title: Current conduct of deep hypothermic circulatory arrest in China.
abstract: BACKGROUND
  Deep hypothermic circulatory arrest for adult aortic arch repair is still associated with significant mortality and morbidity. Furthermore, there is still significant variation in the conduct of this complex perioperative technique. This variation in deep hypothermic circulatory arrest practice has not been adequately characterized and may offer multiple opportunities for outcome enhancement. The hypothesis of this study was that the current practice of adult deep hypothermic circulatory arrest in China has significant variations that might offer therapeutic opportunities for reduction of procedural risk.
  
  
  METHODS
  An adult deep hypothermic circulatory arrest questionnaire was developed and then administered at a thoracic aortic session at the International Cardiothoracic and Vascular Anesthesia Congress convened in Beijing during 2010. The data was abstracted and analyzed.
  
  
  RESULTS
  The majority of the 56 respondents were anesthesiologists based in China at low-volume deep hypothermic circulatory arrest centers. The typical aortic arch repair had a prolonged deep hypothermic circulatory arrest time at profound hypothermia. The target temperature for deep hypothermic circulatory arrest was frequently measured distal to the brain. The most common perfusion adjunct was antegrade cerebral perfusion, typically monitored with radial arterial pressure and cerebral venous oximetry. The preferred neuroprotective agents were steroids and propofol.
  
  
  CONCLUSIONS
  The identified opportunities for outcome improvement in this delineated deep hypothermic circulatory arrest model include nasal/tympanic temperature measurement and routine cerebral perfusion, preferably with unilateral antegrade cerebral perfusion monitored with radial artery pressure and cerebral oximetry. Development and dissemination of an evidence-based consensus would enhance these practice-improvement opportunities.
authors.affiliation: Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: J G T
authors.initials: JG
authors.lastname: Augoustides
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.forename: K
authors.initials: K
authors.lastname: Ghadimi
authors.forename: J
authors.initials: J
authors.lastname: Choi
authors.forename: Y
authors.initials: Y
authors.lastname: Yue
authors.forename: G
authors.initials: G
authors.lastname: Silvay
keywords: China; adult aortic arch repair; antegrade cerebral perfusion; cardiopulmonary bypass; cerebral oximetry; deep hypothermic circulatory arrest; neuroprotection; practice variation; propofol; questionnaire; radial artery pressure; retrograde cerebral perfusion; steroids; temperature monitoring