1. NIRS og cirkulatorisk arrestNIRS og cirkulatorisk arrest
How low can you go………How low can you go………
2. Dyb hypoterm cirkulatorisk arrestDyb hypoterm cirkulatorisk arrest
Bedøver pt.Bedøver pt.
Starter operationenStarter operationen
Går på by-passGår på by-pass
Køler til 18 grader (Dyb hypotermi)Køler til 18 grader (Dyb hypotermi)
Går i arrestGår i arrest
Starter by-passStarter by-pass
VarmerVarmer
Afvikler by-passAfvikler by-pass
3. Prosthetic replacement of the aortic arch.Prosthetic replacement of the aortic arch.
J Thorac Cardiovasc SurgJ Thorac Cardiovasc Surg 19751975
Griepp RBGriepp RB,, Stinson EBStinson EB,, Hollingsworth JFHollingsworth JF,, Buehler DBuehler D..
AbstractAbstract
Four patients are reported in whom the aortic arch and variable portions of theFour patients are reported in whom the aortic arch and variable portions of the
ascending and descending aorta were replaced with a prosthesis. In threeascending and descending aorta were replaced with a prosthesis. In three
patients the preoperative diagnosis was dissecting aneurysm of the aortic archpatients the preoperative diagnosis was dissecting aneurysm of the aortic arch
and in one an arteriosclerotic aneurysm of the aortic arch was present. Aand in one an arteriosclerotic aneurysm of the aortic arch was present. A
combination of surface cooling and cardiopulmonary bypass was utilized tocombination of surface cooling and cardiopulmonary bypass was utilized to
produce total body hypothermia. Arch replacement was carried out during aproduce total body hypothermia. Arch replacement was carried out during a
period of total circulatory arrest. Cardiopulmonary bypass was then utilized toperiod of total circulatory arrest. Cardiopulmonary bypass was then utilized to
warm the patient and resuscitate the heart. The average duration of cerebralwarm the patient and resuscitate the heart. The average duration of cerebral
ischemia was 43 minutes and the average duration of myocardial ischemiaischemia was 43 minutes and the average duration of myocardial ischemia
was 74 minutes. The average lowest esophageal temperature was 14 degreeswas 74 minutes. The average lowest esophageal temperature was 14 degrees
C., and the average lowest rectal temperature was 18 degrees C. ThreeC., and the average lowest rectal temperature was 18 degrees C. Three
patients are alive and well 4 to 13 months following surgery. One patient diedpatients are alive and well 4 to 13 months following surgery. One patient died
4 days postoperatively of pulmonary insufficiency. This experience indicates4 days postoperatively of pulmonary insufficiency. This experience indicates
that by utilizing total body hypothermia and circulatory arrest aortic archthat by utilizing total body hypothermia and circulatory arrest aortic arch
replacement can be carried out with an acceptable mortality rate. Correctivereplacement can be carried out with an acceptable mortality rate. Corrective
surgery could be offered to patients with life-threatening enlarging aneurysmssurgery could be offered to patients with life-threatening enlarging aneurysms
of the aortic arch.of the aortic arch.
4. Neurologiske skader efter DHCANeurologiske skader efter DHCA
Svensson LG, Crawford ES, Hess KR,Svensson LG, Crawford ES, Hess KR,
et al.et al.
Deep hypothermia with circulatoryDeep hypothermia with circulatory
arrest. Determinants of stroke andarrest. Determinants of stroke and
early mortality in 656 patients.early mortality in 656 patients.
J Thorac CardiovascJ Thorac Cardiovasc
Surg 1993;106:19-28; discussionSurg 1993;106:19-28; discussion
28-31.28-31.
6. Neurologiske skader efter DHCANeurologiske skader efter DHCA
Transitoriske/permanenteTransitoriske/permanente
neurologisk skaderneurologisk skader
Stroke/diffuseStroke/diffuse
Non-emboliskNon-embolisk
EmboliskEmbolisk
7. Ann Cardiothorac Surg. 2013 May; 2(3): 303–315.Ann Cardiothorac Surg. 2013 May; 2(3): 303–315.
Deep hypothermic circulatory arrestDeep hypothermic circulatory arrest
Bulat A. Ziganshin1,2 and John A. Elefteriades 1Bulat A. Ziganshin1,2 and John A. Elefteriades 1
The Yale eksperienceThe Yale eksperience
We believe that the….of StraightWe believe that the….of Straight
forward DHCA justifies its use inforward DHCA justifies its use in
majority….majority….
8. A meta-analysis of deep hypothermic circulatory arrestA meta-analysis of deep hypothermic circulatory arrest versusversus
moderate hypothermic circulatory arrest with selective antegrademoderate hypothermic circulatory arrest with selective antegrade
cerebral perfusioncerebral perfusion
David H. Tian1David H. Tian1
et alet al
Ann Cardiothorac Surg 2013;2(2):148-158Ann Cardiothorac Surg 2013;2(2):148-158
Results: Nine comparative studies were identified forResults: Nine comparative studies were identified for
inclusion in the present meta-analysis.inclusion in the present meta-analysis.
Stroke rates were significantly lower in patients undergoingStroke rates were significantly lower in patients undergoing
MHCA+SACP (P=0.0007, I2=0%)MHCA+SACP (P=0.0007, I2=0%)
comparable results were observed with temporarycomparable results were observed with temporary
neurological deficit, mortality, renal failure or bleeding.neurological deficit, mortality, renal failure or bleeding.
Infrequent and inconsistent reporting of systemic outcomesInfrequent and inconsistent reporting of systemic outcomes
precluded analysis of other systemic outcomes.precluded analysis of other systemic outcomes.
Conclusions: The present meta-Conclusions: The present meta-
analysis indicated the superiorityanalysis indicated the superiority
of MHCA+SACP in terms ofof MHCA+SACP in terms of
stroke risk.stroke risk.
9. NIRS og cirkulatorisk arrestNIRS og cirkulatorisk arrest
Association between cerebral desaturationAssociation between cerebral desaturation
and an increased risk of in patientsand an increased risk of in patients
undergoing deep hypothermic circulatoryundergoing deep hypothermic circulatory
arrest for cardiothoracic surgeryarrest for cardiothoracic surgery
J. Schön et alJ. Schön et al
Applied Cardiopulmonary Pathophysiology 13:Applied Cardiopulmonary Pathophysiology 13:
201-207, 2009201-207, 2009
10. NIRS og cirkulatorisk arrestNIRS og cirkulatorisk arrest
Conclusion: These findings suggest that anConclusion: These findings suggest that an
rSO2 lower than 80% of preoperativerSO2 lower than 80% of preoperative
baseline in patients undergoingbaseline in patients undergoing
cardiac and/or thoracic aortic surgery withcardiac and/or thoracic aortic surgery with
DHCA is associated with a significant riskDHCA is associated with a significant risk
of an adverse neurologicalof an adverse neurological
outcome. Preventing cerebral desaturationoutcome. Preventing cerebral desaturation
during DHCA procedures may thus help toduring DHCA procedures may thus help to
reduce postoperative neurological deficitsreduce postoperative neurological deficits
