Hypothermia, Low Flow Extracorporeal Circulation and Controlled Cardiac Arrest for Open Heart Surgery

Sealy, W. C.; Brown, Ivan W.; Young, W. Glenn; Stephen, C. R.; Harris, Joanne; Merritt, Doris H.

doi:10.1097/00132586-195710000-00096

Cited by 5 publications

(4 citation statements)

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“…This initial observation was confirmed by subsequent findings in experiments in the intact animal heart, cooled in a non-arrested state, and document the existence of hypothermia-induced cardiac dysfunction and reduced CO after rewarming ( Ross, 1954 ; Blair et al, 1956 ; Fedor et al, 1958 ; Popovic and Kent, 1965 ; Steen et al, 1980 ; Tveita et al, 1996a ). However, the introduction of CPB in cardiac surgery ( Sealy et al, 1957 ) appeared to eliminate the occurrence of post-hypothermic cardiac dysfunction. Subsequently, post-operative cardiac dysfunction has been attributed to the preceding period of ischemia-reperfusion during cardiac surgery and not to the hypothermic exposure ( Toller and Metzler, 2005 ).…”

Section: Discussionmentioning

confidence: 99%

“…Rewarming methods used in accidental hypothermia patients have been mostly adapted from modern cardiac surgery, where cardio-pulmonary bypass (CPB) has been routinely applied over the past 60 years to cool and rewarm patients ( Sealy et al, 1957 ). Although the overall morbidity and mortality associated with the use of CPB has steadily decreased since its introduction in cardiac surgery, hypothermic CPB can lead to post-hypothermic impairment of cardiac ventricular function ( Schultz et al, 2006 ) and central nervous system complications ( Newman et al, 1995 ; Selnes et al, 1999 ; Grigore et al, 2002 ; Newman et al, 2006 ; Grigore et al, 2009 ; Debaty et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

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Functional recovery after accidental deep hypothermic cardiac arrest: Comparison of different cardiopulmonary bypass rewarming strategies

et al. 2022

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Introduction: Using a porcine model of accidental immersion hypothermia and hypothermic cardiac arrest (HCA), the aim of the present study was to compare effects of different rewarming strategies on CPB on need for vascular fluid supply, level of cardiac restitution, and cerebral metabolism and pressures.Materials and Methods: Totally sixteen healthy, anesthetized castrated male pigs were immersion cooled to 20°C to induce HCA, maintained for 75 min and then randomized into two groups: 1) animals receiving CPB rewarming to 30°C followed by immersion rewarming to 36°C (CPB30, n = 8), or 2) animals receiving CPB rewarming to 36°C (CPB36, n = 8). Measurements of cerebral metabolism were collected using a microdialysis catheter. After rewarming to 36°C, surviving animals in both groups were further warmed by immersion to 38°C and observed for 2 h.Results: Survival rate at 2 h after rewarming was 5 out of 8 animals in the CPB30 group, and 8 out of 8 in the CPB36 group. All surviving animals displayed significant acute cardiac dysfunction irrespective of rewarming method. Differences between groups in CPB exposure time or rewarming rate created no differences in need for vascular volume supply, in variables of cerebral metabolism, or in cerebral pressures and blood flow.Conclusion: As 3 out of 8 animals did not survive weaning from CPB at 30°C, early weaning gave no advantages over weaning at 36°C. Further, in surviving animals, the results showed no differences between groups in the need for vascular volume replacement, nor any differences in cerebral blood flow or pressures. Most prominent, after weaning from CPB, was the existence of acute cardiac failure which was responsible for the inability to create an adequate perfusion irrespective of rewarming strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional recovery after accidental deep hypothermic cardiac arrest: Comparison of different cardiopulmonary bypass rewarming strategies

et al. 2022

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“…of hypothermia led inventors to add heat exchangers to extracorporeal blood circuits in order to achieve core hypothermia -preferential cooling of those organs and tissues which receive the largest share of arterial blood flow. [31][32][33][34] Core hypothermia combines the advantages of mechanical cardiopulmonary support with those of reduced oxygen needs. The first blood-heat exchangers were sturdy, reusable devices built on the industrial model of automobile radiators.…”

Section: Deep Hypothermiamentioning

confidence: 99%

Cardiopulmonary Bypass: The Historical Foundation, the Future Promise

Galletti¹,

Mora²

1995

Cardiopulmonary Bypass

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Cardiopulmonary bypass (CPB) is used so routinely in hospitals around the world that most of the participantssurgeons, anesthesiologists, perfusionists, operating room nurses and, above all, patients -forget that this landmark in clinical technology is not even 40 years old. In fact, many of the pioneers are still active in the field. Yet, so much has been done to transform a once-hazardous procedure into standard medical practice-through basic science, quality control, and good manufacturing-that one hardly remembers the days (not so long ago) when "pump-oxygenators," as they were graphically called, were assembled just outside the operating room by tinkerers with a dream. The purpose of this chapter is to recall the inventiveness displayed by a small coterie of gifted investigators to whom we owe the mechanical and physiologic foundations of open-heart surgery, and to reflect on the new demands that continuing clinical advances will undoubtedly make on this technology.

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“…Hypothermia in combination with cardiopulmonary bypass for open cardiac surgery, as introduced by Sealy et al (1957), offers the advantage 6 -74291 1 of decreased metabolism in vital organs. A less desirable effect is the elevation of systemic vascular resistance produced even by a moderate degree of hypothermia (Rose et al, 1957;NordCn et al, 1970).…”

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confidence: 99%

The Influence of Anaesthetics on Systemic Vascular Resistance During Cardiopulmonary Bypass

Nordén

1974

Scandinavian Journal of Thoracic and Cardiovascular Surgery

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The influence of various anaesthetic techniques was studied during total cardiopulmonary bypass with a disc oxygenator, high flow perfusion and mild hypothermia. Data were obtained from 52 adult patients undergoing corrective surgery for congenital or acquired heart disease. The material was randomly divided in two groups with 28 and 24 patients, respectively. Before perfusion, the same anaesthetic technique was applied to all patients. During perfusion, halothane was vapourized into the oxy-

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Hypothermia, Low Flow Extracorporeal Circulation and Controlled Cardiac Arrest for Open Heart Surgery

Cited by 5 publications

References 0 publications

Functional recovery after accidental deep hypothermic cardiac arrest: Comparison of different cardiopulmonary bypass rewarming strategies

Functional recovery after accidental deep hypothermic cardiac arrest: Comparison of different cardiopulmonary bypass rewarming strategies

Cardiopulmonary Bypass: The Historical Foundation, the Future Promise

The Influence of Anaesthetics on Systemic Vascular Resistance During Cardiopulmonary Bypass

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