Wikipedia:Articles for deletion/Deep hypothermic circulatory arrest


 * The following discussion is an archived debate of the proposed deletion of the article below. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review).  No further edits should be made to this page.

The result was keep. Nomination withdrawn. ( (non-admin closure) ) Mhhossein (talk) 11:02, 15 April 2016 (UTC)

Jytdog (talk) 09:59, 15 April 2016 (UTC)

Deep hypothermic circulatory arrest

 * – ( View AfD View log  Stats )

The subject of this article is covered better at Targeted temperature management in terms of current medical practice. This article as it stands, is a couple of quotes out of old sources. To the extent this is meant to be about cryonics this article is unhelpful and should just redirect there. But there is no here, here. This appears to be a failed WP:POVFORK. Jytdog (talk) 16:05, 10 April 2016 (UTC) (withdrawn Jytdog (talk) 09:58, 15 April 2016 (UTC)}
 * Keep Delete Well covered in TTM and could be included as an adjunct to Cardioplegia. The term may be useful, so a delete and redirect to TTM may be appropriate.-- &#9790;Loriendrew&#9789;  &#9743;(ring-ring)  17:55, 10 April 2016 (UTC) changing to keep per arguments below.-- &#9790;Loriendrew&#9789;   &#9743;(ring-ring)  02:09, 15 April 2016 (UTC)
 * Note: This debate has been included in the list of Medicine-related deletion discussions. Shawn in Montreal (talk) 18:31, 10 April 2016 (UTC)
 * Keep The use of deep hypothermic circulatory arrest in surgery is a separate practice in medicine from Targeted Temperature Management (TTM) also known as therapeutic hypothermia. All book references and PubMed references to TTM pertain to therapeutic hypothermia, not hypothermic circ arrest. Therapeutic hypothermia is the reduction of normal body temperature by several degrees after cardiac arrest or other neurological injury for purposes of facilitating neurological recovery by inhibiting the immune-inflammatory cascade that happens after injury. In lay terms, think of it like putting a cold compress on an injury to reduce swelling. In contrast, deep or profound hypothermic circulatory arrest is instituted as a protective measure *before* causing injury by stopping blood circulation to do surgery in a bloodless field. Not only are the names, mode of use, and purposes different, but the mechanisms by which cold protects the brain from injury during circulatory arrest is different from the mechanisms by which mild cold helps the brain heal after circulatory arrest or other injury. The protection mechanism of deep (and even colder) hypothermic circulatory arrest protection by reducing cerebral metabolic demand by suppressing brain activity. The healing facilitation of mild hypothermic *after* circulatory arrest is reduction of inflammation. They are apples and oranges. Cryobiologist (talk) 19:46, 10 April 2016 (UTC)
 * Cardioplegia is a separate subject again, different from either hypothermic circ arrest or TTM. Cardioplegia is cooling the heart to protect the heart during circulatory arrest in the heart during open heart surgery. During cardioplegia, the bypass pump keeps blood circulation going to the rest of the body, including the brain. During deep hypothermic circulatory arrest, the bypass pump is turned off stopping blood circulation to the entire body and brain. It's cerebroplegia to protect the brain during circ arrest, not cardioplegia to protect the heart. Cryobiologist (talk) 20:11, 10 April 2016 (UTC)


