Talk:Deep hypothermic circulatory arrest

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Untitled[edit]

We need references other than Grey's Anatomy --Gbleem 03:18, 8 September 2006 (UTC)[reply]

Wiki Education Foundation-supported course assignment[edit]

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Ss168948, TRadley22.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 19:12, 16 January 2022 (UTC)[reply]

No brain activity?[edit]

Is this correct. Why exactly is this done. Something about blood pressure? --Gbleem 06:04, 10 September 2006 (UTC)[reply]

Renaming[edit]

The proper name for this is circulatory arrest. Did they call it a standstill operation on Grey's Anatomy? Dlodge 19:36, 21 October 2007 (UTC)[reply]

A Pubmed Search for "standstill operation" reveals no matches (with quotes, without quotes there are 116 matches for non-consecutive words). A search on "circulatory arrest" (with quotes) reveals 3515 articles. This term is something coined by Grey's Anatomy - it has no basis in the medical literature, or as part of common hospital lingo (referred to as "circ arrest"). Dlodge 21:44, 3 December 2007 (UTC)[reply]
Moved. Dlodge (talk) 16:46, 13 March 2012 (UTC)[reply]

"The body can not live for more than 7 minutes without blood circulating"[edit]

I propose removal of this odd, unsubstantiated sentence in the opening paragraph of the article. This sentence contradicts the content of the article itself, namely a medico-surgical technique that stops blood from circulating ("circulatory arrest"), for up to 30 minutes or longer, in order to save the life of the patient. At no point during the procedure are the cells that comprise the body "not able to live" because blood isn't circulating. Even in normothermic circulatory arrest, necrosis (unprogrammed cell death) does not occur in cells for many hours after cessation of "blood circulating;" the fact that there are victims of cardiac arrest who've survived more than 7 minutes of normothermic circulatory arrest makes the aforementioned sentence explicitly false. Blacksun1942 (talk) 17:47, 14 November 2013 (UTC)[reply]

Grey's Anatomy[edit]

The Grey's Anatomy reference apparently refers to a procedure which is not the same as this, real-life, procedure; further it adds nothing to the article. If it must be included, it should be only a line not a paragraph as large as any other section.

research section[edit]

I appreciate the work you have done turning this nothing article into something Cryobiologist.

Some issues with this section...

  1. Part of this is constructed like a review paper written by a scientist. Relevant primary sources have been gathered, and a narrative constructed out of them, based on the author's judgement of what primary sources were important. That is normal and expected when writing a review. But that is not how Wikipedia articles are generated. We read secondary sources and summarize them. It is is bizarre, i know, but that is what we do here. Editors can fight all day - and never reach a rational decision, if the sources we use are primary. Editor A thinks the 1955 dog study is garbage and should get little weight. Editor B thinks it is super-important and should be elaborated at great length. There is no end to that. This is why we use reviews. They tell us what papers mattered. What was really significant strides forward.
  1. The part at the end moves over into some kind of "reporting" using popular science media. Again we should be using reviews from the literature to guide content.
  1. I'm grateful that through out this distinctions are made between clinical work and work on animals. I do struggle with descriptions of experiments where there was significant mortality, not mentioning that.
  1. should we split this, maybe into "history" and "research". when i come back to this i want to add content about the device development that went on with this, and the regulatory environment around that. so interesting.
Thanks, Jytdog, for taking the time to explain. I agree that rather than just an historical introduction to EPR in the Research section, the article really needs a history section covering the established use of DHCA in elective surgery. I've already found reviews for that that I believe you'll find satisfactory. I'll write the History section this weekend. Then I'll improve the Research section discussion of EPR per your observations. Cryobiologist (talk) 08:36, 22 April 2016 (UTC)[reply]
Research

Periods of stopped blood circulation longer than 45 to 60 minutes require the brain to be colder than 14°C during stoppage for later recovery to be successful. Preclinical research into cooling to temperatures near 0°C for medical applications was begun as long ago as 1943 at the Johns Hopkins School of Medicine.[1] By the 1950s, recovery of large non-hibernating mammals from temperatures as low as 1.5°C had been demonstrated.[2] Temperatures below 10°C were shown to allow recovery from circulatory arrest periods longer than one hour,[3] two hours[4][5][6], and three hours[7] in some cases.

