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Discussion

DHCA

Hello. I have a question. Has anybody who works with cardiothoracic Patient care ever seen a Patient who is on CPB Being placed into Deep Hypothermia AND Circulatory arrest? I am not sure how many nurses have never heard of this but occasionally in the OR When they are working on a cardiac case they will actually not only place a Patient onto the full CPB Flow Cardiopulmonary Bypass, but they will also cool the Patient down whilst they are In ASYSTOLE AND After reaching profound hypothermia at around 11-19 degrees C, they can turn the CPB PUMP OFF! WHILE THE Heart is still in ASYSTOLE. Isn't that amazing? It is only for up to around 20-45 minutes however I find this amazing to know that a Patient can recover after an operation that involves this. When the Patient is cooled down to these hypothermic temperatures the EEG Is nearly silent. And then after it all, the Patient usually wakes up neurologically intact

This all depends on fact that the metabolism is slowed Down so much that Oxygen consumption is decreased significantly. Have you ever gotten to observe this? This is why patients who are involved in accidental drowning in Extremely cold water have in some cases been resuscitated and rewarmed on CPB And have made a remarkable recovery. DHCA Is truly amazing.

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    I've seen it occasionally when working on thoracic aortic aneurysms, especially those involving the aortic arch where other vessels split off. In fact, I recently circulated a case where not only did we replace the ascending aorta and the aortic arch, but also the brachiocephalic artery and left common carotid artery. The circulatory arrest is kept as brief as possible, and we also place cannulas into other vessels (in this case the axillary artery and femoral artery) so that we can turn the pump back on and provide oxygenated blood to the brain while still bypassing the aorta. These cases are also much more tense in nature than standard CPB cases.

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    Dr. Robert F. Spetzler of Barrow Neurosurgical Associates in Phoenix, AZ uses DHCA for surgery on brain aneurysms.

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    Dr. Robert F. Spetzler of Barrow Neurosurgical Associates in Phoenix, AZ uses DHCA for surgery on brain aneurysms.

    Ben Carson used it for the first time ever to separate twins conjoined at the skull.

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