Deep hypothermia circulatory arrest: is it enough to protect the brain?

2014 ◽  
Vol 31 ◽  
pp. 119
Author(s):  
Y. Miyerbekov ◽  
T. Kuandykov ◽  
V. Mutagirov
Keyword(s):  
Circulatory Arrest ◽  
Deep Hypothermia ◽  
The Brain

Aortic Arch Repair (Circulatory Arrest)

2019 ◽  
pp. 263-267
Author(s):  
Shyamal Asher
Keyword(s):  
Blood Flow ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Anesthetic Management ◽  
Deep Hypothermia ◽  
The Body ◽  
Adequate Knowledge ◽  
Aortic Arch Repair ◽  
Aortic Dissections ◽  
The Brain

Aortic arch repair is a technically challenging surgery that requires collaboration between the anesthesiology, cardiac surgery, and perfusion teams. To accomplish a total aortic arch repair, blood flow to the brain and the rest of the body has to be interrupted. The most common aortic arch pathologies encountered for surgery are aortic arch aneurysms followed by aortic dissections. The need for hypothermia and circulatory arrest during aortic arch surgeries leads to unique implications for anesthetic management. Therefore, adequate knowledge of the planned surgery and specific surgical and nonsurgical cerebral protection techniques are necessary. Furthermore, an understanding of intraoperative neurophysiologic and temperature monitoring at deep hypothermia as well as postbypass coagulopathy management are needed in these challenging cases.

scholarly journals Does deeper hypothermia reduce the risk of acute kidney injury after circulatory arrest for aortic arch surgery?

2021 ◽  
Author(s):  
Andrew M Vekstein ◽  
Babtunde A Yerokun ◽  
Oliver K Jawitz ◽  
Julie W Doberne ◽  
Jatin Anand ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Deep Hypothermia ◽  
Moderate Hypothermia ◽  
Bladder Temperature ◽  
Increased Risk ◽  
The Impact

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.

Continuous Pulmonary Infusion of L-Arginine During Deep Hypothermia and Circulatory Arrest Improves Pulmonary Surfactant Integrity in Piglets

2008 ◽  
Vol 86 (2) ◽  
pp. 429-435 ◽  
Author(s):  
Yanmin Yang ◽  
Zhaokang Su ◽  
Jiming Cai ◽  
Shunmin Wang ◽  
Jinfen Liu ◽  
...  
Keyword(s):  
Pulmonary Surfactant ◽  
Circulatory Arrest ◽  
Deep Hypothermia

Unilateral Antegrade Cerebral Perfusion Through the Right Axillary Artery Provides Uniform Flow Distribution to Both Hemispheres of the Brain

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Jian Ye ◽  
Guangping Dai ◽  
Lawrence N. Ryner ◽  
Piotr Kozlowski ◽  
Luojia Yang ◽  
...  
Keyword(s):  
Cerebral Blood Volume ◽  
Axillary Artery ◽  
Circulatory Arrest ◽  
Flow Distribution ◽  
Mr Perfusion ◽  
Mr Perfusion Imaging ◽  
Regional Cerebral Blood Volume ◽  
The Right ◽  
The Brain ◽  
Antegrade Cerebral Perfusion

Background —Bilateral antegrade cerebral perfusion (ACP) has decreased in popularity over the past decade because of its complexity and the risk of cerebral embolism. We used magnetic resonance (MR) perfusion imaging to assess flow distribution in both hemispheres of the brain during unilateral ACP through the right carotid artery via a cannula placed in the right axillary artery in conjunction with hypothermic circulatory arrest. Methods and Results —Twelve pigs were randomly exposed to 120 minutes of either bilateral ACP through both carotid arteries (n=6) or unilateral ACP through the right axillary artery (n=6) at pressures of 60 to 65 mm Hg at 15°C, followed by 60 minutes of cardiopulmonary bypass at 37°C. MR perfusion images were acquired every 30 minutes before, during, and after ACP. The brain was perfusion fixed for histopathology. During initial normothermic cardiopulmonary bypass, MR perfusion imaging showed a uniform distribution of flow in the brain. In both the bilateral and unilateral ACP groups, the same pattern was maintained, with an increase in regional cerebral blood volume during ACP and reperfusion. The changes in regional cerebral blood volume and mean transit time were similar in both hemispheres during and after unilateral ACP. No difference was observed between the 2 groups. Histopathology showed normal morphology in all regions of the brain in both groups. Conclusions —Both bilateral ACP and unilateral ACP provide uniform blood distribution to both hemispheres of the brain and preserve normal morphology of the neurons after prolonged hypothermic circulatory arrest.

