No abstract available.
Free Tissue Flaps* ; Hypothermia, Induced*

Mild hypothermia, as a common means of intraoperative nerve protection, has been used in clinical practice. Compared with the traditional methods such as freezing helmet and nasopharyngeal cooling, hypothermic blood perfusion is considered to be a promising treatment for mild hypothermia, but it lacks experimental and theoretical verification of its cooling effect. In this study, the commercial finite element simulation software COMSOL combined the Pennes equation with the cerebrovascular network model to construct a new simplified human brain model, which was further used to simulate the cooling process of cerebral hypothermic blood perfusion. When the hypothermic blood perfusion was 33 ℃, the human brain could enter the mild hypothermic state within 4 minutes. By comparing with helmet cooling, the feasibility and efficiency of the blood perfusion scheme were verified. By comparing with the calculation results based on Pennes equation, the rationality of the model constructed in this study were verified. This model can non-intrusively predict the changes of brain temperature during surgery, and provide a reference for the setting of treatment parameters such as blood temperature, so as to provide personalized realization of safer and more effective mild hypothermia neuro protection.
Humans ; Hypothermia, Induced/methods* ; Hypothermia ; Hemoperfusion ; Brain/physiology* ; Body Temperature

No abstract available.
Circulatory Arrest, Deep Hypothermia Induced ; Thoracic Surgery

PURPOSE: No proven neuroprotective treatment exists for ischemic brain damage after cardiac arrest (CA). Although several animal studies have shown that mild to moderate hypothermia markedly mitigates ischemic brain damage after CA, the clinical safety and efficacy of mild hypothermia remain unproven. We conducted this preliminary study to evaluate the clinical feasibility and safety of mild resuscitative hypothermia (RH) for comatose patients of out-of-hospital CA. METHODS: We performed prospectively a preliminary, non-randomized, uncontrolled, clinical feasibility trial over four years in a university-based hospital. Consecutive patients admitted or transferred to the emergency medical center after out-of-hospital CA who met inclusion and exclusion criteria were enrolled. Hypothermia was induced as soon as possible after return of spontaneous circulation (ROSC) by using external surface cooling methods and cold saline gastric lavage at the target temperature (34 degrees C) and was maintained for 24 hours by using external surface cooling methods, which was followed by passive rewarming. RESULTS: Twelve patients were enrolled. Mean arrest time was 20+/-12 minutes (range 2 to 40); the mean advanced cardiac life support (ACLS) time was 12+/-8 minutes (range 4 to 27) and the mean time from start of ACLS to initiation of RH was 129 +/-113 minutes (range 40 to 420). Achieving the target temperature took 160+/-79 minutes (range 80 to 330) and the mean rewarming time was 605+/-190 minutes (range 360 to 960). One patient developed transient atrial fibrillation and premature ventricular complex during the induction period. Hypotension developed in six patients during hypothermia, pneumonia associated with induced hypothermia developed in four patients. Other complications, such as myoclonus (n=4), increased serum amylase (n=7), increased serum creatinine (n=2), and potassium abnormalities (n=2), also occurred. These complications occurred more frequently in patients with poor cardiac function after ROSC. No serious complications, such as ventricular fibrillation, bleeding, or sepsis, occurred. CONCLUSION: Mild RH after CA appears clinically feasible. However, induction with surface external cooling methods is slow, and maintenance of mild hypothermia was difficult. Future efforts to shorten the induction time and to develop more effective maintenance methods and more cautious applications to patients with poor cardiac function after ROSC are needed. Furthermore, well-designed, prospective, randomized, and controlled, multi-center efficacy trials are needed to evaluate the effect of mild RH.
Advanced Cardiac Life Support ; Amylases ; Animals ; Atrial Fibrillation ; Brain ; Coma* ; Creatinine ; Emergencies ; Gastric Lavage ; Heart Arrest ; Hemorrhage ; Humans ; Hypotension ; Hypothermia* ; Hypothermia, Induced ; Myoclonus ; Out-of-Hospital Cardiac Arrest* ; Pneumonia ; Potassium ; Prospective Studies ; Rewarming ; Sepsis ; Ventricular Fibrillation ; Ventricular Premature Complexes

To present a case of a patient who will undergo pulmonary embolectomy under deep hypothermic circulatory arrest, to discuss the use of deep hypothermic circulatory arrest, and to elaborate on the various techniques utilized to provide optimum neuroprotection.
Human ; Female ; Middle Aged ; HYPOTHERMIA ; NEUROPROTECTIVE AGENTS ; CIRCULATORY ARREST, DEEP HYPOTHERMIA INDUCED ; HEART ARREST, INDUCED

PURPOSE: Therapeutic hypothermia (TH) improves the probability of survival and neurologic recovery after resuscitation from out-of-hospital cardiac arrest (OHCA). However, the best time to initiate TH after the return of spontaneous circulation (ROSC) remains unknown. METHODS: The aim of this study was to evaluate the correlation between TH initiation time after ROSC and the resulting neurological outcome. Methods: A retrospective analysis was performed on 122 OHCA patients enrolled between January 2008 and December 2011. Therapeutic hypothermia (32~34degrees C) was induced immediately after ROSC. The primary measure of outcome was neurological function at hospital discharge, as determined by a cerebral performance category (CPC) scale. RESULTS: Out of the 122 patients, 34 patients (27.9%) had a good neurological outcome at hospital discharge. The initiation time following ROSC was shorter, although not statistically significant, in patients with good neurological outcomes compared to those with poor outcomes. Based on subgroup analysis, only the shockable rhythm group showed a significant difference, in the time after ROSC to TH initiation, between good and poor neurological outcome groups. Receiver operator characteristic analysis suggested that an initiation time of 250 min after ROSC was most predictive of CPC 1-2 outcomes compared to other time points. Furthermore, the 250 min initiation time after ROSC correlated with neurological outcome in patients with OHCA undergoing TH treatment. CONCLUSION: Compared to late initiation, early initiation (within 250 min) with TH had neurologic benefits for patients with OHCA.
Dinucleoside Phosphates ; Humans ; Hypothermia ; Hypothermia, Induced ; Out-of-Hospital Cardiac Arrest ; Resuscitation ; Retrospective Studies