One of the anticipated medical uses of long circulatory arrest times, or so-called clinical suspended animation, is treatment of traumatic injury. In 1984 CPR pioneer Peter Safar and U.S. Army surgeon Ronald Bellamy proposed suspended animation by hypothermic circulatory arrest as a way of saving people who had exsanguinated from traumatic injuries to the trunk of the body.[8] Exsanguination is blood loss severe enough to cause death. Until the 1980s, it had been thought impossible to resuscitate victims who lost blood until their heart stopped, resulting in these victims being declared dead when cardiac resuscitation failed. Traditional treatments such as CPR and fluid replacement or blood transfusion are not effective when cardiac arrest has already occurred and bleeding remains uncontrolled.[9] Safar and Bellamy proposed flushing cold solution through blood vessels of victims of deadly bleeding, and leaving them in a state of cold circulatory arrest with the heart stopped until the cause of bleeding could be surgically repaired to allow later resuscitation. In preclinical studies at the University of Pittsburgh during the 1990s, the process was called deep hypothermia for preservation and resuscitation, and then suspended animation for delayed resuscitation.[10]

The process of cooling victims of fatal bleeding for surgical repair and later resuscitation was finally called Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT), or EPR.[11][12][13] It is presently undergoing human clinical trials.[14] In the trials, victims who suffer clinical death of less than five minutes duration from blood loss are being cooled from normal body temperature of 37°C to less than 10°C by pumping a large quantity of ice-cold saline into the largest blood vessel of the body (aorta). By remaining in circulatory arrest at temperatures below 10°C (50 °F), it is believed that surgeons have up to two hours to fix injuries before circulation must be restarted.[15] Surgeons involved with this research have said that EPR changes the definition of death for victims of this type of trauma.[16]

