Talk:Deep hypothermic circulatory arrest

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

Wiki Education Foundation-supported course assignment
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Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 19:12, 16 January 2022 (UTC)

No brain activity?
Is this correct. Why exactly is this done. Something about blood pressure? --Gbleem 06:04, 10 September 2006 (UTC)

Renaming
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)
 * 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)
 * Moved. Dlodge (talk) 16:46, 13 March 2012 (UTC)

"The body can not live for more than 7 minutes without blood circulating"
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)

Grey's Anatomy
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
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)

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. By the 1950s, recovery of large non-hibernating mammals from temperatures as low as 1.5°C had been demonstrated. Temperatures below 10°C were shown to allow recovery from circulatory arrest periods longer than one hour, two hours , and three hours in some cases.
 * Research

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. 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. 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.

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. It is presently undergoing human clinical trials. 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. Surgeons involved with this research have said that EPR changes the definition of death for victims of this type of trauma.

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

Record coldest
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. 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.

-- Jytdog (talk) 02:03, 9 May 2016 (UTC)
 * 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)