Problems and Pitfalls of Qualification for Extracorporeal Rewarming in Severe Accidental Hypothermia

Jarosz, Anna; Kosiński, Sylweriusz; Darocha, Tomasz; Paal, Peter; Gałązkowski, Robert; Hymczak, Hubert; Drwiła, Rafał

doi:10.1053/j.jvca.2016.05.015

Cited by 14 publications

(13 citation statements)

References 19 publications

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“…Also not statistically significant, the − 0.31 mmol/L difference in central venous potassium compared with peripheral potassium may represent a difference that is no longer considered acceptable [32], and that may be clinically significant in the very specific setting of hypothermic CA. Another reason to choose central venous potassium may be that, although peripheral sampling may avoid some complications linked to central blood sampling, such as iatrogenic trauma to the femoral vessels [33], it may be extremely technically challenging to obtain a peripheral sample, as shown by some of our study cases. Given the relative ease of obtaining femoral compared with peripheral venous blood sampling as well as the trend for central venous potassium to be lower than the peripheral one, we would propose to use central venous blood as the preferred site for a single potassium sampling.…”

Section: Discussionmentioning

confidence: 99%

“…Another reason may be pseudo-hyperkalaemia, which may also occur during or after blood collection, due to excessive tourniquet time or mechanical trauma during venepuncture or transport [13, 14, 34]. This may be the case especially in hypothermia, where the puncture or catheterization of vessels is often difficult, notably due to the difficulty in identifying a pulse in cardiac arrest patients [33] and where numerous attempts to puncture the vessels are common [33]. The use of ultrasound, which has been recommended to prevent this [33], or sampling through an in-place femoral catheter, was designed not only to ensure the correct sampling site but also to minimize the risk of haemolysis.…”

Section: Discussionmentioning

confidence: 99%

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Intra-patient potassium variability after hypothermic cardiac arrest: a multicentre, prospective study

Pasquier

Blancher

Buse

et al. 2019

Scand J Trauma Resusc Emerg Med

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BackgroundTo date, the decision to set up therapeutic extra-corporeal life support (ECLS) in hypothermia-related cardiac arrest is based on the potassium value only. However, no information is available about how the analysis should be performed. Our goal was to compare intra-individual variation in serum potassium values depending on the sampling site and analytical technique in hypothermia-related cardiac arrests.MethodsAdult patients with suspected hypothermia-related refractory cardiac arrest, admitted to three hospitals with ECLS facilities were included. Blood samples were obtained from the femoral vein, a peripheral vein and the femoral artery. Serum potassium was analysed using blood gas (BGA) and clinical laboratory analysis (CL).ResultsOf the 15 consecutive patients included, 12 met the principal criteria, and 5 (33%) survived. The difference in average potassium values between sites or analytical method used was ≤1 mmol/L. The agreement between potassium values according to the three different sampling sites was poor. The ranges of the differences in potassium using BGA measurement were − 1.6 to + 1.7 mmol/L; − 1.18 to + 2.7 mmol/L and − 0.87 to + 2 mmol/L when comparing respectively central venous and peripheral venous, central venous and arterial, and peripheral venous and arterial potassium.ConclusionsWe found important and clinically relevant variability in potassium values between sampling sites. Clinical decisions should not rely on one biological indicator. However, according to our results, the site of lowest potassium, and therefore the preferred site for a single potassium sampling is central venous blood. The use of multivariable prediction tools may help to mitigate the risks inherent in the limits of potassium measurement.Trial registrationClinicalTrials.gov Identifier: NCT03096561.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intra-patient potassium variability after hypothermic cardiac arrest: a multicentre, prospective study

Pasquier

Blancher

Buse

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…If available, extracorporeal blood rewarming with ECMO can also be time intensive to set up (possibly up to 6 hours) and labor intensive to continue. 8 Transfer to an extracorporeal rewarming site is not always possible and capable hospitals may need additional time to set up their machines. Therefore, it is crucial to look at the outcomes of severely hypothermic patients without extracorporeal blood rewarming.…”

