Deep hypothermic circulatory arrest: Alternative strategies for cerebral perfusion. A review article

Abstract

Deep hypothermic circulatory arrest is an essential tool in the surgeon's armamentarium. There are essentially three strategies to address cerebral ischemia during arrest periods. Early surgical case series pioneered the option of complete anoxia with deep hypothermia. Subsequent innovators introduced the concept of retrograde perfusion of the cerebral vessels through the venous system, and others have advocated the use of selective and non-selective antegrade perfusion of the cerebral arteries. Clinical studies assessing outcomes of the three approaches are compromised by small patient numbers, retrospective design and surgeon bias. In this review, the authors will briefly discuss the conceptual basis of these strategies and the literature comparing these approaches in terms of key neurologic outcomes. The importance of this topic will emphasize the key role the perfusion community plays in establishing guidelines for best practice in circulatory arrest to go forward with education and research in this area.

Changes in hippocampal ultrastructure and vimentin expression in rhesus monkeys following selective deep hypothermia and blood occlusion

“…Complex intracranial space occupying lesions in neurosurgery, such as huge complex intracranial aneurysms of the posterior circulation or huge complex intracranial vascular malformations, require the induction of a cerebral blood occlusion to insure surgery success and reduce surgical complications. However, many researchers have studied protection of the cerebrum following cerebral occlusion as it is an important factor that influences prognosis (Elmistekawy and Rubens, 2011;Nakamura et al, 2011).…”

“…Currently, deep hypothermic systemic circulatory arrest technology is available in clinical neurosurgery but has many disadvantages that mean the blood occlusion safe time cannot meet the clinical surgery operation time requirements; therefore, it can easily induce complications, such as blood viscosity, blood coagulation, arrhythmia, and respiratory failure (Cronberg et al, 2009). Previous study results have indicated that deep hypothermia with selective antegrade cerebral perfusion can improve cerebral endurance to ischemia and hypoxia in the cerebrum of rhesus monkeys, extend the safe time of blood occlusion, and avoid various systemic deep hypothermia complications (Yao, 2001;Elmistekawy and Rubens, 2011). In this study, the effectiveness and safety of selective cerebral deep hypothermic protection technology is further discussed by observing the change in hippocampal ultrastructure and vimentin expression in rhesus monkeys after recovery from selective deep hypothermia and blood occlusion.…”

Comparison of Clinical Outcomes in Patients Who Underwent Bare Metal Coronary Stenting Versus Coronary By-pass Surgery

“…However, recent improvements in revascularization technology, especially in areas involving drug eluting stents (DES) and operation techniques, increase the role of revascularization in the management of complex CAD (3)(4)(5) . A better understanding of coronary lesion anatomy and the development of percutaneous and surgical techniques, accordingly, lead to the improvement of longterm morbidity and mortality of complex CAD (1,2) .…”

Effect of Hypothermia-Induced Respiratory Arrest on Cerebral Circulation in Rats

“…Circulation in the cerebral microvessels continued during severe hypothermia, and it went on even after hypothermic respiratory arrest while the heart was beating. In pial venules, the blood continued to fl ow for 8-10 min after respiratory arrest.At present, numerous features of pathophysiology of hypothermic states and clinical application of hypothermic protection are known [1,4]. However, the effects of cooling of the whole organism down to and below the core temperature (CT) of 25 o C on microcirculation were little studied.…”