title: Novel approach for independent control of brain hypothermia and systemic normothermia: cerebral selective deep hypothermia for refractory cardiac arrest.
abstract: A 38-year-old man was found unconscious, alone in the driver's seat of his car. The emergency medical team identified his condition as pulseless ventricular tachycardia. Defibrillation was attempted but failed. Extracorporeal membrane oxygenation (ECMO) was started in the emergency room 52 min after the estimated arrest following the extracorporeal cardiopulmonary resuscitation (ECPR) protocol in our center. The initial prognosis under the standard protocol was <25% chance of survival. A novel adjunctive to our ECPR protocol, cerebral selective deep (<30°C) hypothermia (CSDH), was applied. CSDH adds a second independent femoral access extracorporeal circuit, perfusing cold blood into the patient's common carotid artery. The ECMO and CSDH circuits demonstrated independent control of cerebral and core temperatures. Nasal temperature was lowered to below 30°C for 12 hours while core was maintained at normothermia. The patient was discharged without significant neurological deficit 32 days after the initial arrest.
authors.affiliation: Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Lin
authors.affiliation: Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Heng-Wen
authors.initials: HW
authors.lastname: Chou
authors.affiliation: Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yi-Chih
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Joey-Jen
authors.initials: JJ
authors.lastname: Hwang
authors.affiliation: Asia Pacific Medical Technology Development Company, Hong Kong, China.
authors.forename: John R
authors.initials: JR
authors.lastname: Gilbert
authors.affiliation: Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
mesh_terms: D000328:Adult; D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002560:Cerebrovascular Circulation; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy*
keywords: Brain; Catheter; Device; Intervention; Technique