Characteristics and outcome of patients with hypothermic out-of-hospital cardiac arrest: Experience from a European trauma center

Ruttmann, Elfriede; Dietl, Marion; Kastenberger, Tobias; Attal, R.; Ströhle, Mathias; Ulmer, Hanno; Mair, Peter

doi:10.1016/j.resuscitation.2017.08.242

Cited by 15 publications

(18 citation statements)

References 32 publications

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“…To avoid undetected rescue collapse, recent investigators recommend checking avalanche victims for vital signs, and monitor ECG from the outset of extrication ( 136 ). A higher rate of successful resuscitations after witnessed cardiac arrests agree with the findings of most investigators ( 8 , 9 , 30 , 39 , 44 ). Nevertheless, there are also reports of high survival rates in articles, in which information concerning whether CA is witnessed or not is lacking ( 33 , 42 ).…”

Section: Discussionsupporting

confidence: 91%

Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

et al. 2021

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Introduction: This systematic review and meta-analysis aims at comparing outcomes of rewarming after accidental hypothermic cardiac arrest (HCA) with cardiopulmonary bypass (CPB) or/and extracorporeal membrane oxygenation (ECMO).Material and Methods: Literature searches were limited to references with an abstract in English, French or German. Additionally, we searched reference lists of included papers. Primary outcome was survival to hospital discharge. We assessed neurological outcome, differences in relative risks (RR) of surviving, as related to the applied rewarming technique, sex, asphyxia, and witnessed or unwitnessed HCA. We calculated hypothermia outcome prediction probability score after extracorporeal life support (HOPE) in patients in whom we found individual data. P < 0.05 considered significant.Results: Twenty-three case observation studies comprising 464 patients were included in a meta-analysis comparing outcomes of rewarming with CPB or/and ECMO. One-hundred-and-seventy-two patients (37%) survived to hospital discharge, 76 of 245 (31%) after CPB and 96 of 219 (44 %) after ECMO; 87 and 75%, respectively, had good neurological outcomes. Overall chance of surviving was 41% higher (P = 0.005) with ECMO as compared with CPB. A man and a woman had 46% (P = 0.043) and 31% (P = 0.115) higher chance, respectively, of surviving with ECMO as compared with CPB. Avalanche victims had the lowest chance of surviving, followed by drowning and people losing consciousness in cold environments. Assessed by logistic regression, asphyxia, unwitnessed HCA, male sex, high initial body temperature, low pH and high serum potassium (s-K+) levels were associated with reduced chance of surviving. In patients displaying individual data, overall mean predictive surviving probability (HOPE score; n = 134) was 33.9 ± 33.6% with no significant difference between ECMO and CPB-treated patients. We also surveyed 80 case reports with 96 victims of HCA, who underwent resuscitation with CPB or ECMO, without including them in the meta-analysis.Conclusions: The chance of surviving was significantly higher after rewarming with ECMO, as compared to CPB, and in patients with witnessed compared to unwitnessed HCA. Avalanche victims had the lowest probability of surviving. Male sex, high initial body temperature, low pH, and high s-K+ were factors associated with low surviving chances.

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Section: Discussionsupporting

confidence: 91%

Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

et al. 2021

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“…1,9,[31][32][33][34][35] Asphyxia during drowning or avalanche burial is the major reason for poor outcome in hypothermia victims in cardiac arrest and was present 40% of Registry patients. 10,14 Major trauma was present in about one third of patients but did not contribute substantially to mortality. This supports suggestions from previous case reports that major trauma is not a reason to withhold ECLS rewarming in arrested hypothermia victims.…”

Section: Discussionmentioning

confidence: 99%

“…36,37 Witnessed cardiac arrest, return of spontaneous circulation despite hypothermia and exposure to cold in young and previously healthy hypothermia victims were factors favoring survival in registry patients, while age, sex, core temperature, cardiac rhythm and duration of CPR did not affect outcome. 14,38,39 Data regarding prognostic markers in hypothermic cardiac arrest vary substantially in recently published work on this topic. As in our study, rhythm was not correlated with survival in other publications 9,40 but was a significant predictor in others.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of cardiovascular collapse, neurologic dysfundtion and Glasgow Outcome Score (GOS) did not differ significantly between the patients with preserved circulation and those in cardiac arrest. Arrested hypothermia victims had a lower median core temperature (25 [23-27]°C vs. 30 [28][29][30][31][32][33]°C; p < 0.001), a lower Glasgow Coma Scale (GCS) (3[3-3} vs. 7 [3][4][5][6][7][8][9][10][11][12][13][14][15]; p < 0.001) and more often sustained asphyxia (24 vs. 3; p < 0.001) (Table 2 & Fig. 1).…”

