In long duration Cardio thoracic and vascular surgeries, Perfusionist and Surgeons induce either TCA or DHCA to prevent ischemic damage and to maintain myocardial protection, among them Which is better and what is the major difference between them?
In my opinion, there is not any circulation in the first case (TCA),
while there is a grade of circulation in the second (DHCA).
Estimado Theodore:
El paro circulatorio total (TCA) se lleva a cabo en la reparación del arco aórtico y en las cirugías de la Aorta Ascendente. El TCA puede ser un paro circulatorio con hipotermia sistémica profunda (PCHSP), sin embargo, debido al daño neurológico permanente que está técnica produce si se extiende más de 45 minutos y a la mortalidad que ocasiona si se prolongaba por más de 65 minutos. El límite de tiempo “seguro” para la PCHSP es de 30 minutos. En la actualidad, se realiza un paro circulatorio con hipotermia sistémica moderada, en aquellas intervenciones de resección completa de la aorta ascendente, o del arco aórtico, pero que no requieran periodos de paro circulatorios prolongados, ya múltiples estudios abalan que el tejido cerebral está bien perfundido en hipotermia moderada, lo que que acorta el recalentamiento progresivo del paciente y por ende los tiempos de Circulación Extracorpórea, así como la morbi-mortalidad de los pacientes expuestos a estas cirugías.
Saludos
DHCA có nhiều lợi thế hơn do chỉ ngưng tạm thời do hạ thân nhiệt nên dễ phục hồi hơn nếu cấp cứu kịp thời
In my humbled opinion deep hypothermic circulatory arrest (DHCA), total circulatory arrest (TCA), profound hypothermic circulatory arrest (PHCA), all are different names for the same procedure and techniques used for bloodless field in ( cardiac surgery) e.g great vessels, intracardiac and congenital and in other procedures and in sever trauma, some complicated cancer surgery and in resent research work, 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/ DHCA as a way of saving people who had exsanguinated from traumatic injuries to the trunk of the body. Exsanguination is blood loss severe enough to cause death. Until the 1980s, it had been thought impossible to resuscitate people whose heart stopped because of blood loss, resulting in these people 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. Safar and Bellamy proposed flushing cold solution through blood vessels of patients with 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.
The process of cooling people with fatal bleeding for surgical repair and later resuscitation was finally called Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT), or EPR.It is presently undergoing human clinical trials. In the trials, patients who experience clinical death for 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 one to two hours to fix injuries before circulation must be restarted. Surgeons involved with this research have said that EPR changes the definition of death for victims of this type of trauma. So in short this is a technique evolved in early 1950s and the name is modified and changed finally associated with cerebral perfusion to reduce its complication and to gain extra timing without brain insult. as i mentioned above the different names e.g EPR-CAT is for the same technique of hypothermia using the same principles but different definition of the procedure.
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