 * Everyone gets it that the use of hypothermia in CBP is something that cryonics folks pin a lot of their hopes on. But in actual practice of medicine, it is discussed together with TTM, and the use of hypothermia in CBP is  not completely accepted and is being moved away from.   - a 2014 review - actually identifies its use a a risk factor for poor neurological outcomes and, another 2014 review, discusses the move away from DHCA (already two years ago) to more moderate or mild hypothermia, as these approaches are showing better outcomes. Jytdog (talk) 20:39, 10 April 2016 (UTC)
 * You are still confusing two separate subjects. DHCA is not hypothermia during CBP (cardiopulmonary bypass), nor is DHCA chilling people to get better outcomes after cardiac arrest (TTM). DHCA is using cardiopulmonary bypass to first cool the patient to 18 degrees Celsius or colder, and then stopping blood circulation all together. This is a completely different thing. DHCA is used by not just used by cardiovascular surgeons during aortic arch repair, but probably even more commonly by neurosurgeons doing repair on otherwise inoperable cerebral aneurysms. The resulting isoelectric EEG is not incidental, but deliberate and even augmented by barbiturates when necessary because the more effectively action potentials are inactivated during the procedure, the better neurological outcomes have been shown to be. I understand that you were led to this article because the cryonics article pointed to it as an example of survivable isoelectric EEG in medicine, but please don't assume this means that DHCA isn't established mainstream medicine. Cryobiologist (talk) 21:32, 10 April 2016 (UTC)
 * I am not the littlest, tiniest bit confused. You are making arguments on personal authority (your putative great authority and my putative ignorance) that don't matter in Wikipedia. I have cited sources and even the other editor arguing to keep below can see that this is one field. Jytdog (talk) 21:40, 10 April 2016 (UTC)
 * You are asking for proof of a negative, specifically that DHCA isn't called TTM in medicine. A PubMed search for "Targeted Temperature Management" produces 187 hits. A PubMed search for "hypothermic circulatory arrest" produces 2113 hits. A PubMed search for "Targeted Temperature Managment" and "hypothermic circulatory arrest" produces zero hits. There are plenty are articles in the world about spacecraft, and there are plenty of article about submarines, but it would probably be hard to find a specific article explaining that submarines aren't spacecraft. Cryobiologist (talk) 22:25, 10 April 2016 (UTC)
 * that is better, thanks. A search for ""therapeutic hypothermia" brings up ~500 pubmed articles that discuss both.  Sure one is more emergency medicine and the other is more focused on CV surgery, but they do the same thing for the same purpose - neuroprotection.  That article is much more developed than this one.  I had redirected this to that, and was considering renaming that one as a next step, and then elaborating on everything there, when you reverted the redirect. That is still what I intend to do, and it wouldn't surprise me at all if content would need to be split back out once it is actually developed enough to be a decent article.  So how about that?  We could even work on that together if you like.  If you agree I can withdraw this AfD, and we can re-do the redirect, rename that article, elaborate it, and see if a re-split is needed.  What do you say? Jytdog (talk) 22:42, 10 April 2016 (UTC)


 * I would certainly rather work with you to make articles better rather than debate. With respect to the current proposal, when I read the abstracts, every article that comes up on PubMed under "therapeutic hypothermia" still refers exclusively to the use of mild hypothermia after cardiac arrest or other cerebral ischemia has occurred. For further corroboration of this exclusive meaning of therapeutic hypothermia or TTM, see this this review article for nurses which says


 * To see how DHCA doesn't fit into this, general explanations of DHCA are here and here. I can understand why you think the DHCA article is bad. It's quality and length should at least reflect the amount of popular press coverage this type of surgery has gotten, which is more than some other medical articles I've seen on Wikipedia with more obscure topic matter. Why don't we work on the DHCA article together, and try to take a break from "cryonics" debates for awhile if others will let us. Cryobiologist (talk) 23:47, 10 April 2016 (UTC)
 * Jytdog: Are you withdrawing? Mhhossein (talk) 12:33, 14 April 2016 (UTC)


 * Keep The topic is notable under this title. For example, see Deep hypothermic circulatory arrest in Paediatric Cardiology. The particular feature of this technique seems to be the arrest of the circulation rather than its continuation.  TTM is much more general concept, as its name indicates.  So, one topic is more particular than the other.  None of this is a reason to delete anything. Andrew D. (talk) 21:09, 10 April 2016 (UTC)


