151
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Canyoning Accidents in Austria from 2005 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010102. [PMID: 31877835 PMCID: PMC6982325 DOI: 10.3390/ijerph17010102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 12/30/2022]
Abstract
Canyoning has become a popular recreational sport. Nevertheless, little is known about injuries or diseases associated with canyoning. The aim of this study was to examine accident causes, injury patterns, out-of-hospital and in-hospital treatment and outcomes. For this purpose, national out-of-hospital data from the Austrian Alpine Safety Board and regional in-hospital data from Innsbruck Medical University Hospital were analysed for the period from November 1, 2005 to October 31, 2018. Nationally, 471 persons were involved in such accidents; 162 (34.4%) were severely injured, nine of whom died. Jumping (n = 110, 23.4%), rappelling (n = 51, 10.8%), sliding (n = 41, 8.7%) and stumbling (n = 26, 5.5%) were the most common causes of canyoning accidents. A large proportion of injuries were documented for the lower extremities (n = 133, 47.5%), followed by the upper extremities (n = 65, 23.2%) and the spine (n = 44, 15.7%). Death was mainly caused by drowning. Overall mortality was 1.9% (n = 9), and the absolute risk was 0.02 deaths per 1000 hrs of canyoning. Many uninjured persons required evacuation (n = 116, 24.6%), which resulted in a substantial expense and workload for emergency medical services. Increased safety precautions are required to reduce accidents while jumping and rappelling and fatalities caused by drowning.
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152
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Pasquier M, Blancher M, Buse S, Boussat B, Debaty G, Kirsch M, de Riedmatten M, Schoettker P, Annecke T, Bouzat P. Intra-patient potassium variability after hypothermic cardiac arrest: a multicentre, prospective study. Scand J Trauma Resusc Emerg Med 2019; 27:113. [PMID: 31842931 PMCID: PMC6916106 DOI: 10.1186/s13049-019-0694-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022] Open
Abstract
Background To 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. Methods Adult 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). Results Of 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. Conclusions We 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 registration ClinicalTrials.gov Identifier: NCT03096561.
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Affiliation(s)
- M Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - M Blancher
- Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, Grenoble, France
| | - S Buse
- Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, Grenoble, France
| | - B Boussat
- Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, Grenoble, France
| | - G Debaty
- Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, Grenoble, France
| | - M Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | | | - P Schoettker
- Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - T Annecke
- Klinik für Anästhesiologie und Operative Intensivmedizin, University Hospital of Cologne, Köln, Germany
| | - P Bouzat
- Department of anesthesiology and critical care, Grenoble Alps Trauma Center, University Hospital of Grenoble, Grenoble, France
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153
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Kuhnke M, Albrecht R, Schefold JC, Paal P. Successful resuscitation from prolonged hypothermic cardiac arrest without extracorporeal life support: a case report. J Med Case Rep 2019; 13:354. [PMID: 31787101 PMCID: PMC6886195 DOI: 10.1186/s13256-019-2282-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background We report a case of successful prolonged cardiopulmonary resuscitation (5 hours and 44 minutes) following severe accidental hypothermia with cardiac arrest treated without rewarming on extracorporeal life support. Case presentation A 52-year-old Italian mountaineer, was trapped in a crevasse and rescued approximately 7 hours later by a professional rescue team. After extrication, he suffered a witnessed cardiac arrest with ventricular fibrillation. Immediate defibrillation and cardiopulmonary resuscitation were started. His core temperature was 26.0 °C. Due to weather conditions, air transport to an extracorporeal life support center was not possible. Thus, he was rewarmed with conventional rewarming methods in a rural hospital. Auto-defibrillation occurred at a core temperature of 29.8 °C after 5 hours and 44 minutes of continued cardiopulmonary resuscitation. With a core temperature of 33.4 °C, he was finally admitted to a level 1 trauma center and extracorporeal life support was no longer required. Seven weeks following the accident, he was discharged home with complete neurological recovery. Conclusions Successful rewarming from severe hypothermia without extracorporeal life support use as performed in this case suggests that patients with primary hypothermic cardiac arrest have a chance of a favorable neurological outcome even after several hours of cardiac arrest when cardiopulmonary resuscitation and conventional rewarming are performed continuously. This may be especially relevant in remote areas, where extracorporeal life support rewarming is not available.