Section: Rewarming Principle and Techniquesmentioning

confidence: 99%

<p>Case of Severe Accidental Hypothermia Cardiac Arrest in a Subtropical Climate and Review of Management</p>

Chau¹,

Joseph

Ledesma³

et al. 2020

OAEM

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“…The main mission of ELSO is to collect registry of ECMO treatments and provide guidelines associated with ECMO treatment, also for ECMO transport (24). The centralized model with the use of specialized ECMO transport has been developed in many centers around the world (25,26,(30)(31)(32)(33)(34)(35). The ELSO Registry showed that minimum number of ECMO therapies to achieve good outcomes is six per year but more than 30 annual adult ECMO applications were associated with significantly lower mortality (25)(26)(27)(28)(29)(30)(31).…”

Section: Ecmo Reactivationmentioning

confidence: 99%

“…Therefore, the position of therapy in centralized dedicated centers is strongly promoted, rather than diversifying therapies in smaller regional units (25,30). The centralized model with the use of specialized ECMO transport has been developed in many centers around the world (25,26,(30)(31)(32)(33)(34)(35).…”

Section: Ecmo Reactivationmentioning

confidence: 99%

BEST Life—“Bringing ECMO Simulation To Life”—How Medical Simulation Improved a Regional ECMO Program

et al. 2018

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The implemented "ECMO for Greater Poland" program takes full advantage of the ECMO (extracorporeal membrane oxygenation) perfusion therapy to promote health for 3.5 million inhabitants in the region. The predominant subjects of implementation are patients with hypothermia, with severe reversible respiratory failure (RRF), and treatment of other critical states leading to heart failure such as sudden cardiac arrest, cardiogenic shock or acute intoxication. Finally, it promotes donation after circulatory death (DCD) strategy in selected organ donor cases. ECMO enables recovery of organs' function after unsuccessful lifesaving treatment. Because this organizational model is complex and expensive, we use advanced high-fidelity medical simulation to prepare for real-life implementation. During the first four months, we performed scenarios mimicking "ECMO for DCD," "ECMO for ECPR (extended cardiopulmonary resuscitation)," "ECMO for RRF" and "ECMO in hypothermia." It helped to create algorithms for aforementioned program arms. In the following months, three ECMO courses for five departments in Poznan (capitol city of Greater Poland) were organized and standardized operating procedures for road ECMO transportation within Medical Emergency System were created. Soon after simulation program, 38 procedures with ECMO perfusion therapy including five road transportations on ECMO were performed. The Maastricht category II DCD procedures were done four times on real patients and in two cases double successful kidney transplantations were carried out for the first time in Poland. ECMO was applied in two patients with hypothermia, nine adult patients with heart failure, and five with RRF, for the first time in the region. In the pediatric group, ECMO was applied in four patients with RRF and 14 with heart failure after cardiac surgery procedures. Additionally, one child was treated successfully following 200 km-long road transport on ECMO. We achieved good and promising results especially in VV ECMO therapy. Simulation-based training enabled us to build a successful procedural chain, and to eliminate errors at the stage of identification, notification, transportation, and providing ECMO perfusion therapy. We discovered the important role of medical simulation, not only to test the medical professional's skills, but also to promote ECMO therapy in patients with critical/life-threatening states. Moreover, it also resulted in increase of the potential organ pool from DCD in the Greater Poland region.

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Problems and Pitfalls of Qualification for Extracorporeal Rewarming in Severe Accidental Hypothermia

Cited by 14 publications

References 19 publications

Intra-patient potassium variability after hypothermic cardiac arrest: a multicentre, prospective study

Intra-patient potassium variability after hypothermic cardiac arrest: a multicentre, prospective study

<p>Case of Severe Accidental Hypothermia Cardiac Arrest in a Subtropical Climate and Review of Management</p>

BEST Life—“Bringing ECMO Simulation To Life”—How Medical Simulation Improved a Regional ECMO Program

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