 * There is no reason for this WP:SPLIT to exist; it is just a cryonics WP:POV fork. Jytdog (talk) 21:13, 10 April 2016 (UTC)
 * No, that's all wrong. The page started as being about a "standstill operation" – a technique of surgery in which the circulation is stopped.  There has been some variation of title but that's just a matter of medical jargon and is no reason to delete.  Also, splits and forks are addressed by merger, not deletion.  But this page in question was created in 2006 while the TTM page which the nominator prefers was created later, in 2007, and so the claim of forking is therefore false.  My !vote stands. Andrew D. (talk) 21:36, 10 April 2016 (UTC)
 * We delete POV forks especially when there is plenty of room in the broader article. You don't seem to be arguing to benefit the encyclopedia but rather about something else (I do get it that you were unhappy over that Lens regeneration stuff).  Look at this piece of crap article - two extended quotes  - and see what links here.  The dahling of the cryonics crowd, is what this is.  Nothing more.  No here here.   Jytdog (talk) 21:40, 10 April 2016 (UTC)
 * The connection with cryonics seems quite tangential as this is a technique developed for use in living patients. Here's another source about the topic: Deep hypothermic circulatory arrest.  This further demonstrates the notability of the topic and the irrelevance of the cryonics connection.  There's not the slightest case for deletion here and so my !vote stands. Andrew D. (talk) 21:54, 10 April 2016 (UTC)
 * That source is the same as which is already in the article (current ref #2, just a different publication).-- &#9790;Loriendrew&#9789;  &#9743;(ring-ring)  21:58, 10 April 2016 (UTC)
 * I found that source in an independent search so I suppose it's a good one. But there's plenty more out there as Google Scholar provides over 11,000 papers when one searches for this exact title.  This is more than ample to demonstrate notability and so, again, there's no reason for us to be deleting anything.  The nomination seems to have its origin is some dispute about cryonics when this technique is more about cardiac and neurosurgery.  The nomination is therefore disruptive in nature, as it fails to focus on the main aspects of the topic. My !vote stands.  Andrew D. (talk) 22:06, 10 April 2016 (UTC)
 * I had originally redirected this very thin stub to the Targeted temperature management article and that was reverted by Cryobiologist here. Hence the AfD, which is based on our policies about overlapping content (NOTABILITY, SPLIT, POV fork).  and is 100% rooted in the article that exists and how it should fit in the Encyclopedia that exists, and your further comments make it even more clear how personally-driven this is for you.  Anyway. enough back and forth  except... google scholar for a medical topic.   . Jytdog (talk) 22:15, 10 April 2016 (UTC)
 * The nomination seems to be 100% battleground because it makes no sense when considered in terms of our policies for building the encyclopedia. If one doesn't care for Google scholar, then there are over 5000 search results in Google books.  Again, these are more than ample to demonstrate the notability of the topic and the bizarre nature of the nomination.  The nominator should please cease their attempts to shout down contrary !votes as this tends to make the discussion rather tiresome.  I shall be retiring now to sleep but any further attempt to seize the last word should not be construed as changing my !vote which is now quite definite in opposition to deletion of this notable topic. Andrew D. (talk) 22:28, 10 April 2016 (UTC)
 * Could have done a merge request too. And I have no question that your vote will be changed. I am making clear how funky your vote is.  But you are right, none of this is helpful an I will hat it. Jytdog (talk) 22:33, 10 April 2016 (UTC)


 * delete per nominator's rationale(subject is covered at Targeted_temperature_management)--Ozzie10aaaa (talk) 22:30, 10 April 2016 (UTC)
 * So everyone is clear on the chronology, the DHCA article was never forked from Targeted_temperature_management, and Targeted_temperature_management never contained any mention of DHCA until today when a small passage was added concurrent with the redirection and then deletion nomination of the DHCA article. Merger can seem justified if it appears that overlap previously existed, but it didn't. Cryobiologist (talk) 00:21, 11 April 2016 (UTC)
 * Indeed. The DHCA page was created in 2006 (as "standstill operation") while the TTM page was created later, in 2007. Andrew D. (talk) 06:18, 11 April 2016 (UTC)
 * I don't mean POV fork in time, I mean in function. Jytdog (talk) 06:19, 11 April 2016 (UTC)
 * That would be a redundant fork, not a POV fork. But, it appears that this is not a fork at all; they are just related articles. Andrew D. (talk) 06:30, 11 April 2016 (UTC)
 * respectfully disagree w/--Ozzie10aaaa (talk) 15:10, 11 April 2016 (UTC)


