{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T22:05:09Z","timestamp":1793657109662,"version":"4.5.1"},"reference-count":40,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T00:00:00Z","timestamp":1684972800000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Hj\u00e4rt-Lungfonden","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Agreement for Medical Education and Research, Sweden","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,4,28]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Neurological complications after surgery for acute type A aortic dissection (ATAAD) increase patient morbidity and mortality. Carbon dioxide flooding is commonly used in open-heart surgery to reduce the risk of air embolism and neurological impairment, but it has not been evaluated in the setting of ATAAD surgery. This report describes the objectives and design of the CARTA trial, investigating whether carbon dioxide flooding reduces neurological injury following surgery for ATAAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The CARTA trial is a single-centre, prospective, randomised, blinded, controlled clinical trial of ATAAD surgery with carbon dioxide flooding of the surgical field. Eighty consecutive patients undergoing repair of ATAAD, and who do not have previous neurological injuries or ongoing neurological symptoms, will be randomised (1:1) to either receive carbon dioxide flooding of the surgical field or not. Routine repair will be performed regardless of the intervention. The primary endpoints are size and number of ischaemic lesions on brain MRI performed after surgery. Secondary endpoints are clinical neurological deficit according to the National Institutes of Health Stroke Scale, level of consciousness using the Glasgow Coma Scale motor score, brain injury markers in blood after surgery, neurological function according to the modified Rankin Scale and postoperative recovery 3 months after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval has been granted by Swedish Ethical Review Agency for this study. Results will be disseminated through peer-reviewed media.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04962646\">NCT04962646<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-063837","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T13:27:00Z","timestamp":1685021220000},"page":"e063837","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Carbon dioxide flooding to reduce postoperative neurological injury following surgery for acute type A aortic dissection: a prospective, randomised, blinded, controlled clinical trial, CARTA study protocol - objectives and design"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct04962646","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4165-3940","authenticated-orcid":false,"given":"Jacob","family":"Ede","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Teurneau-Hermansson","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Moseby-Knappe","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Neurology, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitta","family":"Ramgren","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Diagnostic Radiology, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Bjursten","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1951-7723","authenticated-orcid":false,"given":"Per","family":"Ederoth","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Anaesthesiology and Intensive care, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e5rten","family":"Larsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Mattsson-Carlgren","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Neurology, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"},{"name":"Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Sj\u00f6gren","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Wierup","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5786-864X","authenticated-orcid":false,"given":"Shahab","family":"Nozohoor","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Zindovic","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Sk\u00e5ne University Hospital Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,25]]},"reference":[{"key":"2025121407250918000_13.5.e063837.1","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1007\/s12253-020-00835-x","article-title":"Ruptured aortic aneurysm and dissection related death: An autopsy database analysis","volume":"26","author":"P\u00e1l","year":"2020","journal-title":"Pathol Oncol Res"},{"key":"2025121407250918000_13.5.e063837.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.630400"},{"key":"2025121407250918000_13.5.e063837.3","doi-asserted-by":"publisher","DOI":"10.1378\/chest.117.5.1271"},{"key":"2025121407250918000_13.5.e063837.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000483"},{"key":"2025121407250918000_13.5.e063837.5","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezw235"},{"key":"2025121407250918000_13.5.e063837.6","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1093\/ejcts\/ezx231","article-title":"Hospital volumes and later year of operation correlates with better outcomes in acute type A aortic dissection","volume":"53","author":"Geirsson","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025121407250918000_13.5.e063837.7","first-page":"77","article-title":"German Registry for acute aortic dissection type A: Structure, results, and future perspectives","volume":"65","author":"Boening","year":"2017","journal-title":"Thorac Cardiovasc Surg"},{"key":"2025121407250918000_13.5.e063837.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.031264"},{"key":"2025121407250918000_13.5.e063837.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.12.026"},{"key":"2025121407250918000_13.5.e063837.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.01.033"},{"key":"2025121407250918000_13.5.e063837.11","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1093\/ejcts\/ezaa197","article-title":"Stroke in acute type A aortic dissection: The Nordic consortium for acute type A aortic dissection (NORCAAD)","volume":"58","author":"Chemtob","year":"2020","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025121407250918000_13.5.e063837.12","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs025"},{"key":"2025121407250918000_13.5.e063837.