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CASE REPORT
Novel approach for independent control of brain hypothermia and systemic normothermia: cerebral selective deep hypothermia for refractory cardiac arrest
  1. Chih-Hsien Wang1,
  2. Yu-Ting Lin1,
  3. Heng-Wen Chou1,
  4. Yi-Chih Wang1,
  5. Joey-Jen Hwang1,
  6. John R Gilbert2,
  7. Yih-Sharng Chen1
  1. 1Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
  2. 2Asia Pacific Medical Technology Development Company, Hong Kong, China
  1. Correspondence to Professor Y-S Chen, Department of Cardiovascular Surgery, National Taiwan University Hospital, 7 Chung-Shan S Rd, Taipei 100, Taiwan; yschen1234{at}gmail.com, yschen11{at}mail2000.com.tw

Summary

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.

  • Brain
  • Catheter
  • Device
  • Intervention
  • Technique

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2016-012806

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    Footnotes

    • Contributors C-HW: writing and designing the system. Y-TL and H-WC: patient care. Y-CW and J-JH: catheter intervention. JRG: design. YSC: writing, design of the system, and intervention.

    • Competing interests Chih-Hsien Wang, Yu-Ting Lin, Mao Ting, Heng-Wen Chou, Yi-Chih Wang, Juey-Jen Hwang, Yih-Sharng Chen: none. John R. Gilbert is both the CTO and a shareholder of APMTD, which is the master distributor for the TwinFlo® Device in Taiwan.

    • Patient consent Obtained.

    • Ethics approval The institutional review board approved the study (series No 2016-03049 BIPA).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The authors agree to share unpublished data if requested.