title: Hypothermic circulatory arrest for acute traumatic aortic rupture associated with shock.
abstract: OBJECTIVE
  Hypothermic circulatory arrest is considered to be a contraindication in acute traumatic aortic rupture (TAR) because full heparinization and hypothermia may lead to fatal bleeding if concomitant hemorrhagic injuries are present. However, in extremely emergent situations, rapid volume infusion via cardiotomy vacuums and the institution of hypothermic circulatory arrest appears to be the only method for saving patients with uncontrollable bleeding. In this study, we evaluate the feasibility of hypothermic circulatory arrest for treating patients with TAR with hemorrhagic shock.
  
  
  METHODS
  Ten patients (nine men and one woman; mean age, 35 ± 18 years), with acute TAR caused by blunt chest trauma and in a shock state, underwent surgery between 1999 and 2007. All ten patients exhibited rupture of the isthmus, and polytraumatism was frequent. Any life-threatening blood loss from other injuries was surgically treated before aortic surgery. All patients were operated on with standard cardiopulmonary bypass under hypothermic circulatory arrest.
  
  
  RESULTS
  All patients received prosthetic graft replacement. The overall hospital mortality was 10.0% (1/10). One patient died of intraabdominal and pulmonary bleeding during surgery, and the other nine were discharged without complications. There was no evidence of any new or increased hemorrhagic complications during heparinization in the nine surviving patients. Mean operation and circulatory arrest times were 305 ± 44 min and 27 ± 7 min, respectively.
  
  
  CONCLUSIONS
  Hypothermic circulatory arrest is feasible for saving TAR patients with unstable hemodynamics resulting from rupture, provided associated injuries are properly treated in advance.
authors.affiliation: Department of Cardiac Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba 277-8567, Japan. kj_kawahito@msn.com
authors.forename: Koji
authors.initials: K
authors.lastname: Kawahito
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
mesh_terms: D000063:Accidents, Traffic; D000208:Acute Disease; D000328:Adult; D000369:Aged, 80 and over; D001019:Aortic Rupture / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult