PROFOUND HYPOTHERMIA (<10°C) COMPARED TO DEEP HYPOTHERMIA (15°C) IMPROVES NEUROLOGIC OUTCOME IN DOGS AFTER 2 HOURS CIRCULATORY ARREST INDUCED TO ENABLE RESUSCITATIVE SURGERY

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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Budd-Chiari Syndrome Resulting from a Membranous Web of the Inferior Vena Cava: Operative Repair Using Profound Hypothermia and Circulatory Arrest

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(10)60400-6 ◽

1987 ◽

Vol 43 (2) ◽

pp. 212-214 ◽

Cited By ~ 14

Author(s):

J. Peter Murphy ◽

Igor Gregoric ◽

Denton A. Cooley

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Circulatory Arrest ◽

Vena Cava ◽

Budd Chiari Syndrome ◽

Profound Hypothermia ◽

Operative Repair ◽

Chiari Syndrome

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

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2008.03.068 ◽

2008 ◽

Vol 86 (2) ◽

pp. 429-435 ◽

Cited By ~ 2

Author(s):

Yanmin Yang ◽

Zhaokang Su ◽

Jiming Cai ◽

Shunmin Wang ◽

Jinfen Liu ◽

...

Keyword(s):

Pulmonary Surfactant ◽

Circulatory Arrest ◽

Deep Hypothermia

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Clinical neurologic and developmental studies after cardiac surgery utilizing hypothermic circulatory arrest and cardiopulmonary bypass

Cardiology in the Young ◽

10.1017/s1047951100001712 ◽

1993 ◽

Vol 3 (3) ◽

pp. 308-316 ◽

Cited By ~ 13

Author(s):

Gil Wernovsky ◽

Richard A. Jonas ◽

Paul R. Hickey ◽

Adré J. du Plessis ◽

Jane W. Newburger

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Circulatory Arrest ◽

Neurodevelopmental Outcome ◽

Hypothermic Circulatory Arrest ◽

Cerebral Injury ◽

Profound Hypothermia ◽

The Central Nervous System

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

Perfusion ◽

10.1177/0267659117715695 ◽

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.

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