Deep hypothermic circulatory arrest (DHCA) is a technique used in cardiac surgery to facilitate operations on the aortic arch. It involves inducing circulatory arrest through deep hypothermia to prevent ischemic injury while working on the aortic arch. Various neuroprotective strategies are used like pharmacological neuroprotection, neurological monitoring, and cerebral perfusion techniques like antegrade cerebral perfusion and retrograde cerebral perfusion to extend the safe duration of DHCA. Optimal temperature management and the differences between unilateral versus bilateral cerebral perfusion are factors considered to reduce neurocognitive risks of DHCA.
EMBOLISM AND FILTERS USED IN CARDIOPULMONARY BYPASSGLORY MINI MOL. A
FILTERS USED IN CARDIOPULMONARY BYPASS
EMBOLISM
DEFINITION: obstruction of an artery, by a clot of blood or an air bubble.
This emboli is categorized to
Biological emboli
Foreign emboli
Gaseous emboli
There are current technologies to decrease this embolic event delivered to patient
Membrane oxygenators
FILTER
Blood surface coating
Bubble traps
Emboli detection system
Blood Filters
Depth filters
Consist of packed fibers of Dacron wool or
polyurethane foam .
No defined pore size
These filters have large wetted surface
areas to filter the blood by absorption , they are effective in
trapping gross bubbles.
Screen filters
composed of a woven
mesh of polyester fibers
defined pore sizes
From 20 -40 μm
(all of the arterial line filters used are the screen type)
Cardiopulmonary bypass development and history
Indication of cpb
Hardware in cpb
Arterial and venous cannulation
Oxygenator
Heat exchanger
Filter
How to conduct cpb and problems in cpb
Cardioplegia
Post cardiac arrest brain injury Jan 2023.pptxmansoor masjedi
Post cardiac arrest period is a critical period after return of spontaneous circulation . Optimal care and management is associated with best outcome with least neurological devastating sequella.
EMBOLISM AND FILTERS USED IN CARDIOPULMONARY BYPASSGLORY MINI MOL. A
FILTERS USED IN CARDIOPULMONARY BYPASS
EMBOLISM
DEFINITION: obstruction of an artery, by a clot of blood or an air bubble.
This emboli is categorized to
Biological emboli
Foreign emboli
Gaseous emboli
There are current technologies to decrease this embolic event delivered to patient
Membrane oxygenators
FILTER
Blood surface coating
Bubble traps
Emboli detection system
Blood Filters
Depth filters
Consist of packed fibers of Dacron wool or
polyurethane foam .
No defined pore size
These filters have large wetted surface
areas to filter the blood by absorption , they are effective in
trapping gross bubbles.
Screen filters
composed of a woven
mesh of polyester fibers
defined pore sizes
From 20 -40 μm
(all of the arterial line filters used are the screen type)
Cardiopulmonary bypass development and history
Indication of cpb
Hardware in cpb
Arterial and venous cannulation
Oxygenator
Heat exchanger
Filter
How to conduct cpb and problems in cpb
Cardioplegia
Post cardiac arrest brain injury Jan 2023.pptxmansoor masjedi
Post cardiac arrest period is a critical period after return of spontaneous circulation . Optimal care and management is associated with best outcome with least neurological devastating sequella.
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Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
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n a Ross procedure, a surgeon removes the abnormal aortic valve. The surgeon then replaces it with the child's own pulmonary valve. The surgeon uses a valve from a cadaver donor (conduit) to replace the pulmonary valve.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
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Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
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Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
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Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
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How many patients does case series should have In comparison to case reports.pdfpubrica101
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2. • DHCA VS MHCA with SACP.
• Unilateral VS Bilateral ACP protection During DHCA.
• Optimal temperature Management in Aortic arch Surgery.
• DHCA & Neurocognitive functions.
• DHCA with RCP : How long is safe?
Insight..
