Extracorporeal Life Support for Refractory Cardiac Arrest from Accidental Hypothermia: A 10-Year Experience in Edinburgh

Khorsandi, Maziar; Dougherty, Scott; Young, Neil; Kerslake, Dean; Giordano, Vincenzo; Lendrum, Robbie; Walker, William S.; Zamvar, Vipin; Yim, Ivan; Pessotto, Renzo

doi:10.1016/j.jemermed.2016.10.043

Cited by 24 publications

(21 citation statements)

References 31 publications

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“…Based on our results, the prediction of survival probability to hospital discharge was both statistically and clinically significantly improved if estimated with our score instead of a traditional dichotomous potassium-based triage decision. Our mixed method of retrospective data collection from different sources circumvented the major limitation of all studies reporting survival after hypothermic CA, namely their small sample size, ranging from case reports to case series with patient numbers in low double digits [3,13,31,32]. The prospective inclusion of sufficient patients for a study of this nature would take years, even if several international centers cooperated to conduct a multivariable analysis comparable to our study.…”

Section: Discussionmentioning

confidence: 99%

Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score

et al. 2018

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“…Our study has shown that regardless of the rewarming method, the RR is associated with mortality. It is reasonable to choose active internal rewarming when rewarming patients is urgent because of the haemodynamic instability due to severe hypothermia [5, 28–31]. However, considering the potential risk of complications with invasive rewarming methods [1], as well as the insufficient evidence that these methods improve the outcome in all patients with severe hypothermia, the best approach, not only for patient outcomes but also for healthcare cost, may be the stepwise approach that begins with active external and minimally invasive rewarming, and saving invasive method for patients who cannot be rewarmed adequately.…”

Section: Discussionmentioning

confidence: 99%

Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry

Watanabe

Matsuyama

Morita

et al. 2019

Scand J Trauma Resusc Emerg Med

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BackgroundAccidental hypothermia (AH) is defined as an involuntary decrease in core body temperature to < 35 °C. The management of AH has been progressing over the last few decades, and numerous techniques for rewarming have been validated. However, little is known about the association between rewarming rate (RR) and mortality in patients with AH.MethodThis was a multicentre chart review study of patients with AH visiting the emergency department of 12 institutions in Japan from April 2011 to March 2016 (Japanese accidental hypothermia network registry, J-Point registry). We retrospectively registered patients using the International Classification of Diseases, Tenth Revision code T68: ‘hypothermia’. We excluded patients whose body temperatures were unknown or ≥ 35 °C, who could not be rewarmed, whose rewarmed temperature or rewarming time was unknown, those aged < 18 years, or who or whose family members had refused to join the registry. RR was calculated based on the body temperature on arrival at the hospital, time of arrival at the hospital, the documented temperature during rewarming, and time of the temperature documentation. RR was classified into the following five groups: ≥2.0 °C/h, 1.5–< 2.0 °C/h, 1.0–< 1.5 °C/h, 0.5–< 1.0 °C/h, and < 0.5 °C/h. The primary outcome of this study was in-hospital mortality. The association between RR and in-hospital mortality was evaluated using multivariate logistic regression analysis.ResultDuring the study, 572 patients were registered in the J-Point registry, and 481 patients were included in the analysis. The median body temperature on arrival to the hospital was 30.7 °C (interquartile range [IQR], 28.2 °C–32.4 °C), and the median RR was 0.85 °C/h (IQR, 0.53 °C/h–1.31 °C/h). The in-hospital mortality rates were 19.3% (11/57), 11.1% (4/36), 14.4% (15/104), 20.1% (35/175), and 34.9% (38/109) in the ≥2.0 °C/h, 1.5–< 2.0 °C/h, 1.0–< 1.5 °C/h, 0.5–< 1.0 °C/h, and < 0.5 °C/h groups, respectively. Multivariate regression analysis revealed that in-hospital mortality rate increased with each 0.5 °C/h decrease in RR (adjusted odds ratio, 1.49; 95% confidence interval, 1.15–1.94; Ptrend < 0.01).ConclusionThis study showed that slower RR is independently associated with in-hospital mortality.

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“…Current methods of rewarming are based on recommendations and guidelines established by the Swiss Hypothermia Scale. 3,13,15 Besides body temperature less than 28°C, an attention is to be paid particularly to the reduced consciousness, systolic blood pressure less than 90 mmHg and ventricular arrhythmias. 3,4,15,17 If any of these factors are present in a severe hypothermia case the patient should be referred to the nearest hospital with an ECLS availability.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] Recent developments and achievements in the field of the ECLS led to a spread of cases treated with VA-ECMO, which is reflected in the current available case reports [9][10][11][12] and case series. 5,8,[13][14][15][16] These reports focus particularly on the circumstances of an accident and the outcome, less is known about a specific VA-ECMO setting and actual course of the therapy.…”

Section: Introductionmentioning

confidence: 99%

Management of accidental hypothermia: an established extracorporeal membrane oxygenation centre experience

et al. 2019

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Introduction: Data on management of severe accidental hypothermia published from an established high-volume extracorporeal membrane oxygenation centre are scarce. Methods: A total of 28 patients with intravesical temperature lower than 28°C on admission were either treated with veno-arterial extracorporeal membrane oxygenation or rewarmed conservatively. Results: A total of 10 patients rewarmed on veno-arterial extracorporeal membrane oxygenation (age: 37 ± 12.6 years) and 18 conservatively (age: 55.2 ± 11.2 years) were collected over a course of 5 years. The dominant cause was alcohol intoxication with exposure to cold (39%), 12 patients were resuscitated prior to admission. The admission temperature in the extracorporeal membrane oxygenation group (23.8 ± 2.6°C) was lower than in the non–extracorporeal membrane oxygenation group (26.0 ± 1.5°C, p = 0.01). The peripheral percutaneous veno-arterial extracorporeal membrane oxygenation was always cannulated in malignant arrhythmias causing refractory cardiac arrest. The typical extracorporeal membrane oxygenation blood flow was 3-4 L/minute and sweep gas flow 2 L/minute, the median extracorporeal membrane oxygenation duration was 48.3 (28.1-86.7) hours. The median rates of rewarming did not differ (0.41 (0.35-0.7)°C/hour in extracorporeal membrane oxygenation and 0.77 (0.54-0.98)°C/hour in non–extracorporeal membrane oxygenation, p = 0.46) as well as the admission arterial lactate, pH and potassium. Their development was not different between the groups except for higher pH between the third and ninth hour of rewarming in the extracorporeal membrane oxygenation group. The hospital mortality was 10% in the extracorporeal membrane oxygenation group and 11.1% in the non–extracorporeal membrane oxygenation group with the median last Glasgow Coma Scale 15 and Cerebral Performance Score 1. Conclusion: Veno-arterial extracorporeal membrane oxygenation for severe hypothermia shows promising outcome data collected in an extracorporeal membrane oxygenation/extracorporeal cardiopulmonary resuscitation centre located in a European urban area. Except for presence of refractory cardiac arrest, the established hypothermia-related prognostic indicators did not differ between patients in need for extracorporeal membrane oxygenation and those rewarmed without extracorporeal membrane oxygenation.

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Extracorporeal Life Support for Refractory Cardiac Arrest from Accidental Hypothermia: A 10-Year Experience in Edinburgh

Cited by 24 publications

References 31 publications

Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score

Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score

Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry

Management of accidental hypothermia: an established extracorporeal membrane oxygenation centre experience

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