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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-one anesthetized dogs were surface cooled at 5 C and rewarmed after a variable period. Respiration was controlled with a volume respirator. When cardiac arrest occurred, circulation was provided with the mechanical ventricular assistance (MVA) device in 23 dogs. Of the animals maintained for four hours below 10 C on the MVA, 83% were successfully resuscitated. None of the dogs maintained for two hours below 10 C without circulation could be resuscitated. Eleven dogs were studied for a long-term survival after chest closure. Only four of them survived longer than three days. Death after rewarming was due to severe pulmonary insufficiency. Results of this study suggest that provision of oxygenation and a pulsatile circulation during hypothermia improve tissue viability of nonhibernators. The model shows potential for in situ preservation of multiple organs in the cadaver.
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PMID:Survival of dogs subjected to profound hypothermia with circulatory support. 106 90

Four patients are reported in whom the aortic arch and variable portions of the ascending and descending aorta were replaced with a prosthesis. In three patients the preoperative diagnosis was dissecting aneurysm of the aortic arch and in one an arteriosclerotic aneurysm of the aortic arch was present. A combination of surface cooling and cardiopulmonary bypass was utilized to produce total body hypothermia. Arch replacement was carried out during a period of total circulatory arrest. Cardiopulmonary bypass was then utilized to warm the patient and resuscitate the heart. The average duration of cerebral ischemia was 43 minutes and the average duration of myocardial ischemia was 74 minutes. The average lowest esophageal temperature was 14 degrees C., and the average lowest rectal temperature was 18 degrees C. Three patients are alive and well 4 to 13 months following surgery. One patient died 4 days postoperatively of pulmonary insufficiency. This experience indicates that by utilizing total body hypothermia and circulatory arrest aortic arch replacement can be carried out with an acceptable mortality rate. Corrective surgery could be offered to patients with life-threatening enlarging aneurysms of the aortic arch.
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PMID:Prosthetic replacement of the aortic arch. 118 83

The advantages of a bloodless field and total cardiac relaxation have popularized the technique of deep hypothermia and total circulatory arrest for the correction of complex congenital cardiac defects in infancy. There is, however, a significant potential for cerebral and pulmonary complications. Presently, the most common technique is that of using a combination of surface cooling and cardiopulmonary bypass cooling and rewarming. Normal neurological development has been claimed with the present technique of hypothermia at 20 degrees C and total circulatory arrest for periods up to an hour; however, there are reports of seizure activity in the early postoperative period. There is also a disturbing incidence of respiratory insufficiency and, occasionally, hemorrhagic pulmonary edema. This study, using growing puppies and subjecting them to deep hypothermia and total circulatory arrest for varying periods of time, disclosed that animals subjected to 60 min of circulatory arrest recovered neurologically; however, there were histological changes of anoxia in the brain. Animals subjected to 30 min of total circulatory arrest were normal neurologically and there was no histological evidence of anoxic damage to brain tissue. Puppies that were continuously on cardiopulmonary bypass had no significant pulmonary changes caused by increasing the inspired oxygen tension in the ventilator; however, striking changes were noted when limited cardiopulmonary bypass was employed for core cooling and total circulatory arrest combined with pulmonary ventilation with 100% oxygen. We conclude from this experimental study that the use of surface cooling and core cooling with subsequent total circulatory arrest at 20 degrees C is a safe procedure, providing the period of time of cardiac arrest is kept around 30 min. We also conclude that the alveolar oxygen tension should be maintained at the lowest level possible during the interval of circulatory arrest to avoid the apparent rapid onset of post-traumatic pulmonary insufficiency.
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PMID:Effect of deep hypothermia, limited cardiopulmonary bypass, and total arrest on growing puppies. 120 92

Because use of the bubble oxygenator during open-heart surgery is associated with complications such as hemolysis, pulmonary insufficiency and oliguria, a membrane oxygenator was used in conjunction with hypothermia in 37 infants. The main features of the oxygenator are gravitational blood flow, oxygenation into an airless, collapsible blood reservoir, low-flow roller pump flow back to the patient, accurate determination of flows and careful use of a heat exchanger. Gas flow (98% oxygen, 2% carbon dioxide) for the unit of 2 m2 is maintained at 3 to 4 1/min. Specific precautions are taken to ensure absence of bubbles. Three prime solutions are used, the final one having an osmolality of 381 mOsmol and containing 129.9 meq of sodium, 3.8 of potassium and 94.0 of chloride and 2001 mg/dl of glucose. Six patients died, but none of the deaths could be directly related to the use of the oxygenator. Respiratory complications were minimal, as were other complications. The technique is reliable in oxygenating blood in an tracorporeal circulation, but further familiarity with the membrane oxygenator for use in open-heart surgery in infants is desirable before firm conclusions can be drawn as to its value.
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PMID:Use of a membrane oxygenator for open-heart surgery in infants. 126 May 50

