Derin Hipotermik Sirkülatuar Arrest: Tarihçe, Klinik Uygulamalar ve Nörolojik Koruma Stratejileri

Mehmet Burak Coşkun

doi:10.5281/zenodo.14569387

Authors

Mehmet Burak Coşkun Sağlık Bakanlığı https://orcid.org/0000-0001-6748-575X

DOI:

https://doi.org/10.5281/zenodo.14569387

Keywords:

Deep Hypothermic Circulatory Arrest (DHCA), Cardiopulmonary Bypass (CPB), Cerebral Protection, Pharmacological Support, Cardiovascular Surgery

Abstract

Deep hypothermic circulatory arrest (DHCA) is a critical technique utilized in complex cardiovascular surgeries to temporarily halt blood circulation by reducing body temperature. This approach enables surgeons to create a hemodynamically stable and motionless surgical field while ensuring cerebral protection and preserving organ function. The foundations of DHCA trace back to the 1950s, with Griepp et al. pioneering its application in aortic arch surgeries in 1975, thus laying the groundwork for modern utilization.

The clinical procedure involves three essential stages: initiation of cardiopulmonary bypass (CPB), induction of hypothermia, and implementation of circulatory arrest. CPB facilitates extracorporeal blood oxygenation and recirculation, while hypothermia significantly reduces metabolic rates by up to 90%, protecting organs under low oxygen conditions. Circulatory arrest is generally limited to 30–40 minutes. Cerebral protection techniques, including antegrade and retrograde cerebral perfusion, play a pivotal role in minimizing neurological complications.

Pharmacological interventions are integral to DHCA, providing neuroprotection and controlling inflammation. Barbiturates decelerate cerebral metabolism, steroids suppress inflammatory responses, and osmotic diuretics mitigate cerebral edema. Despite its efficacy and safety in contemporary surgical practice, DHCA requires meticulous monitoring and management to prevent complications. Future advancements in surgical protocols and pharmacological strategies hold promise for reducing associated risks and improving patient outcomes.

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