Background: DHCA is used for open heart procedures where the ability to perfuse the brain through the head vessels is not possible with standard proximal aorta cannulation. Repairs of the aortic arch, congenital repairs involving the aortic arch, repairs to the head and neck great vessels, or neurosurgical and pulmonary end arterectomies may require DHCA. In some emergency cases, DHCA may be performed unplanned for example to repair laceration in the right ventricle when opening the sternum.

Case: 22 years old male with severe aortic regurgitation, mild to moderate mitral regurgitation, mild tricuspid regurgitation, severe pulmonal regurgitation will undergo double valve replacement, PDA ligation and vegetation evacuation. DHCA was performed unplanned to repair PDA because of laceration happened when PDA was ligated. DHCA was performed until temperature of 20.7°C for 43 minutes. There is sequel of ischemic lesion in left parietal lobe while admitted to the intensive care unit.

Summary: Several factors that need attention in this unplanned DHCA are: (1) response, skills, and ability of a surgeon to adapt with the situation; (2) well time management; (3) ice-packs around the patient’s head; and (4) pharmacologic agents such as midazolam, vecuronium, steroid and mannitol to reduce cerebral oxygen metabolism rate and to give cerebral protection in this condition.

Pendahuluan: DHCA digunakan pada prosedur bedah jantung terbuka dimana kemampuan perfusi ke otak melalui pembuluh darah kepala tidak memungkinkan dengan kanulasi aorta proksimal yang standar. Operasi arkus aorta, kelainan kongenital yang melibatkan arkus aorta, pembuluh darah besar kepala dan leher, atau endarterektomi neurosurgikal dan pulmonal dapat memerlukan DHCA.Namun terkadang beberapa kasus memerlukan penggunaan DHCA secara darurat dan tidak terencana seperti misalnya untuk memperbaiki laserasi pada ventrikel kanan saat menggergaji sternum.

Kasus: Laki-laki, usia 22 tahun dengan AR severe, MR mild-moderate, TR mild, PR severe akan dilakukan DVR, ligasi PDA dan evakuasi vegetasi.DHCA terpaksa dilakukan secara tidak terencana untuk melakukan repair PDA akibat robekan yang terjadi saat ligasi PDA. DHCA dilakukan hingga suhu mencapai 20,7°C selama 43 menit.Pada perawatan ICU didapatkan sekuel iskemik di lobus parietal kiri.

Ringkasan: Beberapa faktor yang perlu diperhatikan dalam DHCA yang tidak terencana ini, antara lain: (1) respon, keterampilan, dan kemampuan adaptasi terhadap situasi dari ahli bedah; (2) pembagian waktu yang baik; (3) pemberian es blok di area sekitar kepala pasien; dan (4) pemberian agen-agen farmakologis seperti midazolam, vecuronium, steroid dan manitol untuk menekan laju konsumsi oksigen serebral serta memberikan proteksi serebral pada kondisi ini.

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