The use of emergent portable bypass systems is increasing. Because of limited patient use in any one institution, a combined experience can better determine the applicability of these systems. A total of 187 patients from 17 centers were analyzed. Causes leading to bypass initiation were cardiac arrest (125 patients), cardiogenic shock (44), profound hypothermia (7), pulmonary insufficiency (9), and miscellaneous (2). Weaning from bypass was successful in 30.5% (57 patients). Sixty-four patients (34.2%) were transferred to standard bypass or other modes of circulatory assist. Of the total population, 40 patients (21.4%) were alive greater than 30 days. There were no survivors of unwitnessed arrests. Major diagnostic or therapeutic interventions were carried out on bypass in 74.9% of all patients. In survivors, 77.1% (37/48) had major therapeutic interventions as compared with 50.0% (67/135) of nonsurvivors. Emergency portable bypass systems can successfully resuscitate and support cardiac hemodynamics, although the underlying causes necessitating bypass remain difficult to correct. When corrective intervention can be performed, there is an increased chance of survival. Unwitnessed arrest, prolonged cardiopulmonary resuscitation, and lack of treatment options are relative contraindications. Appropriate patient selection and early application of these systems should lead to improved survival.
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PMID:Emergent applications of cardiopulmonary support: a multiinstitutional experience. 849 57

A retrospective chart review was conducted of 26 organ donors to determine hemodynamic and metabolic derangements encountered and nursing requirements for donor organ maintenance. There were 15 boys and 11 girls with a mean age 6.57 +/- 5.46 years. Mean donor maintenance time was 10.5 +/- 6.7 hours. Cardiorespiratory derangements included hypotension in 16, hypertension in 6, arrhythmias in 17 (premature ventricular contraction in 4, bradycardia in 8, paroxysmal atrial tachycardia in 3, and ventricular tachycardia in 2), asystolic events in 5, pulmonary insufficiency in 6, anemia in 8, and thrombocytopenia in 8. Metabolic and hormonal derangements included hyperglycemia in 18, hypokalemia in 20, hyperkalemia in 4, hyponatremia in 3, hypernatremia in 17, metabolic acidosis in 10, and diabetes insipidus in 15. Hypothermia (temperature 33.3 degrees +/- 0.4 degrees C, mean +/- SD) occurred in 14 donors. The mean physiologic Stability Index score was 22.2 +/- 4.7 and mean Therapeutic Intervention Score was 46.7 +/- 5.8. Total number of nursing hours spent in donor maintenance was 424.5 hours. Therapies offered included diuretics in 10, sodium bicarbonate in 8, antibiotics in 6, insulin in 12, pitressin in 13, verapamil in 3, isoproterenol in 3, dopamine in 17, and intravenous potassium boluses in 14. Of the potential 26 donors, 46 kidneys, 8 hearts, 14 livers, 3 pancreas, and 9 corneas were retrieved in transplantable condition. With appropriate donor maintenance, organs suitable for transplantation can be retrieved despite significant pathophysiologic derangements. Physicians intending to provide donor support should be comfortable with invasive monitoring and cardiorespiratory support and be prepared to provide a nurse to patient ratio of 2:1 at the bedside.
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PMID:Pediatric organ donor maintenance: pathophysiologic derangements and nursing requirements. 278 Jan 31

By consensus, the most clinically important consequence of near drowning is hypoxemia. Whether it is due to physiologic shunting induced by diffuse alveolar flooding from saltwater aspiration or to diffuse atelectasis induced by surfactant inactivation from freshwater aspiration, both physiologic disturbances can be reversed with the institution of positive-pressure breathing in the form of PEEP or CPAP, which should be the mainstay of pulmonary management of respiratory insufficiency in these patients. The use of prophylactic antibiotics or corticosteroids as an adjunct in the management of pulmonary insufficiency resulting from near drowning is not warranted, may be detrimental, and remains controversial. The most crucial clinical consequence of the hypoxemia resulting from near drowning is cerebral injury and the consequent neurologic sequelae. The general consensus supported by large clinical studies is that near-drowning victims who, after initial resuscitation, are spontaneously breathing and are not comatose have a uniformly benign neurologic outcome. A significant subset of comatose near-drowning victims survive with eventually normal neurologic recovery when routine aggressive supportive intensive care is administered. Uncontrolled studies reporting improved outcomes with the institution of complex cerebral salvage techniques, such as induction of hypothermia, intracerebral pressure monitoring, induction of barbiturate coma, and the use of corticosteroids and osmotic diuretics, remain controversial. It is now clear that neither induced hypothermia nor barbiturate coma improves survival or neurologic outcome in these patients and may be detrimental.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Near drowning: consensus and controversies in pulmonary and cerebral resuscitation. 330 78