Microvascular fluid exchange during CPB with deep hypothermia circulatory arrest or low flow

Perfusion ◽  
2017 ◽  
Vol 32 (8) ◽  
pp. 661-669
Author(s):  
Bjørg Elvevoll ◽  
Paul Husby ◽  
Venny L. Kvalheim ◽  
Lodve Stangeland ◽  
Arve Mongstad ◽  
...  
Keyword(s):  
Brain Injury ◽  
Circulatory Arrest ◽  
Deep Hypothermia ◽  
Low Flow ◽  
Cerebral Microdialysis ◽  
Tissue Water ◽  
Fluid Exchange ◽  
Fluid Extravasation ◽  
Total Tissue ◽  
Water Contents

Objective: Use of deep hypothermic low-flow (DHLF) cardiopulmonary bypass (CPB) has been associated with higher fluid loading than the use of deep hypothermia circulatory arrest (DHCA). We evaluated whether these perfusion strategies influenced fluid extravasation rates and edema generation differently per-operatively. Materials and Methods: Twelve anesthetized pigs, randomly allocated to DHLF (n = 6) or DHCA (n = 6), underwent 2.5 hours CPB with cooling to 20°C for 30 minutes (min), followed by 30 min arrested circulation (DHCA) or 30 min low-flow circulation (DHLF) before 90 min rewarming to normothermia. Perfusion of tissues, fluid requirements, plasma volumes, colloid osmotic pressures and total tissue water contents were recorded and fluid extravasation rates calculated. During the experiments, cerebral microdialysis was performed in both groups. Results: Microvascular fluid homeostasis was similar in both groups, with no between-group differences, reflected by similar fluid extravasation rates, plasma colloid osmotic pressures and total tissue water contents. Although extravasation rates increased dramatically from 0.10 (0.11) ml/kg/min (mean with standard deviation in parentheses) and 0.16 (0.02) ml/kg/min to 1.28 (0.58) ml/kg/min and 1.06 (0.41) ml/kg/min (DHCA and DHLF, respectively) after the initiation of CPB, fluid filtrations during both cardiac arrest and low flow were modest and close to baseline values. Cerebral microdialysis indicated anaerobic metabolism and ischemic brain injury in the DHCA group. Conclusion: No differences in microvascular fluid exchange could be demonstrated as a direct effect of DHCA compared with DHLF. Thirty minutes of DHCA was associated with anaerobic cerebral metabolism and possible brain injury.

scholarly journals Inhibition of microRNA-29c protects the brain in a rat model of prolonged hypothermic circulatory arrest

2015 ◽  
Vol 150 (3) ◽  
pp. 675-684.e1 ◽  
Author(s):  
Yongchao Wang ◽  
Tianxiang Gu ◽  
Enyi Shi ◽  
Lei Yu ◽  
Chun Wang ◽  
...  
Keyword(s):  
Rat Model ◽  
Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
The Brain

Edema of the brain following circulatory arrest

1962 ◽  
Vol 2 (2) ◽  
pp. 141-143 ◽  
Author(s):  
C.G. Gunn ◽  
G.R. Williams ◽  
I.T. Parker
Keyword(s):  
Circulatory Arrest ◽  
The Brain

Abstract 2594: Remote Ischemic Preconditioning Protects the Brain Against Injury Following Hypothermic Circulatory Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hanna Kaakinen ◽  
Stavros P Loukogeorgakis ◽  
Viktor Tsang ◽  
Eija Niemelä ◽  
Hannu Tuominen ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Ischemic Preconditioning ◽  
Circulatory Arrest ◽  
Lactate Concentration ◽  
T Test ◽  
Histopathological Analysis ◽  
Eeg Activity ◽  
Behavioral Score ◽  
The Brain ◽  
Brain Lactate

Ischemic preconditioning (IPC) is an innate mechanism that protects tissues from injury during ischemia and reperfusion. IPC has systemic effects that protect tissues remote from those undergoing preconditioning (remote IPC; RIPC). RIPC can be elicited by applying brief periods of ischemia to tissues with ischemic tolerance (skeletal muscle) yet protect vital organs that are more susceptible to ischemic damage. Using a porcine model, we determined if RIPC of the limb is protective against brain injury caused by hypothermic circulatory arrest (HCA). 12 piglets were randomized to control and RIPC groups before undergoing cardiopulmonary bypass (CPB) and 60 minutes HCA at 18oC. RIPC was induced by 4 cycles of 5-minute ischemia alternating with reperfusion of the hind limb (inflation of pneumatic cuff to 200mmHg) prior to CPB. Intracranial pressure and temperature, brain lactate concentration and electroencephalographic (EEG) activity were monitored for 8 hours after HCA. Assessment of neurological status was performed daily for 7 days post-operatively, using a species-specific quantitative behavioral score. All animals were sacrificed and brain tissue was harvested for histopathological analysis. Data were analyzed using 2-way ANOVA or student’s t-test. Study groups were balanced for baseline and intra-operative parameters; no differences were observed in intracranial pressure and temperature. Brain lactate concentration was significantly lower (p<0.0001, ANOVA) and recovery of EEG activity faster (p<0.05, ANOVA) in the RIPC group compared to control. RIPC had a beneficial effect on neurological function during the 7-day follow-up period (behavioral score; p<0.0001 vs. control, ANOVA). Histopathological analysis demonstrated a significant reduction in total cerebral injury in RIPC animals compared to controls [injury score; median (interquartile range): control 6.4 (5.0 – 8.0) vs. RIPC 1.6 (0.5–2.5), p<0.001, t-test]. These data demonstrate, for the first time, that RIPC protects the brain against HCA-induced injury, resulting in accelerated recovery of neurological function. RIPC might be neuroprotective in patients undergoing surgery with HCA and improve long-term outcomes. Clinical trials to test this hypothesis are warranted.

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