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Topic-icon Management deep hypothermic cardiac arrest

  • Jörg Schulze
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2 years 8 months ago - 2 years 8 months ago #18 by Jörg Schulze
Jörg Schulze created the topic: Management deep hypothermic cardiac arrest
Hello collegues,
how is the management in your hospital?
In our swiss clinic:
arterial canula: A. subclavia (A. carotis) with femflex, 18-20°C body core temperature without head perfusion, 500-1000 mg thiopental before arrest, heating: water 8-10°C above core temp, NIRS-monitoring
In our german clinic:
arterial canula: a. subclavia/a. carotis with dacron vessel prothesis or truncus bracheocephalicus with 90° aortic can., 28°C body core temp. with head perfusion 10-15 ml/kg/min, heating: water 8-10°C above core temp, NIRS-monitoring
Last Edit: 2 years 8 months ago by Jörg Schulze.

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2 years 8 months ago #21 by Alexander Konetzka
Alexander Konetzka replied the topic: Management deep hypothermic cardiac arrest
Hello everybody,
it depends on case!

Mostly:
arterial canula: Aorta desc or Ductus arteriosus and Tr. brachiocephalicus: size of the canula depends on the height and weight of the patient.
18-20°C body core temperature with ACP :30-40 ml/kg weight, heating: water 8-10°C above core temp, NIRS-monitoring. Radial and femoral pressure monitoring.
Ultrafiltration in rewarming phase.

Cheers B)

Is someone here who use CO2 by infants in ACP?

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  • Jörg Schulze
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2 years 8 months ago - 2 years 8 months ago #25 by Jörg Schulze
Jörg Schulze replied the topic: Management deep hypothermic cardiac arrest

Alexander Konetzka wrote: Is someone here who use CO2 by infants in ACP?


Ooops, like this? :P

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Last Edit: 2 years 8 months ago by Jörg Schulze.

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2 years 7 months ago - 2 years 7 months ago #41 by Jolanda Consiglio
Jolanda Consiglio replied the topic: Management deep hypothermic cardiac arrest
In the Inselspital 10% of our cases are with DHCA. That means >100 cases / Year. We have two main procedure: One is the elective case where the surgion is quite shure to have the distale anastomose done in less than 20 Minutes; we cool the bladder only to 30 ° (Brain is in this time mostly <25°).
For emergency or more dificult cases we cool to 28° Bladder. (Normally the patient is at the end of the DHCA 2 -3 ° colder than at the beginning) . Bevor Arrest we give 20mg/Pentothal /Kg KG,
Always with cerebral perfusion. If canula is in the A.subclavia and the surgion is able to clamp the truncus, we can go for antegrad cerebral Perfusion for the right side trough Arterial Canula in the arteria subclavia and with a selective distal perfusionscatheter for the left carotide. The Flow in the Subclavia is + - 10ml/Kg (knowing that a part of the flow run away trough the Mammaria and also of cause regarding NIRS and line Pressure)
If the Arterial canula is in the A.Aszendens, then we do selective antegrad cerebral Perfusion in both carotides. The Flow for this catheter is about 6 ml/kg KG (+ - 3ml) regarding the NIRS and the Line Pressure. Temperature for Brain ist 22 °. For rewarming the arterial Canula is of cause new in the Sidearm from the Graft. Our Procedure is based on studies we did ourselves in the past. Our results are good!
Last Edit: 2 years 7 months ago by Jolanda Consiglio.

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