Cardiac arrest caused by accidental severe hypothermia and myocardial infarction during general anesthesia

Abstract

Therapeutic hypothermia is often used for traumatic brain injury because of its neuroprotective effect and decreased secondary brain injury. However, this procedure lacks clinical evidence supporting its efficacy, and adverse outcomes have been reported during general anesthesia. A 61-year-old man with a history of percutaneous coronary intervention (PCI) was admitted with traumatic brain injury. Immediately after admission, he underwent mild therapeutic hypothermia with a target temperature of 33.0°C for neuroprotection. During general anesthesia for emergency surgery because he developed a mass effect, hypothermic cardiac arrest occurred following an additional decrease in the core body temperature. Moreover, myocardial infarction caused by restenosis of the previous PCI lesion also contributed to the cardiac arrest. Although the patient recovered spontaneous circulation after an hour-long cardiopulmonary resuscitation with rewarming, he eventually died of subsequent repetitive cardiac arrests. When anesthetizing patients undergoing therapeutic hypothermia, caution is required to prevent adverse outcomes that can be caused by unintentional severe hypothermia and exacerbation of underlying heart disease.

Risk factors for postreperfusion syndrome during living donor liver transplantation in paediatric patients with biliary atresia: a retrospective analysis

“…Infection of the surgical site, inhibition of a series of coagulation cascade enzymes, impairment of platelet function and an extension of the postoperative ICU stay as well as the overall length of hospitalisation are all frequently caused by intraoperative hypothermia 20–22. Arrhythmias, myocardial ischaemia and cardiac arrest may also result from it 23. The effect of hypothermia on thrombin and platelets leads to an increase in blood loss and blood transfusion in children.…”

“… 20–22 Arrhythmias, myocardial ischaemia and cardiac arrest may also result from it. 23 The effect of hypothermia on thrombin and platelets leads to an increase in blood loss and blood transfusion in children. Our results also support this view.…”

Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions

“…127 Hypothermia can cause POCA. 128,129 One case described a 61-year-old man undergoing an emergency decompressive craniectomy after head trauma. 129 Before surgery, the patient had undergone mild therapeutic hypothermia for neuroprotection.…”

“…128,129 One case described a 61-year-old man undergoing an emergency decompressive craniectomy after head trauma. 129 Before surgery, the patient had undergone mild therapeutic hypothermia for neuroprotection. During surgery, the patient developed ventricular fibrillation, attributed to an anesthesia-related further decrease in temperature because the esophageal temperature at the time of arrest was 32.0 °C, as opposed to 33.0 °C before anesthesia induction.…”