Temporary neurological dysfunction after deep hypothermic circulatory arrest: a clinical marker of long-term functional deficit

Ergin, Mehmet; Uysal, Suzan; Reich, David L.; Apaydin, Anil Z.; Lansman, Steven L.; McCullough, Jock N.; Griepp, Randall B.

doi:10.1016/s0003-4975(99)00432-4

Cited by 211 publications

(160 citation statements)

References 11 publications

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“…For these reasons and for the marginal benefit obtained the PH is rarely used today (15). DH (14.1-20 ℃): most patients achieve electrical silence with this temperature range (12 (18). DH also has a number of drawbacks such as high CPB required for cooling and warming of the blood, cerebral microvascular endothelial dysfunction, edema formation, coagulopathy and impaired function of many organs including kidneys, brain, vascular smooth muscle, intestinal mucosa, alveolar epithelium, liver or pancreas (19).…”

Section: Hypothermiamentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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Abstract:The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 ℃) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

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Section: Hypothermiamentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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“…The temporary neurologic deficits were defined as postoperative confusion, delirium, obtundation, or transit focal deficits with negative evidence on computed tomography or magnetic resonance imaging. 8) The permanent or temporary neurologic deficits caused by preoperative brain malperfusion, hemodynamic instability, or atrial fibrillation were excluded in this study.…”

Section: Definition Of Complicationsmentioning

confidence: 99%

Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Fukunaga

Saji

Kanemitsu

et al. 2015

ATCS

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IntroductionType A acute aortic dissection (AAD) is still a devastating disease, which mortality rate following medical managements reaches to 50% within the first 48 h. 1) The mortality rate associated with AAD after surgery has decreased, but it reached to roughly 20% worldwide. 2) In Japan, hospital mortality rate after an emergency surgery for AAD was 9.2% in 2010. 3) Antegrade cerebral perfusion (ACP) is one of the techniques for cerebral protection during proximal aortic surgery. This technique has been applied to a repair of AAD and effective circulation management could be achieved by Comas et al. 2) Controversy that which arterial cannulation site is optimal in a repair of AAD exists. 4,5) Femoral artery is the usual cannulation site for cardiopulmonary bypass in a repair of AAD, 6) on the other hand, the retrograde perfusion via the femoral artery causes retrograde thromboembolism from atheromatous debris in the thoracic and was performed in 34 patients. Mean age was 64.5 ± 13.7 years of age. Preoperative shock status was in three due to cardiac tamponade. Organ malperfusion occurred in 11 patients preoperatively. Mean follow-up period was 9.6 ± 8.4 months and follow-up rate was 100%. Results: Hospital mortality rate was 8.8%. No newly required hemodialysis and new onset of temporary or permanent neurologic deficits were present in survivors. There were no statistically significant differences of mortality rate, new onset of permanent or temporary neurologic deficits and distal organ dysfunction between ACP duration <60 min and ≥60 min. The 12-month survival was 84.4% ± 6.4%. And, freedom from aorta-related events at 12 and 18 months were 100% ± 0.0% and 88.9% ± 10.5%, respectively. Conclusions: The duration of ACP via right axillary artery does not affect early outcomes following a repair of AAD.

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“…TND is a reversible, diffuse, subtle injury which is an indicator of global cerebral injury due to inadequate cerebral protection. TND following arch reconstruction using DHCA alone has been shown to occur in approximately 25% of all cases, and a linear relationship has been demonstrated between the incidence of TND and the duration of DHCA (15,16,17). In order to limit adverse neurologic outcomes, many investigations have focused upon determining a "safe" duration of DHCA.…”

Section: Wwwintechopencommentioning

confidence: 99%