The Role of Deep Hypothermia in Cardiac Surgery

Gocoł, Radosław; Hudziak, Damian; Bis, Jarosław; Mendrala, Konrad; Morkisz, Łukasz; Podsiadło, Paweł; Kosiński, Sylweriusz; Piątek, Jacek; Darocha, Tomasz

doi:10.3390/ijerph18137061

Cited by 32 publications

(14 citation statements)

References 76 publications

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“…Many cardiac-preserving techniques have been used since the inception of cardiac surgery. However, cardioplegic arrest and hypothermia are the mainstay approaches to protecting the heart during cardiac surgery [ 91 ]. Hypothermia provides cardioprotection, mainly by slowing down the metabolism of cardiomyocytes.…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

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The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

et al. 2023

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In the United States, about one million people are seen to visit the operating theater for cardiac surgery annually. However, nearly half of these visits result in complications such as renal, neurological, and cardiac injury of varying degrees. Historically, many mechanisms and approaches have been explored in attempts to reduce injuries associated with cardiac surgery and percutaneous procedures. Devices such as cardioplegia, mechanical circulatory support, and other methods have shown promising results in managing and preventing life-threatening cardiac-surgery-related outcomes such as heart failure and cardiogenic shock. Comparably, cardioprotective devices such as TandemHeart, Impella family devices, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) have also been proven to show significant cardioprotection through mechanical support. However, their use as interventional agents in the prevention of hemodynamic changes due to cardiac surgery or percutaneous interventions has been correlated with adverse effects. This can lead to a rebound increased risk of mortality in high-risk patients who undergo cardiac surgery. Further research is necessary to delineate and stratify patients into appropriate cardioprotective device groups. Furthermore, the use of one device over another in terms of efficacy remains controversial and further research is necessary to assess device potential in different settings. Clinical research is also needed regarding novel strategies and targets, such as transcutaneous vagus stimulation and supersaturated oxygen therapy, aimed at reducing mortality among high-risk cardiac surgery patients. This review explores the recent advances regarding the use of cardioprotective devices in patients undergoing percutaneous procedures and cardiac surgery.

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Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

“…Hypothermia provides cardioprotection, mainly by slowing down the metabolism of cardiomyocytes. This reduces their demand for oxygen and energy consumption [ 91 , 92 ]. A Topical Cooling Device (TCD) is an example of devices that are used to achieve hypothermia during cardiac surgeries.…”

Section: Cardioprotective Devices That Unload the Heartmentioning

confidence: 99%

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

et al. 2023

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“…Reperfusion injury also involves activation of the innate immune system, which results in tissue inflammation that is amplified by release of cytokines from activated leukocytes [1 && ]. Deep hypothermia applied before circulatory arrest provides substantial neuroprotection and has been used in cardiac surgery since the 1950s [3]. Several case reports document full neurological recovery among people who have become accidentally hypothermic before cardiac arrest [4,5].…”

Section: Andandmentioning

confidence: 99%

Temperature control after cardiac arrest: friend or foe

Nolan

Soar

2022

Current Opinion in Critical Care

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Purpose of reviewMost patients who are successfully resuscitated after cardiac arrest are initially comatose and require mechanical ventilation and other organ support in an ICU. Best practice has been to cool these patients and control their temperature at a constant value in the range of 32–36 oC for at least 24 h. But the certainty of the evidence for this practice is increasingly being challenged. This review will summarize the evidence on key aspects of temperature control in comatose postcardiac arrest patients.Recent findingsThe Targeted Temperature Management 2 (TTM-2) trial documented no difference in 6-month mortality among comatose postcardiac arrest patients managed at 33 oC vs. targeted normothermia. A systematic review and meta-analysis completed by the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) concluded that temperature control with a target of 32–34 °C did not improve survival or favourable functional outcome after cardiac arrest. Two observational studies have documented an association between predicted moderate hypoxic–ischaemic brain injury and better outcome with temperature control at 33–34 oC compared with 35–36 oC.SummaryWe suggest actively preventing fever by targeting a temperature 37.5 oC or less for those patients who remain comatose following return of spontaneous circulation (ROSC) after cardiac arrest.

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“…In this setting, a decrementing increase in sodium influx helps to impair the severity of calcium influx following restoration of calcium levels and reduce hypercontractility and cellular injury [34]. During surgery, hypothermia functions to significantly reduce metabolism and oxygen consumption and attenuate the injury incurred by ischemia [35].…”

Section: Therapeutic Hypothermia and Preconditioningmentioning

confidence: 99%

An Overview of Therapy Guidelines for Cardiac Arrest and the Potential Benefits of Hemoglobin-Based Oxygen Carriers

et al. 2022

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Currently, there is an unmet therapeutic need for the medical management of cardiac arrest, as is evident from the high mortality rate associated with this condition. These dire outcomes can be attributed to the severe nature and poor prognosis of this disorder. However, the current treatment modalities, while helping to augment survival, are limited and do not offer adequate improvements to outcomes. Treatment modalities are particularly lacking when considering the underlying pathophysiology of the metabolic phase of cardiac arrest. In this study, we explore the three phases of cardiac arrest and assess the factors related to positive clinical outcomes and survival for these events. Furthermore, we evaluate the present guidelines for resuscitation and recovery, the issues related to ischemia and tissue reperfusion, and the benefit of oxygen-delivery therapeutic methods including blood transfusion therapy and synthetic hemoglobins (HBOCs). The current therapy protocols are limited specifically by the lack of an efficient method of oxygen delivery to address the metabolic phase of cardiac arrest. In this article, we investigate the next generation of HBOCs and review their properties that make them attractive for their potential application in the treatment of cardiac arrest. These products may be a viable solution to address complications associated with ischemia, reperfusion injury, and organ damage.

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The Role of Deep Hypothermia in Cardiac Surgery

Cited by 32 publications

References 76 publications

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

Temperature control after cardiac arrest: friend or foe

An Overview of Therapy Guidelines for Cardiac Arrest and the Potential Benefits of Hemoglobin-Based Oxygen Carriers

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