 * keep . For now. Yes, these techniques are both about cooling, sort of like model rockets and Apollo Program are both about rockets. But in practice they are quite different procedures, are not done by the same people (it would be a disaster if they were), and have quite different goals. DHCA is done by major vascular surgeons, and it cools way down till the heart stops so (very fast) surgery can be done without blood pressure. The other technique cools a little to get some effects of cooling on the brain, but the goal is NOT to stop the heart. The DHCA article will probably need to be expanded when the EPR-CAT trial results come in. The emergency people are pushing the latter term EPR (Emergency Preservation and Resuscitation) for the trauma procedure in which a patient arrives to the ER with a penetrating wound to the chest which can only be fixed after an (otherwise fatal) period with no blood pressure, and so "DHCA" is induced emergently with cold washout (rather than in a controlled way, as is done for aneurism repair). But here, the U. Pittsburgh people who got the grant money to try this in humans (after success in pigs) want to call it something else. . People trying for grant money always want to split so they can have their own cool term (sorry), and people who aren't getting the money always want to lump. Speaking of lumping, it's also fine with me if the articles are merged, provided the DHCA material all gets put into the Targeted_temperature_management article and gets its own section (despite comments above, the DHCA material is certainly NOT covered in the Targeted_temperature_management article, one major reason being that DHCA sometimes does not aim for a targetted temp which is managed, but cools much as one can till before you are stopped by other circumstances). But after EPR results are added, this thing is going to be too long, and somebody will be back here again, saying we should have a split per WP:SS, and somebody else will wonder whose idea it was to shove these different things together in the first place. S  B Harris 01:45, 11 April 2016 (UTC)


 * Comment - to clarify the POV fork thing - I am not talking about historically, but rather functionally - how these articles are used and interlinked within WP.   This article is not even linked at the relevant articles about aortic procedures (which need a ton of work themelves)  It is linked at all the cryonics articles.    And I am very very aware of the difference in the procedures.  What they share is a common approach (use of cold in medicine), a common goal (primarily neuroprotective) and common problems in rewarming and reperfusion.  Was thinking of renaming the other to make it better "head" article like "Therapeutic Hypothermia" or maybe better "Hypothermia in medicine".  From an encyclopedic perspective that would make total sense.  I  was fully anticipating a re-split of things as necessary.  But right now the two articles live in different universes and this one is pitiful  and underlinked. Jytdog (talk) 02:12, 11 April 2016 (UTC)
 * I certainly agree that Therapeutic hypothermia (which already links to Targetted temp management) Hypothermia in medicine are both vastly better terms for a merged article than using Targeted temperature management, which is just wrong for the deep hypothermic arrest methods. Perhaps even better is Hypothermia for neuroprotection in medicine, since hypothermia in medicine covers everything to use of initial cold packs on sports injuries. Interestingly enough, some of the latter is probably what happens to brains in mild hypothermia. When it works, it probably works like those cold packs, not by altering metabolism (it's not severe enough to do much of that) but by altering other pathways (and damping others, such as inflammatory cascades). On the other hand, the deep hypothermia arrest techniques are very brute force metabolic approaches as can be seen by the fact that their duration time limits can more or less be calculated by the old Q10 rule: brain metabolism is cut roughly by 2 (actually more like 2.2) for every 10 C drop from normal temperature. There is no such principle at work in the mild hypothermia targetted techniques. In fact, sometimes they don't work at all!  S  B Harris 03:02, 11 April 2016 (UTC)


 * my nomination is withdrawn. I hear the community and cryobiologist has done some work that makes this worth keeping. Jytdog (talk) 09:58, 15 April 2016 (UTC)


 * The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review). No further edits should be made to this page.