Rewarming from accidental hypothermia by extracorporeal circulation. A retrospective study

Abstract

Patients with non-asphyxiated deep accidental hypothermia have a reasonable prognosis and should be rewarmed before further therapeutic decisions are made. In contrast, drowned patients with secondary hypothermia have a very poor prognosis. The treatment protocol under such conditions should be the subject for further discussion.

Rewarming From Severe Accidental Hypothermia With Circulatory Arrest

“…Severe accidental hypothermia remains a challenging clinical problem mainly aff ecting victims of outdoor accidents who suff er from prolonged exposure to a cold environment or immersion/submersion in cold water 1 . Most reports from urban environments are associated with drug or alcohol abuse, serious illness in the elderly, suicide or accidents related to sports activity 2 .…”

Accidental Deep Hypothermia With Cardiac Arrest. Prompt Complete Recovery After Rewarming by Extracorporeal Circulation. Case Report

“…The mortality rate of deep accidental hypothermia with cardiac arrest varies between 20 to 80 % from one study to another 2,5,6 . This variability can be explained by diff erences in accident mechanisms, patient population, pre-hospital handling as well as determination of the rewarming strategy.…”

“…This variability can be explained by diff erences in accident mechanisms, patient population, pre-hospital handling as well as determination of the rewarming strategy. The therapeutic approach is basically determined by the question of whether cardiac arrest has to be considered as a direct consequence of hypothermia or is attributed to the sequela of asphyxia 2 . If asphyxia precedes cardiac arrest, even in a deeply hypothermic patient, the chances of survival are very small.…”

“…If asphyxia precedes cardiac arrest, even in a deeply hypothermic patient, the chances of survival are very small. Hyperkalemia is known as a marker of poor prognosis in patients with accidental hypothermia and its correlation with patient's outcome is more precise than other biochemical variables such as central venous pH, pCO 2 or activated clotting time 1,2,7,8 . Asphyxia as well as trauma, crush trauma especially, are associated with signifi cant hyperkalemia 7,8 .…”

“…Despite improvement in pre-hospital rescue care, in-hospital intensive care and rewarming techniques, the mortality rate remains high 2 . Since its introduction, rewarming by extracorporeal circulation (ECC) has become the treatment of choice for deeply hypothermic patients with cardiac arrest 3 .…”