Section: Outcomementioning

confidence: 99%

“…[11][12][13] Many questions are still unsolved such as the role of vasoactive drugs in advanced life support in hypothermia, how to choose amongst rewarming modalities, the best rate of rewarming, and the optimum target temperature. [14][15][16][17] Serum potassium level is currently the only widely accepted prognostic indicator in hypothermic patients with cardiac arrest. Cutoffs beyond which attempted resuscitation is likely to be futile are 8 mmol/l for hypothermic avalanche victims and 12 mmol/ l for all other victims.…”

Section: Introductionmentioning

confidence: 99%

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Hypothermic Cardiac Arrest – Retrospective cohort study from the International Hypothermia Registry

et al. 2021

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Aim: The International Hypothermia Registry (IHR) was created to increase knowledge of accidental hypothermia, particularly to develop evidencebased guidelines and find reliable outcome predictors. The present study compares hypothermic patients with and without cardiac arrest included in the IHR. Methods: Demographic, pre-hospital and in-hospital data, method of rewarming and outcome data were collected anonymously in the IHR between 2010 and 2020. Results: Two hundred and one non-consecutive cases were included. The major causeof hypothermia was mountain accidents, predominantly in young men. Hypothermic Cardiac Arrest (HCA) occurred in 73 of 201 patients. Core temperature was significantly lower in the patients in cardiac arrest (25.0 vs. 30.0°C, p < 0.001). One hundred and fifteen patients were rewarmed externally (93% with ROSC), 53 by extra-corporeal life support (ECLS) (40% with ROSC) and 21 with invasive internal techniques (71% with ROSC). The overall survival rate was 95% for patients with preserved circulation and 36% for those in cardiac arrest. Witnessed cardiac arrest and ROSC before rewarming were positive outcome predictors, asphyxia, coagulopathy, high potassium and lactate negative outcome predictors. Conclusions: This first analysis of 201 IHR patients with moderate to severe accidental hypothermia shows an excellent 95% survival rate for patients with preserved circulation and 36% for HCA patients. Witnessed cardiac arrest, restoration of spontaneous circulation, low potassium and lactate and absence of asphyxia were positive survival predictors despite hypothermia in young, healthy adults after mountaineering accidents. However, accidental hypothermia is a heterogenous entity that should be considered in both treatment strategies and prognostication.

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Prognostic thresholds of outcome predictors in severe accidental hypothermia

Mendrala,

Darocha,

Brožek

et al. 2024

Intern Emerg Med

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Hemodynamically unstable patients with severe hypothermia and preserved circulation should be transported to dedicated extracorporeal life support (ECLS) centers, but not all are eligible for extracorporeal therapy. In this group of patients, the outcome of rewarming may sometimes be unfavorable. It is, therefore, crucial to identify potential risk factors for death. Furthermore, it is unclear what criterion for hemodynamic stability should be adopted for patients with severe hypothermia. The aim of this study is to identify pre-rewarming predictors of death and their threshold values in hypothermic patients with core temperature ≤ 28 °C and preserved circulation, who were treated without extracorporeal rewarming. We conducted a multicenter retrospective study involving patients in accidental hypothermia with core temperature 28 °C or lower, and preserved spontaneous circulation on rewarming initiation. The data were collected from the International Hypothermia Registry, HELP Registry, and additional hospital data. The primary outcome was survival to hospital discharge. We conducted a multivariable logistic regression and receiver operating characteristic curve (ROC) analysis. In the multivariate analysis of laboratory tests and vital signs, systolic blood pressure (SBP) adjusted for cooling circumstances and base excess (BE) were identified as the best predictor of death (OR 0.974 95% CI 0.952–0.996), AUC ROC 0.79 (0.70–0.88). The clinically relevant cutoff for SBP was identified at 90 mmHg with a sensitivity of 0.74 (0.54–0.89) and a specificity of 0.70 (0.60–0.79). The increased risk of death among hypothermic patients with preserved circulation occurs among those with an SBP below 90 mmHg and in those who developed hypothermia in their homes.

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Characteristics and outcome of patients with hypothermic out-of-hospital cardiac arrest: Experience from a European trauma center

Cited by 15 publications

References 32 publications

Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

Hypothermic Cardiac Arrest – Retrospective cohort study from the International Hypothermia Registry

Prognostic thresholds of outcome predictors in severe accidental hypothermia

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