New diastolic cardiomyopathy in patients with severe accidental hypothermia after ECMO rewarming: a case-series observational study

Abstract

IntroductionAccidental hypothermia is a condition associated with significant morbidity and mortality. Hypothermia has been reported to affect left ventricular systolic and diastolic function. However, most of the data come from animal experimental studies.Aim of the studyThe purpose of the present study was to assess the impact of severe accidental hypothermia on systolic and diastolic ventricular function in patients treated using veno-arterial extracorporeal membrane oxygenation (ECMO).MethodsWe prospectively assessed nine hypothermic patients (8 male, age 25–78 years) who were transferred to the Severe Accidental Hypothermia Center and treated with ECMO. Transthoracic echocardiography was performed on admission (in patients without cardiac arrest) and on discharge from ICU after achieving cardiovascular stability. Cardiorespiratory stability and full neurologic recovery was achieved in all patients.ResultsBiomarkers of myocardial damage (CK, CKMB, hsTnT) were significantly elevated in all study patients. Admission echocardiography performed in patients in sinus rhythm, revealed moderate-severe bi-ventricular systolic dysfunction and moderate bi-ventricular diastolic dysfunction. Discharge echocardiography showed persistent mild bi-ventricular diastolic dysfunction, although systolic function of both ventricles returned to normal. Discharge echocardiography in patients admitted with cardiac arrest showed normal (5 patients) or moderately impaired (1 patient) global LV systolic function on discharge. However, mild or moderate LV diastolic dysfunction was observed in all 6 patients. Discharge RV systolic function was normal, whereas mild RV diastolic dysfunction was present in these patients.ConclusionAfter severe accidental hypothermia bi-ventricular diastolic dysfunction persists despite systolic function recovery in survivors treated with ECMO.

Therapeutic management of severe hypothermia with veno-arterial ECMO: where do we stand? Case report and review of the current literature

“…In experimental studies on canine or pig models, residual left systolic ventricular dysfunction was demonstrated [14,15]. However, in a more recent prospective work conducted on a small sample of 9 patients in which VA-ECMO was implemented for HT III or IV, the researchers discovered moderate biventricular diastolic dysfunction but no systolic impairment after the rewarming process [16].…”

Shoshin Beriberi and Severe Accidental Hypothermia as Causes of Heart Failure in a 6-Year-Old Child: A Case Report and Brief Review of Literature

“…It has been demonstrated that post-hypothermic contractile dysfunction is due to an isolated perturbation of systolic function, whereas diastolic function is restored (1). More recently, accidental hypothermia has been reported to affect left ventricular systolic and diastolic functions in adults (2). However, there are only a few reports concerning severe accidental hypothermia (core temperature below 28°C), but none in children, and most of the data are derived from animal experimental studies (2).…”

“…More recently, accidental hypothermia has been reported to affect left ventricular systolic and diastolic functions in adults (2). However, there are only a few reports concerning severe accidental hypothermia (core temperature below 28°C), but none in children, and most of the data are derived from animal experimental studies (2). Although the complete pathophysiology of hypothermia-induced cardiac failure is not known, it seems that, among other factors, cytosolic Ca 2 + overload is involved, possibly via a temperature-dependent dysfunction of ion transport (6).…”

“…The effects of severe hypothermia and rewarming on human cardiac function have not yet been well established, especially in children. However, it is known that hypothermia may play a role in cardiac dysfunction (1, 2). Another cause of heart failure, especially in intensive care, is thiamine deficiency (TD).…”

Accidental hypothermia–an update

“…Cardiac stunning or multi-organ failure are not unusual following prolonged CPR, ischaemia and subsequent ECLS reperfusion, and may require post-resuscitation VA-ECMO until adequate cardiorespiratory recovery. In a recent study, severely hypothermic patients (with and without CA) rewarmed with VA-ECMO, bi-ventricular diastolic dysfunction persisted despite systolic function recovery [ 222 ].…”