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From open-heart surgery to crisis moments! Why has deep hypothermia and circulatory arrest become a must-have for major surgery?
In the history of the development of medical surgery, many technologies have been discovered and widely used. Among them, Deep Hypothermic Circulatory Arrest (DHCA) has become an indispensable tool for treating certain complex diseases due to its unique effect and importance. This procedure allows the heart and brain activity to be suspended when the body temperature drops to 20°C to 25°C, providing effective conditions for some difficult operations.
Deep hypothermia with circulatory arrest is a highly specialized surgical technique that allows extensive surgery to be performed without affecting brain function.
The main reason why DHCA technology is widely used is that it allows surgeons to perform important operations involving the brain or large blood vessels without being restricted by blood flow interference. When the heart stops beating and blood flow is suspended, doctors can observe and operate on the target area more clearly, helping to improve surgical efficiency and safety. According to research, the chance of brain damage with DHCA surgery is relatively small, but the technique is not without risk.
The hypothermia preservation technology used for DHCA originates from the wisdom of the ancient Greek physician Hippocrates, who emphasized that low temperature can reduce bleeding during the treatment process. It is understood that biologically, when the body temperature drops, the metabolic rate of cells decreases accordingly, which means that cells can maintain cell homeostasis for a long time without blood supply and avoid damage. Therefore, therapeutic hypothermia offers an effective approach for patients facing extensive injuries or surgery.
Studies have shown that by lowering the body's temperature, the duration of cardiac arrest can be extended from the normal few minutes to an hour.
Historical Evolution of Hypothermic Circulatory Arrest
DHCA traces its roots to the 1950s, when surgeon Wilfred Bigelow pioneered cooling techniques in animals, ushering in a new era of human heart surgery. Through Bigelo's research, scientists discovered that the brain can survive longer periods of blood flow cessation in an environment as low as 5°C. To this day, DHCA has been widely used in a variety of surgeries, including aortic arch repair and cerebral aneurysm repair.
DHCA protection mechanism
The core of DHCA is to temporarily "protect" the brain in a cooling state. When the brain reaches a temperature below 18°C, brain wave activity almost completely disappears, and the brain enters a state of "electrophysiological silence." This not only reduces the energy consumption of brain cells, but also effectively reduces the impact of free radicals and immune inflammation, further protecting brain tissue.
Achievement of electrophysiological silencing is considered an important indicator for determining the cooling required for an individual patient.
Technology's potential and challenges
Although DHCA surgery has brought hope to patients in clinical applications, the management of overheating during postoperative recovery is a link that the medical team must pay attention to. Studies have shown that improper temperature control during the rewarming process may lead to adverse consequences and even increase the risk of nerve damage in patients. Therefore, how to manage this process more effectively becomes one of the focuses of future research.
Prospects for clinical applications
With the advancement of technology, the future of deep hypothermia circulatory arrest remains promising. New clinical trials are exploring the possibility of using this technology to respond to traumatic injuries, allowing doctors to prolong patient survival when dealing with life-threatening hemorrhages. This not only challenges the medical community's understanding of the boundary between life and death, but may also open up new opportunities for trauma patients.
In the face of such a significant surgical technology, we can't help but wonder, as medical technology becomes more and more sophisticated, will future surgeries be able to achieve a greater balance between risk management and innovative use?