3. HYPOTHERMIA
DEFINITIONS OF BODY TEMPERATURE
Term Temperature
Hyperpyrexia > 40 - 41.5 °C
Hyperthermia >37
Normothermia 35-37
Mild hypothermia 32-35
Moderate hypothermia 25-31
Deep hypothermia 18-24
Profound hypothermia <18
Hypothermia Temperature Use
Tepid 33 – 35 Good for short operation
Mild 31 - 32 Protection of beating heart and neurological system
Moderate 25 - 30 Protection of non beating heart and neurological system
Deep 15 - 20 DHCA for typically 40 - 60 minutes
5. Effect of temperature on Cerebral Metabolic Rate
Temperature
(°C)
CMR
(% baseline)
Duration of safe
CA (min)
CMRO
(ml/100 g/min)
37 100 5 1.48
32 70 (66-74) 7.5 0.80
30 56 (52-60) 9 0.65
28 48 (44-52) 10.5 0.51
25 37 (33-42) 14 0.36
20 24 (21-29) 21 0.20
18 17 (20-25) 25 0.16
15 14 (11-18) 31 0.11
CMR Cerebral Metabolic Rate, CA Circulatory Arrest. CMRO, Cerebral Metabolic Rate for Oxygen
6. Retrograde Cerebral Perfusion (RCP)
Benefits:
Provides hypothermic blood and produces uniform cooling of the brain.
Flushes the air and particulate emboli out of arch vessels.
Provide some oxygen and substrates to the brain
Remove metabolic wastes.
Temperature of the perfusate 10-12°C
Flow rate for RCP.
Most surgeons flow 300-500 ml/min to SVC
pressure 15-25 mmHg
SVC pressures up to 40 mmHg.
Flow rates: up to 1,600 ml/ min with Neurophysiological monitoring
7. Antegrade Cerebral Perfusion
Aim:
To supply oxygenated blood to the brain during DHCA, prevents ischemic injury to brain.
To meet the metabolic demands of the brain.
To wash away the metabolic wastes.
To achieve selected temperature of the brain.
Temperature of the perfusate10-15°C
Flow rate:
10 ml/kg/min (600-1,000 ml/min). flow rates
increased 20-30% for patients at high risk for
postoperative neurologic dysfunction
8. Parameter
of Interests
Methodology ACP RCP
Blood
distribution
MRI -perfusion Uniform distribution Little or no detectable
distribution.
Micro embolization
India ink
Minimal Infraction
Minimal edema
Excessive Infraction
Excessive Edema
Massive embolization
Uniform allocation in
100% of capillaries
Trivial embolization
Trivial, in 10% of capillaries
Sequestration in brain venous
sinuses Deviation to IVC via
azygos vein
CBF in medulla Complete distribution Complete distribution
CBF in cortex 100% distribution 16% distribution
Tech99 albumine Dominant fixation in
brain capillaries
No fixation in brain capillaries
9. Parameter of Interests Methodology ACP RCP
Cerebral blood flow Fluorescence ,microscopy No significant changes
from baseline
Trivial Capillary flow
Brain edema Brain water content,
Fluid sequestration
Minimal water content
- 200ml
Excessive water content
+760 ml
Histopathology changes Histopathologic scoring No morphologic changes Neuronal injury varying
severity
Influence on SEPs SEP abolition recovery Complete abolition and
autonomic recovery by
interruption
Complete abolition after
application and no recovery
Acid-base changes Neural cells pH Unchanged pH levels Decrease to 6.4,
Recovery by reperfusion
Brain metabolism ATP levels phosp-31MRI
Cerebral O2 consumption
Light decrease in base line
Unchanged ATP levels
6.66 ml/min
2 to 3 % of base line High
decrese in ATP levels,
Recovery by perfusion
1.37 ml/min
Postoperative neurological
status
Behavioral scoring
Behavioral recovery
Gradually improved
Complete
No improvement
Complete
10.
11.
12.
13.
14.
15. Conclusion.
• DHCA remains an important technique in Cardiac Surgery and
Anaesthesia.
• Circulatory arrest is induced to facilitate surgery on the Aortic Arch
whilst deep hypothermia is employed prevent ischemic injury.
• Neurological monitoring and pharmacological Neuroprotection are
used reduce the risk of Neurological injury.
• Anterograde and Retrograde Perfusion methods are increasingly
being used to extend the duration of DHCA.