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.11.054"},{"key":"2025121407250918000_13.5.e063837.14","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/j.jtcvs.2018.10.134","article-title":"Malperfusion in acute type A aortic dissection: An update from the Nordic consortium for acute type A aortic dissection","volume":"157","author":"Zindovic","year":"2019","journal-title":"The Journal of Thoracic and Cardiovascular Surgery"},{"key":"2025121407250918000_13.5.e063837.15","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1016\/j.jtcvs.2019.11.003","article-title":"Surgery for type A aortic dissection in patients with cerebral Malperfusion: Results from the International Registry of acute aortic dissection","volume":"161","author":"Sultan","year":"2021","journal-title":"The Journal of Thoracic and Cardiovascular Surgery"},{"key":"2025121407250918000_13.5.e063837.16","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1111\/jocs.12633","article-title":"Impact of hemodynamic instability and organ Malperfusion in elderly surgical patients treated for acute type A aortic dissection","volume":"30","author":"Zindovic","year":"2015","journal-title":"J Card Surg"},{"key":"2025121407250918000_13.5.e063837.17","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1016\/j.jtcvs.2019.06.016","article-title":"Factors associated with acute stroke after type A aortic dissection repair: An analysis of the society of Thoracic Surgeons national adult cardiac surgery database","volume":"159","author":"Ghoreishi","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025121407250918000_13.5.e063837.18","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/j.jtcvs.2018.04.063","article-title":"Adjunct retrograde cerebral perfusion provides superior outcomes compared with hypothermic circulatory arrest alone: A meta-analysis","volume":"156","author":"Tian","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025121407250918000_13.5.e063837.19","doi-asserted-by":"publisher","DOI":"10.1136\/thx.23.2.194"},{"key":"2025121407250918000_13.5.e063837.20","unstructured":"Listewnik M , Kotfis K , \u015alozowski P , et al . The influence of carbon dioxide field flooding in mitral valve operations with cardiopulmonary bypass on S100Ss level in blood plasma in the aging brain"},{"key":"2025121407250918000_13.5.e063837.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.08.047"},{"key":"2025121407250918000_13.5.e063837.22","doi-asserted-by":"publisher","DOI":"10.1177\/0218492315583562"},{"key":"2025121407250918000_13.5.e063837.23","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1051\/ject\/200638123","article-title":"Flooding the surgical field with carbon dioxide during open heart surgery improves segmental wall motion","volume":"38","author":"Skidmore","year":"2006","journal-title":"J Extra Corpor Technol"},{"key":"2025121407250918000_13.5.e063837.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)93219-8"},{"key":"2025121407250918000_13.5.e063837.25","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.athoracsur.2018.10.008","article-title":"Deep hypothermia with retrograde cerebral perfusion versus moderate hypothermia with Antegrade cerebral perfusion for arch surgery","volume":"107","author":"Leshnower","year":"2019","journal-title":"The Annals of Thoracic Surgery"},{"key":"2025121407250918000_13.5.e063837.26","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.013970"},{"key":"2025121407250918000_13.5.e063837.27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512143332401"},{"key":"2025121407250918000_13.5.e063837.28","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.19.5.604"},{"key":"2025121407250918000_13.5.e063837.29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.53221.x"},{"key":"2025121407250918000_13.5.e063837.30","doi-asserted-by":"crossref","unstructured":"Smith A . Symbol digit modalities test: Western Psychological Services Los Angeles. 1973.","DOI":"10.1037\/t27513-000"},{"key":"2025121407250918000_13.5.e063837.31","doi-asserted-by":"publisher","DOI":"10.1159\/000108501"},{"key":"2025121407250918000_13.5.e063837.32","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2008.01027.x"},{"key":"2025121407250918000_13.5.e063837.33","doi-asserted-by":"publisher","DOI":"10.1207\/s15327752jpa4901_13"},{"key":"2025121407250918000_13.5.e063837.34","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-011-9903-x"},{"key":"2025121407250918000_13.5.e063837.35","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e7586","article-title":"SPIRIT 2013 explanation and elaboration: Guidance for protocols of clinical trials","volume":"346","author":"Chan","year":"2013","journal-title":"BMJ"},{"key":"2025121407250918000_13.5.e063837.36","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2002.120333"},{"key":"2025121407250918000_13.5.e063837.37","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000118501.44474.83"},{"key":"2025121407250918000_13.5.e063837.38","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2003.50"},{"key":"2025121407250918000_13.5.e063837.39","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.jtcvs.2019.04.040","article-title":"Direct visualization of carbon dioxide field flooding: Optical and concentration level comparison of Diffusor effectiveness","volume":"159","author":"Vandenberghe","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025121407250918000_13.5.e063837.40","doi-asserted-by":"crossref","DOI":"10.1186\/s13019-022-01916-5","article-title":"Patient tilt improves efficacy of CO(2) field-flooding in minimally invasive cardiac surgery","volume":"17","author":"Vandenberghe","year":"2022","journal-title":"J Cardiothorac Surg"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-063837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T15:25:19Z","timestamp":1765725919000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-063837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,25]]},"published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1136\/bmjopen-2022-063837"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-063837","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5]]}}}