During a six-year period (1979 to 1984), the technique of hypothermic circulatory arrest was used to operate on 128 patients. Our technique included induction of hypothermia (20 degrees to 24 degrees C) by femoral artery cannulation for return of oxygenated blood, "open" aortic reconstruction, and brief periods of circulatory arrest (range, 5 to 31 minutes; mean, 13 minutes). Eighty patients had dissecting aneurysms of the ascending aorta (42 acute, 38 chronic), 28 had fusiform aortic arch aneurysms, and 13 had annulo-aortic ectasia. Seven had other procedures. Ages ranged from 14 to 79 years (mean, 54 years). Of the 113 patients (88%) who survived the operation and were discharged, 107 are currently alive and well. Only 15 of the 21 deaths occurred within 30 days of operation, and 5 (33%) were in severely hypotensive patients whose operations were begun during active resuscitation. Of the 80 patients admitted with ascending aortic or arch dissection, an in-hospital mortality of 7.5% was achieved. A marked reduction was observed in such complications as postoperative hemorrhage, renal failure, and pulmonary insufficiency with our current hypothermic perfusion methods. Moreover, none of the five neurological complications could be attributed to anoxic cerebral injury during the period of circulatory arrest. This experience indicates that moderate levels of hypothermia provide adequate cerebral protection for most cardiovascular procedures, and our results encourage continued use of this method.
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PMID:Hypothermic circulatory arrest for cardiovascular lesions: technical considerations and results. 406 2

In a six month period, 96 newborn infants were transferred from local hospitals to the Department of Neonatology, State University Hospital (Rigshospitalet), Copenhagen. Complications related to transport and potential risk factors were registered prospectively. Considering the condition of the infants, 31% of the transports were not carried out under optimal conditions. Serious complications occurred in 13% of the transports of infants at risk for cardio-pulmonary insufficiency. In 25% of the intubated infants, complications related to displacement of the tracheal tube were observed on arrival, but in only one of these cases the complication was recognized and treated during transport. Hypothermia occurred frequently in low birth weight infants. Failing monitoring equipment and difficulties with stethoscopy and other observations during transport may have contributed to the fatal outcome in one case. Careful planning of neonatal transports according to listed recommendations and considering the specific problems in each case may prevent complications.
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PMID:[Transportation of sick newborn infants]. 849 77

To attain satisfactory results in aortic arch surgery a reliable method of cerebral protection, avoidance of emboli, and control of hemorrhage is mandatory. Deep hypothermic circulatory arrest is the most common technique at present but gives only a limited period of protection, whereas a complicated aortic arch operation may require more time than anticipated. Therefore the selective cannulation and perfusion of the innominate artery has not been widely used until now because it is uncertain whether the left hemisphere of the brain is adequately perfused. Between 1990 and 1995, 21 of 69 patients within the last 36 months, consisting of 15 men and 6 women averaging 45 +/- 13.4 years, underwent operative treatment for aneurysm (n = 9) or type A dissection (n = 12) involving the aortic valve and aortic arch; selective innominate perfusion (SCP [i]) in moderate hypothermia (28 degreesC) for brain protection was used. Extended perioperative monitoring included bilateral somatosensory-evoked potentials (SEP), transcranial Doppler sonography (TCD), a computer-aided topographical electro-encephalometry (CATEEM), and analysis of the arterial and venous oxygen saturation and desaturation. Mean time periods were 229.7 +/- 56.5 minutes for extracorporeal circulation, 151.7 +/- 34.1 minutes for aortic cross-clamping, and 67.05 +/- 34.03 for selective cerebral perfusion via the innominate artery. Not once did the intraoperative monitoring reveal hints of cerebral damage due to inadequate perfusion. All patients survived surgery but two could not be weaned from the respirator; one died 2 days and the other 6 days after the operation due to multiple organ failure (MOF). Another two patients died after 13 days due to untreatable septic syndrome with pulmonary insufficiency. All four patients died within 30 days, during which time they had aortic dissection involving the complete aortic arch and severe aortic valvular incompetence (grade IV). There was no late death and follow-up time of 19.76 +/- 8.04 months revealed an overall mortality rate of 19%. Only temporary neurological affections (left-sided hemiparesis) were found in two patients (9.5%). Additionally, we observed neuropsychological disturbances in one of these. Our first experience with selective cerebral perfusion via innominate artery and the attendant CATEEM monitoring for assessment of adequate bilateral cerebral perfusion suggests that this method is a useful addition to the armamentarium in complicated aortic arch surgery.
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PMID:Selective Cerebral Perfusion Via Innominate Artery in Aortic Arch Replacement Without Deep Hypothermic Circulatory Arrest. 982 9


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