PURPOSE: Bispectral index (BIS) is a non-invasive parameter that expresses the level of consciousness using a numerical value that ranges from 0-100. It can be easily conducted at the patient bed-side throughout a day. We studied whether BIS could be used as a predictive factor for neurological outcome in patients who undergo hypothermia after cardiopulmonary resuscitation. METHODS: The prospective study enrolled patients who underwent induced hypothermia with post-resuscitated state after cardiac arrest and presented to Chonnam National University Hospital from June, 2010 to October, 2010. BIS monitoring was conducted from admission at the intensive care unit until normal temperature was attained after the induction of hypothermia. The patients were divided into two groups based on neurological outcome at discharge and the values obtained from BIS monitoring were compared. RESULTS: Fourteen patients were included in this study. The mortality rate was 28.6% and five patients were discharged with Glasgow Pittsburgh Cerebral Performance Categories 1 or 2. The value of BIS at the start of rewarming was significantly different between the two groups according to neurological outcome, while the value of BIS upon reaching normal temperature did not differ statistically. The significant difference between the two groups was observed in the value of BIS from 19 hours after starting hypothermia. CONCLUSION: BIS can be used to predict the neurological outcome of patients who undergo resuscitation after cardiac arrest.
Consciousness ; Consciousness Monitors ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Intensive Care Units ; Prospective Studies ; Resuscitation ; Rewarming

PURPOSE: Bispectral index (BIS) is a non-invasive parameter that expresses the level of consciousness using a numerical value that ranges from 0-100. It can be easily conducted at the patient bed-side throughout a day. We studied whether BIS could be used as a predictive factor for neurological outcome in patients who undergo hypothermia after cardiopulmonary resuscitation. METHODS: The prospective study enrolled patients who underwent induced hypothermia with post-resuscitated state after cardiac arrest and presented to Chonnam National University Hospital from June, 2010 to October, 2010. BIS monitoring was conducted from admission at the intensive care unit until normal temperature was attained after the induction of hypothermia. The patients were divided into two groups based on neurological outcome at discharge and the values obtained from BIS monitoring were compared. RESULTS: Fourteen patients were included in this study. The mortality rate was 28.6% and five patients were discharged with Glasgow Pittsburgh Cerebral Performance Categories 1 or 2. The value of BIS at the start of rewarming was significantly different between the two groups according to neurological outcome, while the value of BIS upon reaching normal temperature did not differ statistically. The significant difference between the two groups was observed in the value of BIS from 19 hours after starting hypothermia. CONCLUSION: BIS can be used to predict the neurological outcome of patients who undergo resuscitation after cardiac arrest.
Consciousness ; Consciousness Monitors ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Intensive Care Units ; Prospective Studies ; Resuscitation ; Rewarming

Transcranial cerebral oximetry has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. It has been also used in intraoperative monitoring of aortic dissection and surgical procedures performed under deep hypothermia and circulatory arrest. During disending aortic arch exposure, sudden cerebral oxygen saturation change from 63% to 48% was detected. After therapeutic bypass, cerebral oxygen saturation was increased to 65%. During aortic arch repair, deep hypothermic circulatory arrest with retrograde cerebral perfusion was applied for 130 min and cerebral oxygen saturation slowly decreased from 65% to 52%. Patient was discharged from hospital without neurologic complication and cognitive funtion disturbance.
Aorta, Thoracic ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Hypothermia ; Monitoring, Intraoperative ; Oximetry ; Oxygen* ; Perfusion

PURPOSE: This study compared nursing frequency, nursing time, and nursing intervention priorities depending on the method of neonatal induced hypothermia. METHODS: We observed 15 neonatal subjects receiving therapeutic hypothermia for 3 days each. Forty-five nurses experienced with nursing neonatal patients under therapeutic hypothermia provided responses about nursing intervention priorities. Analyses with the chi-square, the Fisher exact test, the paired t-test, the Wilcoxon signed rank test, and the Wilcoxon rank-sum test were performed on the data using SAS version 9.4. RESULTS: The frequency of nursing activities was higher for selective head therapeutic hypothermia (SHTH) than for systemic therapeutic hypothermia (STH), and nursing time was also significantly longer. In terms of nursing intervention priorities, there were priority differences in “risk for ineffective thermoregulation” and “risks for impaired skin integrity” for SHTH compared to STH . CONCLUSION: Since SHTH for neonatal therapeutic hypothermia requires more nursing time and frequent nursing activities than STH, STH is therefore recommended if the therapeutic efficacy is similar. Appropriate nursing personnel should be allocated for neonatal SHTH nursing. Nurses should be aware of nursing interventions for therapeutic hypothermia as the priorities are different for different methods of neonatal therapeutic hypothermia.
Head ; Humans ; Hypothermia ; Hypothermia, Induced* ; Infant, Newborn ; Methods* ; Neonatal Nursing ; Nursing* ; Skin