Use of rheomacrodex and hyperventilation in prolonged circulatory arrest under deep hypothermia induced by surface cooling

Mohri, Hitoshi; Hessel, Eugene A.; Nelson, Ronald J.; Matano, Ichiro; Anderson, Howard N.; Dillard, David H.; Merendino, K. Alvin

doi:10.1016/0002-9610(66)90015-8

Cited by 58 publications

(3 citation statements)

References 13 publications

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“…15 The beneficial effects of low-molecular-weight dextran infusion and prevention of respiratory and metabolic alkalosis during aortic occlusion play major roles in this method. 16,17 Thus at our institute, hypothermia in cardiac surgery has been further developed with continuing improvement, as shown in Table 4. This is due to progress in cardiac surgery in general as well as changes we have adopted over the years.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Surgery under Perfusionless Hypothermia: Siberian Experience

Karaskov¹,

Kitchlu²,

Lomivorotov³

2002

Asian Cardiovasc Thorac Ann

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Between January 1995 and December 1999, 942 patients (452 males and 490 females) aged 1 to 51 years underwent definitive surgery under perfusionless hypothermia for correction of congenital heart defects, predominantly uncomplicated ventricular or atrial septal defects (80%). Hypothermia of 24 degrees C to 28 degrees C was achieved in 15 to 45 minutes (mean, 25.7 +/- 1.2 minutes) by application of crushed ice over the body and head. Aortic crossclamp time ranged from 10 to 76 minutes (mean, 26.1 +/- 0.25 minutes). Cardiac restoration time ranged from 1 to 10 minutes (mean, 2.1 +/- 0.08 minutes). Eight patients (0.85%) died postoperatively: 4 from acute cardiac insufficiency, 2 as a consequence of technical faults, 1 from persistent pulmonary hypertension, and 1 had sudden cardiac arrest. None of the surviving patients showed any gross neurological deficit. Perfusionless hypothermic cardiac surgery, when applied appropriately, is safe and simple, and might still have a place in treating a selected group of patients with uncomplicated congenital heart defects.

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Section: Discussionmentioning

confidence: 99%

Cardiac Surgery under Perfusionless Hypothermia: Siberian Experience

Karaskov¹,

Kitchlu²,

Lomivorotov³

2002

Asian Cardiovasc Thorac Ann

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“…In the present study, we used Mohri's hypothermia model which has the advantage of clinical relevance (Mohri et al 1966). …”

Section: Discussionmentioning

confidence: 99%

Determination of safe interval of circulatory arrest from the cerebral metabolic aspect.

Iguchi

Haneda

Sato

et al. 1986

Tohoku J. Exp. Med.

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To determine the safe interval of hypothermic total circulatory arrest, the cerebral metabolic state was evaluated in 30 dogs. Surface cooling was achieved by deep ether anesthesia and the animals were assigned to three equal groups. Group I : 30 min circulatory arrest and surface rewarming. Group II: 60 min circulatory arrest and surface rewarming. Group III: 60 min circulatory arrest and perfusion rewarming. Brain tissue gas tension was monitored and cerebral 02 consumption was calculated. Cerebral 02 consumption reduced with cooling, parallel to the decrease in cerebral blood flow. Rapid increase in Pot, elevation of Pco2, and decrease of pH in the brain tissue were observed during circulatory arrest. Brain tissue Pot increased significantly after circulatory arrest in Group I, but it remained low during rewarming in Groups II and III. Cerebral 02 consumption was at reduced levels in all groups during rewarming and it remained at 29% of the precooling control level in Group II at the end of rewarming, whereas it recovered to 71% and 57% of the precooling levels in Groups I and III, respectively. It was estimated that cerebral metabolism may be recovered after 30 min circulatory arrest, despite a transient reduction in cerebral 02 consumption. On the other hand, after 60 min circulatory arrest, the recovery of cerebral metabolism was delayed in Group II and organic failure might have occurred in this group. However, even after circulatory arrest for 60 min, cerebral metabolism was recovered in Group III. The safe period of circulatory arrest is considered to be prolonged by use of extra-corporeal circulation.induced hypothermia, surface ; circulatory arrest ; central nervous system ; ether anesthesia Hypothermic total circulatory arrest has been used as an adjunct in cardiac surgery, particulary in small children since Lewis and Taufic (1953) applied it clinically. Although the hypothermia technique has been refined, there still remain several problems in clinical application.Neurological disturbance is the most serious complication following hypothermic circulatory arrest. Clinical and experimental studies regarding the relationship between neurological disturbance and circulatory arrest period have been reported by many investigators (Stevenson

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“…The Japanese used this technique (14,15) to explore surface-induced deep hypothermia with prolonged circulatory arrest. Respiratory alkalosis was later fully endorsed by Mohri and his group at Seattle in an extensive experience with surface-induced deep hypothermia for the correction of congenital cardiac defects in infants (16,17).…”

Section: Graph Of Ph and Pc0 2 Values Defining The Arterial And Venou...mentioning

confidence: 99%

Myocardial Preservation during Hypothermic Cardiopulmonary Bypass: A Team Endeavor

Swan

1988

J Extra Corpor Technol

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Myocardial failure is the primary cause of death following operation using hypothermic cardiopulmonary bypass. The mean mortality rate for coronary bypass in Medicare patients in the United States for 1984 was 5.5%.1njury to the heart is caused by aortic cross-clamping or total circulatory arrest. The lesion of hypoxia is characterized by progressive acidosis. The severity of acidosis correlates with the degree of post-operative myocardial dysfunction. In decision making concerning the management of perfusion or of operative technique, prevention and/or treatment of myocardial acidosis takes precedence over other considerations. Recent advances in understanding the effect of temperature on acidbase equilibria, and the recent introduction of online blood gas monitoring devices have given the perfusionist the necessary means to achieve perfusion which keeps the patient on the alkaline side of biological neutrality. Similarly, the surgeon should utilize the protective value of frequent coronary infusions with a cold, oxygenated, alkaline, buffered, anti-oxidant blood cardiopreservation solution. Figures and tables are presented which enable the perfusionist to understand hypothermic acidbase management, and to use appropriately hyperventilation and high flow perfusion, avoiding any use of CO2 gas, while monitoring the patient’s course using venous blood samples which are uncorrected for temperature. With this team approach, improvement in operative mortality can be expected.

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Use of rheomacrodex and hyperventilation in prolonged circulatory arrest under deep hypothermia induced by surface cooling

Cited by 58 publications

References 13 publications

Cardiac Surgery under Perfusionless Hypothermia: Siberian Experience

Cardiac Surgery under Perfusionless Hypothermia: Siberian Experience

Determination of safe interval of circulatory arrest from the cerebral metabolic aspect.

Myocardial Preservation during Hypothermic Cardiopulmonary Bypass: A Team Endeavor

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