Prognostic Factors for Nonasphyxia-Related Cardiac Arrest Patients Undergoing Extracorporeal Rewarming - HELP Registry Study

Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review

“…The survival rate of 27% for unwitnessed cases of hypothermic OHCA described in the present study, as well as the description of survivors’ characteristics, especially an excellent neurologic outcome, should help clinicians better integrate the particularities of hypothermic CA and strongly consider qualification for transport (prehospital phase) or ECLS evaluation (hospital) of patients, even in cases of UHCA. This may also be the case even in the presence of other unfavorable prognostic factors, as illustrated by the fact that a proportion of published extreme cases of survival in hypothermia, for example, the lowest core temperature (11.8°C), 10 the longest no‐flow time (70 min), 15 the extremely high serum potassium level (11.3 mmol/L), and the longest submersion (>83 min), 16 concerned cases where CA had not been witnessed.…”

“…7 Similarly, the initial serum lactate concentration (ie, measured before or within first 5 minutes of ECPR application) proved to be a strong predictor of survival in a recent study of hypothermic CA, finding a calculated threshold of good prognosis of <11.9 mmol/L. 10 The study by Debaty et al 7 also reported that the highest arterial lactate concentration in a surviving patient was 19 mmol/L, which hindered the relevancy of blood lactate for initial triage. Thus, there is to date no generally accepted cutoff value of lactate in hypothermic cardiac arrest patients associated with better outcome, or one which may be used as a guide to resuscitation or post-resuscitation hemodynamic management.…”

Induced Hypothermia to 4.2°C with Neurologically Intact Survival: A Forgotten Case Series

“…The lowest published core temperature from which a person with accidental hypothermia has been resuscitated with neurologically intact survival is 11.8 C in a 2-y-old boy who sustained an unwitnessed asystolic cardiac arrest. 1 He underwent cardiopulmonary resuscitation for 135 min before he was rewarmed with extracorporeal membrane oxygenation. The lowest published core temperature from which an adult has been resuscitated is 13.7 C. 2 The patient was a 29-y-old woman who fell into an ice-covered stream while ski touring.…”

No Cold Death—Extracorporeal Life Support for All Victims of Accidental Hypothermia

“…They will welcome the case series presented in this issue of the Journal of Cardiothoracic and Vascular Anesthesia because it will inform them on the potential worth of their efforts. 3 Darocha et al retrospectively reviewed 98 patients who experienced non-asphyxiaÀrelated hypothermic cardiac arrest and who underwent rewarming using extracorporeal life support (ECLS) in cardiac surgery departments in Poland over a 7-year period. 3 Patients were between 2 and 85 years old (average 53.8 years) and had a mean core temperature of 23.2˚C on arrival.…”

“…3 Darocha et al retrospectively reviewed 98 patients who experienced non-asphyxiaÀrelated hypothermic cardiac arrest and who underwent rewarming using extracorporeal life support (ECLS) in cardiac surgery departments in Poland over a 7-year period. 3 Patients were between 2 and 85 years old (average 53.8 years) and had a mean core temperature of 23.2˚C on arrival. Fifty-three percent survived, with 94% of these reported to have a good neurologic outcome.…”