References

  1. ^ Partin C (1998). "Profiles in Cardiology, John J. Osborn". Clinical Cardiology. 21: 66–68.
  2. ^ Gollan F, Tysinger DS Jr, Grace JT, Kory RC, Meneely GR (May 1955). "Hypothermia of 1.5 degree C in dogs followed by survival". Americal Journal of Physiology. 181 (2): 297–303. PMID 14376613.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Niazi SA, Lewis FJ (January 1956). "Profound hypothermia in the dog". Surg. Gynecol. Obstet. 102 (1): 98–106. PMID 13299021.
  4. ^ Niazi SD, Lewis JF (January 1957). "Profound Hypothermia in the Monkey With Recovery After Long Periods of Cardiac Standstill". Journal of Applied Physiology. 10 (1): 137–138. PMID 13405842.
  5. ^ Behringer W, Safar P, Wu X; et al. (May 2003). "Survival without brain damage after clinical death of 60-120 mins in dogs using suspended animation by profound hypothermia". Critical Care Medicine. 31 (5): 1523–1531. PMID 12771628. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  6. ^ Letsou GV, Breznock EM, Whitehair J; et al. (May 2003). "Resuscitating hypothermic dogs after 2 hours of circulatory arrest below 6 degrees C". The Journal of Trauma. 54 (5): 177–182. PMID 12768122. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  7. ^ Haneda K, Thomas R, Sands MP, Breazeale DG, Dillard DH (December 1986). "Whole body protection during three hours of total circulatory arrest: an experimental study". Cryobiology. 23 (6): 483–494. PMID 3802887.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ Tisherman, Samuel; Sterz, Fritz (2007). Therapeutic Hypothermia. Springer US. p. 160. In 1984, U.S. Army surgeon Ronald Bellamy and anesthesiologist Peter Safar met and discussed the pathophysiology of rapid death in combat casualties killed in action. Similar patters have been observed in civilian victims of penetrating truncal injuries. Until the 1980s, it had been thougt impossible to resucitate victims of truncal internal exsanguination to cardiac arrest, which occurs over a few minutes, because the surgery required for stopping the hemorrhage cannot be performed rapidly enough in the field. Bellamy and Safar recommended research into a new approach: "suspended animation" for preservation of the organism until hemostasis, followed by delayed resuscitation. Pharmacologic and hypothermic preservation potentials seemed worth exploring.
  9. ^ Alam HB, Pusateri AE, Kindzelski A; et al. (October 2012). "Hypothermia and hemostasis in severe trauma: A new crossroads workshop report" (PDF). The Journal of Trauma and Acute Care Surgery. 73 (4): 809–817. doi:10.1097/TA.0b013e318265d1b8. PMID 23026915. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  10. ^ Kochanek P (June 2007). "Emergency Preservation and Resuscitation: Beyond CPR" (PDF). Society of Critical Care Medicine. Retrieved 20 April 2016. This concept, first described in the literature by Samuel Tisherman, MD, FCCM, from the University of Pittsburgh (Tisherman et al. J Trauma. 1990;30:836), was called deep hypothermia for preservation and resuscitation. In further studies, the process was called suspended animation for delayed resuscitation and eventually emergency preservation for resuscitation.
  11. ^ Thomson, Helen (26 March 2014). "Gunshot victims to be suspended between life and death". New Scientist. Retrieved 20 April 2016.
  12. ^ Wendling, Patrice (March 2010). "Trauma Study Tests Hypothermia's Limits". American College of Emergency Physicians News. Retrieved 20 April 2016.
  13. ^ "EMERGENCY PRESERVATION AND RESUSCITATION FOR CARDIAC ARREST FROM TRAUMA (EPR-CAT)". Acute Care Research. Retrieved 20 April 2016.
  14. ^ "Emergency Preservation and Resuscitation (EPR) for Cardiac Arrest From Trauma (EPR-CAT)". U.S. National Institutes of Health. Retrieved 20 April 2016.
  15. ^ Thomson, Helen (26 March 2014). "Gunshot victims to be suspended between life and death". New Scientist. Retrieved 20 April 2016. The patient will be disconnected from all machinery and taken to an operating room where surgeons have up to 2 hours to fix the injury.
  16. ^ Thomson, Helen (26 March 2014). "Gunshot victims to be suspended between life and death". New Scientist. Retrieved 20 April 2016. "After we did those experiments, the definition of 'dead' changed," says Rhee. "Every day at work I declare people dead. They have no signs of life, no heartbeat, no brain activity. I sign a piece of paper knowing in my heart that they are not actually dead."

-- Jytdog (talk) 08:46, 21 April 2016 (UTC)[reply]

Record coldest[edit]

The following is all unsourced. The paper from 1958 cannot be a source for the claim that the matters discussed in that paper were the coldest as of 2012

Profound hypothermia (< 14 deg°C) usually isn't used clinically. It is a subject of research in animals and human clinical trials. As of 2012, the lowest body temperature ever survived by a human being was 9°C (48°F) as part of a hypothermic circulatory arrest experiment to treat cancer in 1957.[1] This temperature was reached without surgery, using external cooling alone. Similar low temperatures are expected to be reached in emergency preservation and resuscitation (EPR) clinical trials described at the end of this article.

References

  1. ^ Niazi SA, Lewis FJ (February 1958). "Profound hypothermia in man; report of a case" (PDF). Annals of Surgery. 147 (2): 264–266. PMID 13498651. In a 51-year-old woman widespread, metastatic ovarian carcinoma was treated by body cooling to a rectal temperature of 90 C. (48° F.). This low temperature was reached, as planned, during cardiac standstill which lasted for one hour, yet the immediate recovery was complete.

-- Jytdog (talk) 02:03, 9 May 2016 (UTC)[reply]

Sorry about that. I shouldn't have saved it before I was completely finished. It's fixed now. Cryobiologist (talk) 04:20, 9 May 2016 (UTC)[reply]
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