The Use of Extracorporeal Membrane Oxygenation Systems in Severe Accidental Hypothermia After Drowning

Abstract

Cardiopulmonary failure because of drowning with accidental hypothermia (AH) remains a major task for emergency care physicians. In this case series, we describe our experience in nine patients with cardiopulmonary failure after drowning with AH less than 35°C, who were provided on an emergency basis with extracorporeal life support (ECLS) system or extracorporeal membrane oxygenation (ECMO). Conservative rewarming methods are not considered for this study. Preclinical conditions and protocols were gathered. Surgical reports and clinical data sets were collected. Median age was 24 years (range, 6-75 years). Six patients were male. Climatic conditions mostly showed cold to frosty weather. All cases had different preclinical rescue procedures. They reached the emergency department under cardiopulmonary resuscitation (CPR). Indications for ECLS were cardiac arrest, and in one case, pulmonary failure. Mean CPR duration was 60 min (range: 15-120 min). Before implantation, the median pH value was 6.9. Two patients could be successfully weaned from the systems. Cause of death was severe neurologic damage in six patients and cardiac failure in one patient. The use of ECLS/ECMO is a therapy option for a small range of patients with cardiopulmonary failure because of drowning with AH. Nevertheless, the interval of preclinical rescue remains extensively long.

The use of minimal invasive extracorporeal circulation for rewarming after accidental hypothermia and circulatory arrest

“…The survival of six of 17 patients in our series is consistent with the median HOPE score of 31% in our population and matches that of recent analyses 14,18 . However, heterogeneous settings, treatment protocols, and reporting standards make comparison between reports difficult 19‐24 . Most reports refer to their rewarming technique as CPB‐ or ECMO‐based.…”

“…14,18 However, heterogeneous settings, treatment protocols, and reporting standards make comparison between reports difficult. [19][20][21][22][23][24] Most reports refer to their rewarming technique as CPB-or ECMObased. Further technical details are rarely available.…”

Adult Basic Life Support

“…The findings from the 6 new papers identified in this update 359b , 368 , 370 , 375 , 376 , 383 are consistent with the 2015 treatment recommendation. The previously identified limitations of this review (exclusion of factors after the victim is rescued, for example, bystander CPR 383 , 384 , 385 ; specialist interventions, such as the use of extracorporeal membrane oxygenation 386 , 387 , 388 , 389 , 390 , 391 , 392 , 393 ; and the lack of prospective validation of submersion duration as a clinical decision rule) persist. Similarly, continued reports of rare survival after prolonged (more than 30 minutes) submersion 387 , 392 , 394 highlight the need for case-by-case decisions that balance risk and potential for benefit.…”

Accidental hypothermia–an update

“…Finally, a small child-sized head will cool faster by conduction than a large adult-sized head [ 48 ]. Case reports repeatedly demonstrate a poor outcome after drowning, even after ECLS for rewarming [ 51 – 55 ] and use of targeted temperature management [ 56 ]. In drowning, there are currently no methods to reliably predict early on who will survive or the likely long-term neurocognitive outcome, so in the absence of obvious indications of death e.g.…”