Anesthesia for deep hypothermic circulatory arrest in adults: Experience with the first 50 patients

Objective: To evaluate the efficacy of a simple method of central nervous system (CNS) protection in patients undergoing deep hypothermic circulatory arrest (DHCA) lasting less than 30 minutes, for a variety of complex cardiovascular procedures. Design: A retrospective case review. Setting: A university teaching hospital. Participants: Fifty consecutive patients (25 women, 25 men) undergoing elective or emergency cardiovascular operations requiring DHCA between August 1991 and December 1996. Interventions: Patients underwent DHCA for a variety of surgical procedures. Neurologic protection was with thiopental, ice packs to the head, and systemic core hypothermia to a nasopharyngeal temperature (NPT) of 18 degrees to 20 degrees C. Measurements and Main Results: The mean duration of circulatory arrest was 18 +/- 10 minutes (range, 5 to 42 minutes). The mean NPT at time of arrest was 18.7 degrees +/- 1.7 degrees C. Three patients (646) had gross CNS morbidity, one of whom died. The circulatory arrest times for these three patients were 8, 39, and 40 minutes. Perioperative mortality was 8% (n = 4). The circulatory arrest times for the patients who died were 12, 13, 23, and 39 minutes. Conclusion:The anesthetic management of DHCA described is simple, effective, and safe, and can be performed in any institution that performs cardiac surgery. Copyright (C) 1998 by W.B. Saunders Company.