RT Book, Section
A1 Bardissi, Andrew W. El
A1 Oakes, Robert A.
A1 Bolman III, R. Morton
A2 Cohn, Lawrence H.
SR Print(0)
ID 55914830
T1 Chapter 14. Deep Hypothermic Circulatory Arrest
T2 Cardiac Surgery in the Adult, 4e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-163310-9
LK accesssurgery.mhmedical.com/content.aspx?aid=55914830
RD 2024/04/20
AB Deep  hypothermic  circulatory  arrest  (DHCA)  came  about  as  an  extension  and  unification  of  the  work  being  done  in  the  1950s  in  cardiopulmonary  bypass  (Gibbon),  systemic  hypothermia  (Bigelow),  and  aortic  surgery  (Debakey,  Cooley,  Crawford).  Successful  intracardiac  surgery  was  based  on  the  use  of  cardiopulmonary  bypass  (CPB);  however,  some  procedures  (eg,  aortic  arch  surgery)  could  not  be  performed  with  standard  CPB  cannulation  because  of  an  inability  to  perfuse  the  cerebrum.  Bigelow's  work  in  the  animal  lab  demonstrated  that  moderate  hypothermia  could  be  protective  in  cases  in  which  CPB  was  halted  for  up  to  10  minutes.1  The  earliest  use  of  DHCA  in  adult  cardiac  surgery  has  been  accredited  to  Niazi  and  Lewis  in  1958.2  Initially,  DHCA  was  performed  topically  without  the  assistance  of  CPB;  however,  it  soon  became  apparent  that  at  hypothermic  temperatures  the  heart  would  fibrillate  or  slow  to  a  stop.  Rewarming  also  proved  to  be  quite  difficult  because  of  poor  circulatory  function  during  hypothermia.  Many  of  these  issues  were  improved  on  with  the  coordination  of  CPB  with  DHCA  by  the  physiologist  Gollan  and  the  continued  development  and  improvement  of  pump  oxygenators  and  heat  exchangers.3  Extensive  work  on  the  metabolic  aspects  of  DHCA  were  studied  and  put  into  clinical  practice  by  Griepp  and  others  in  the  1970s,  leading  to  safe  and  reliable  techniques  that  have  been  adopted  by  many  into  general  practice.