen. "Aortic arch reconstruction: deep and moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion". Perfusion 32, n.º 5 (30 de enero de 2017): 389–93. http://dx.doi.org/10.1177/0267659116688423.

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Objective: To compare the effects of moderate and deep hypothermic circulatory arrest (DHCA) with selective antegrade cerebral perfusion (SACP) during aortic arch surgery in adult patients and to offer the evidence for the detection of the temperature which provides best brain protection in the subjects who accept aortic arch reconstruction surgery. Methods: A total of 109 patients undergoing surgery of the aortic arch were divided into the moderate hypothermic circulatory arrest group (Group I) and the deep hypothermic circulatory arrest group (Group II). We recorded the data of the patients and their cardiopulmonary bypass (CPB) time, aortic clamping time, SACP time and postoperative anesthetized recovery time, tracheal intubation time, time in the intensive care unit (ICU) and postoperative neurologic dysfunction. Results: Patient characteristics were similar in the two groups. There were four patients who died in Group II and 1 patient in Group I. There were no significant differences in aortic clamping time of each group (111.4±58.4 vs. 115.9±16.2) min; SACP time (27.4±5.9 vs. 23.5±6.1) min of the moderate hypothermic circulatory arrest group and the deep hypothermic circulatory arrest group; there were significant differences in cardiopulmonary bypass time (207.4±20.9 vs. 263.8±22.6) min, postoperative anesthetized recovery time (19.0±11.1 vs. 36.8±25.3) hours, extubation time (46.4±15.1 vs. 64.4±6.0) hours; length of stay in the intensive care unit (ICU) (4.7±1.7 vs. 8±2.3) days and postoperative neurologic dysfunction in the two groups. Conclusion: Compared to deep hypothermic circulatory arrest, moderate hypothermic circulatory arrest can provide better brain protection and achieve good clinical results.
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Moffatt, Samuel E., S. J. B. Mitchell y J. L. Walke. "Deep and profound hypothermia in haemorrhagic shock, friend or foe? A systematic review". Journal of the Royal Army Medical Corps 164, n.º 3 (11 de mayo de 2017): 191–96. http://dx.doi.org/10.1136/jramc-2016-000723.

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IntroductionSurvival in exsanguinating cardiac arrest patients is poor, as is neurological outcome in survivors. Hypothermia has traditionally been seen as harmful to trauma patients and associated with increased mortality; however, there has been speculation that cooling to very low temperatures (≤20°C) could be used to treat haemorrhagic trauma patients by the induction of a suspended animation period through extreme cooling, which improves survival and preserves neurological function. This has been termed emergency preservation and resuscitation (EPR).MethodsA systematic review of the literature was used to examine the evidence base behind the use of deep and profound hypothermia in haemorrhagic shock (HS). It included original research articles (human or animal) with cooling to ≤20°C after HS or an experimental model replicating it. Normovolaemic cardiac arrest, central nervous system injury and non-HS models were excluded.ResultsTwenty articles using 456 animal subjects were included, in which 327 were cooled to ≤20°C. All studies describing good survival rates were possible using EPR and 19/20 demonstrated that EPR can preserve neurological function after prolonged periods of circulatory arrest or minimal circulatory flow. This additional period can be used for surgical intervention to arrest haemorrhage in HS that would otherwise be lethal.ConclusionsThe outcomes of this review have significant implications for application to human patients and the ongoing human clinical trial (EPR for Cardiac Arrest from Trauma). Current evidence suggests that hypothermia ≤20°C used in the form of EPR could be beneficial to the HS patient.
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Treasure, Tom. "Relationship between intelligence and duration of circulatory arrest with deep hypothermia". Journal of Thoracic and Cardiovascular Surgery 111, n.º 4 (abril de 1996): 904. http://dx.doi.org/10.1016/s0022-5223(96)70361-6.

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43

Fulton, FCS(SA), James O. y Johan G. Brink, FCS(SA). "Complex Thoracic Vascular Injury Repair Using Deep Hypothermia and Circulatory Arrest". Annals of Thoracic Surgery 63, n.º 2 (febrero de 1997): 557–59. http://dx.doi.org/10.1016/s0003-4975(96)01110-1.

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44

Lansing, Allan M. "Late neurologic complication after deep hypothermia and circulatory arrest—A hypothesis". Journal of Thoracic and Cardiovascular Surgery 103, n.º 1 (enero de 1992): 172. http://dx.doi.org/10.1016/s0022-5223(19)35086-x.

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Aebert, Hermann, Alexander Brawanski, Alois Philipp, Renate Behr, Odo-Winfried Ullrich, Cornelius Keyl y Dietrich E. Birnbaum. "Deep hypothermia and circulatory arrest for surgery of complex intracranial aneurysms1". European Journal of Cardio-Thoracic Surgery 13, n.º 3 (marzo de 1998): 223–29. http://dx.doi.org/10.1016/s1010-7940(98)00018-9.

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46

KURTH, C. DEAN, JAMES M. STEVEN y SUSAN C. NICHOLSON. "Cerebral Oxygenation During Pediatric Cardiac Surgery Using Deep Hypothermia Circulatory Arrest". Survey of Anesthesiology 39, n.º 6 (diciembre de 1995): 368. http://dx.doi.org/10.1097/00132586-199512000-00031.

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47

Miyerbekov, Y., T. Kuandykov y V. Mutagirov. "Deep hypothermia circulatory arrest: is it enough to protect the brain?" European Journal of Anaesthesiology 31 (junio de 2014): 119. http://dx.doi.org/10.1097/00003643-201406001-00329.

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Dumont, Eric, Michel Carrier, Raymond Cartier, Michel Pellerin, Nancy Poirier, Denis Bouchard y Louis P. Perrault. "Repair of aortic false aneurysm using deep hypothermia and circulatory arrest". Annals of Thoracic Surgery 78, n.º 1 (julio de 2004): 117–20. http://dx.doi.org/10.1016/j.athoracsur.2004.01.028.

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Chen, Qiang, Kai-Peng Sun, Jiang-Shan Huang, Zeng-Chun Wang y Zhi-Nuan Hong. "Resveratrol attenuates neuroinflammation after deep hypothermia with circulatory arrest in rats". Brain Research Bulletin 155 (febrero de 2020): 145–54. http://dx.doi.org/10.1016/j.brainresbull.2019.12.008.

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Uysal, S., D. Reich, M. Silwinski, M. Hibbard y W. Gordon. "Neuropsychological sequelae of deep hypothermic circulatory arrest". Archives of Clinical Neuropsychology 14, n.º 1 (1 de enero de 1999): 67–68. http://dx.doi.org/10.1093/arclin/14.1.67a.

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