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Hypothermia and circulatory arrest 

Hypothermia and circulatory arrest
Chapter:
Hypothermia and circulatory arrest
Author(s):

Jeremy M. Bennett

, Andrew Shaw

, and Chad Wagner

DOI:
10.1093/med/9780199653478.003.0014
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date: 21 October 2019

Induced (therapeutic) hypothermia has been used for cardiac surgical patients undergoing cardiopulmonary bypass for over 50 years. Hypothermia is believed to provide organ protection by decreasing the metabolic requirement of ischaemic tissues, and, most importantly, neuroprotection. Inflammation is reduced, offering additional protection to at-risk tissues and organs. Recent studies have not demonstrated a neurological benefit of hypothermia less than 34ºC in routine coronary artery and valvular surgery. Concern for cardiac dysfunction, increased ventilator and intensive care unit requirements, and coagulopathic bleeding, have prompted renewed interest in mild to normothermic bypass. For procedures where complete arrest of the circulation is mandated, deep hypothermic circulatory arrest remains the preferred approach to reduce the ischaemic consequence to organs and neurological function. Alternative or supplementary techniques include anterograde or retrograde cerebral perfusion. Temperature monitoring, regardless of technique, remains of vital importance as inadvertent hyperthermia (over 37ºC) on rewarming increases the risk of neurological injury.

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