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 (6%) 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.