Successful Resuscitation of a Child with Severe Hypothermia after Cardiac Arrest of 88 Minutes

Abstract

A 4-year-old boy broke through the ice of a frozen lake and drowned. The boy was extricated from the icy water by a rescue helicopter that was dispatched shortly after the incident. Although the boy was severely hypothermic, no cardiac response could be induced with field resuscitation measures, including intubation, ventilation, suction, and cardiopulmonary resuscitation.On admission, the primary findings included fixed, nonreacting pupils and asystole. The first core temperature measured was 19.8° C (67.6° F). During active, external warming, the first ventricular beats were observed 20 minutes after admission, and changed 10 minutes later to a sinus rhythm. Continuous monitoring included repeated arterial blood gas and electrolyte tests; prophylaxis for cerebral edema was performed with hyperventilation and administration of sodium Brevimytal and dexamethasone. Seventy minutes after admission, hemodynamics stabilized and the boy was transferred to the pediatric intensive care unit (PICU), where active external warming was continued to raise the core temperature at a rate of 1° C/hour.Adult respiratory distress syndrome developed, and the boy had to be ventilated in the PICU for 10 days. He was discharged home after another two weeks. He recovered fully. The rapid heat loss with the induction of severe hypothermia (<20° C; 68° F) was the main reason for survival in this rare event of a patient with cardiac arrest lasting 88 minutes after accidental hypotherma.

Predicting outcome after childhood brain injury: Figure 1:

“…Water temperature is an important determinant of outcome; there are isolated case reports of intact survival in icy water even after prolonged immersion. 56 …”

An established extracorporeal membrane oxygenation protocol promotes survival in extreme hypothermia

“…In children, the situation is usually a cold-water drowning. Young children with limited swimming skills become submerged and then cool rapidly because of their limited subcutaneous fat and their large body surface area to mass ratio [1][2][3][4][5][6][7]. The cold water decreases one's ability to hold one's breath, which leads to early inhalation of water and accelerated cooling [8].…”

The Oxygen-Conserving Potential of the Trigeminocardiac Reflex

“…In anesthetized, artificially ventilated male Sprague Dawley rats with blood gases and body temperature controlled, the forehead skin was continuously selectively cooled or electrically stimulated for 1 h. The MCA was permanently occluded, and infarction volume was determined 24 h later. [217][218][219][220] Although hypothermia seems to play an important role in oxygen conservation and hypometabolism observed even in diving animals, 15,39,[221][222][223] the body temperature after a near drowning does not seem to be the critical factor in the subsequent recovery of patients, 218,224,225 suggesting that other components of the DR play an important role in surviving anoxia. Electrical stimulation of the forehead was even more efficient, decreasing infarction volume by 65% while temporal muscle temperature remained unchanged.…”