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Affiliation(s)
- Melanie Kuhnke
- Swiss Air Rescue, Swiss Air-Ambulance (Rega), P.O. Box 1414, 8058, Zurich, Switzerland. .,Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Roland Albrecht
- Swiss Air Rescue, Swiss Air-Ambulance (Rega), P.O. Box 1414, 8058, Zurich, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Paal
- Department of Anesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
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154
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Watanabe M, Matsuyama T, Morita S, Ehara N, Miyamae N, Okada Y, Jo T, Sumida Y, Okada N, Nozawa M, Tsuruoka A, Fujimoto Y, Okumura Y, Kitamura T, Ohta B. Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry. Scand J Trauma Resusc Emerg Med 2019; 27:105. [PMID: 31771645 PMCID: PMC6880476 DOI: 10.1186/s13049-019-0684-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Accidental hypothermia (AH) is defined as an involuntary decrease in core body temperature to < 35 °C. The management of AH has been progressing over the last few decades, and numerous techniques for rewarming have been validated. However, little is known about the association between rewarming rate (RR) and mortality in patients with AH. METHOD This was a multicentre chart review study of patients with AH visiting the emergency department of 12 institutions in Japan from April 2011 to March 2016 (Japanese accidental hypothermia network registry, J-Point registry). We retrospectively registered patients using the International Classification of Diseases, Tenth Revision code T68: 'hypothermia'. We excluded patients whose body temperatures were unknown or ≥ 35 °C, who could not be rewarmed, whose rewarmed temperature or rewarming time was unknown, those aged < 18 years, or who or whose family members had refused to join the registry. RR was calculated based on the body temperature on arrival at the hospital, time of arrival at the hospital, the documented temperature during rewarming, and time of the temperature documentation. RR was classified into the following five groups: ≥2.0 °C/h, 1.5-< 2.0 °C/h, 1.0-< 1.5 °C/h, 0.5-< 1.0 °C/h, and < 0.5 °C/h. The primary outcome of this study was in-hospital mortality. The association between RR and in-hospital mortality was evaluated using multivariate logistic regression analysis. RESULT During the study, 572 patients were registered in the J-Point registry, and 481 patients were included in the analysis. The median body temperature on arrival to the hospital was 30.7 °C (interquartile range [IQR], 28.2 °C-32.4 °C), and the median RR was 0.85 °C/h (IQR, 0.53 °C/h-1.31 °C/h). The in-hospital mortality rates were 19.3% (11/57), 11.1% (4/36), 14.4% (15/104), 20.1% (35/175), and 34.9% (38/109) in the ≥2.0 °C/h, 1.5-< 2.0 °C/h, 1.0-< 1.5 °C/h, 0.5-< 1.0 °C/h, and < 0.5 °C/h groups, respectively. Multivariate regression analysis revealed that in-hospital mortality rate increased with each 0.5 °C/h decrease in RR (adjusted odds ratio, 1.49; 95% confidence interval, 1.15-1.94; Ptrend < 0.01). CONCLUSION This study showed that slower RR is independently associated with in-hospital mortality.
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Affiliation(s)
- Makoto Watanabe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Sachiko Morita
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Naoki Ehara
- Department of Emergency, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Nobuyoshi Miyamae
- Department of Emergency Medicine, Rakuwa-kai Otowa Hospital, Kyoto, Japan
| | - Yohei Okada
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Red Cross Hospital, Kyoto, Japan
| | - Takaaki Jo
- Department of Emergency Medicine, Uji-Tokushukai Medical Center, Uji, Japan
| | - Yasuyuki Sumida
- Department of Emergency Medicine, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Centre, Kyoto, Japan
| | - Masahiro Nozawa
- Department of Emergency and Critical Care Medicine, Saiseikai Shiga Hospital, Ritto, Japan
| | - Ayumu Tsuruoka
- Department of Emergency and Critical Care Medicine, Kidney and Cardiovascular Center, Kyoto Min-iren Chuo Hospital, Kyoto, Japan.,Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Yoshihiro Fujimoto
- Department of Emergency, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yoshiki Okumura
- Department of Emergency Medicine, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
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155
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Hypothermia-rewarming: A Double-edged sword? Med Hypotheses 2019; 133:109387. [PMID: 31541781 DOI: 10.1016/j.mehy.2019.109387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 01/05/2023]
Abstract
Hypothermia is a condition in which the body's core temperature drops below 35.0 °C. Hypothermia is the opposite of hyperthermia, which the metabolism and body functions are abnormal. Severe hypothermia is a life-threatening problem that may cause atrial and ventricular dysrhythmias, coagulopathy, cardiac, and central nervous system depression. What is worse, it is fatal when untreated or treated improperly. Accidental deaths due to hypothermia resulting from immersion in cold water, especially involving naval fighters and maritime victims have occurred continually in the past years. Currently, the treatment of hypothermia has become a research focus. Rewarming is the only approach that should be considered for hypothermia treatment. However, the treatment is of low efficiency, and few active rewarming cases have been reported. It is well known that timely reperfusion is the best way to save the lives of patients with ischemia. Similarly, reoxygenation is effective for hypoxia. However, several studies have identified that improper reperfusion of ischemic tissues and reoxygenation of hypoxic tissues give rise to further injury. Analogically, this study attempts to propose the hypothesis that hypothermia-rewarming injury may also exist. When suffered from hypothermia, both the blood circulation and the oxygen supply in the body will be affected in a deficient state, an injury may also appear in the improper rewarming process. In a word, hypothermia-rewarming may be a double-edged sword.
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156
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Higginson R. Causes of hypothermia and the use of patient-rewarming techniques. ACTA ACUST UNITED AC 2019; 27:1222-1224. [PMID: 30457377 DOI: 10.12968/bjon.2018.27.21.1222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ray Higginson
- Senior Lecturer in Critical Care Physiology, University of South Wales
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157
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Murakami T, Yoshida T, Kurokochi A, Takamatsu K, Teranishi Y, Shigeta K, Tamaki S, Morita S, Mizuno R, Oya M. Accidental Hypothermia Treated by Hemodialysis in the Acute Phase: Three Case Reports and a Review of the Literature. Intern Med 2019; 58:2743-2748. [PMID: 31178478 PMCID: PMC6794177 DOI: 10.2169/internalmedicine.1945-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Accidental hypothermia is defined as a core body temperature <35°C. Even with the use of multiple active rewarming methods, it has a high mortality rate. No standard treatment strategy for moderate or severe hypothermia in the absence of cardiac arrest has yet been established. We herein report three patients with severe or moderate accidental hypothermia who were treated by hemodialysis in the acute phase. This case report with a literature review describes the usefulness of hemodialysis for the treatment of moderate and severe accidental hypothermia without cardiac arrest.
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Affiliation(s)
| | - Tadashi Yoshida
- Apheresis and Dialysis Center, Keio University School of Medicine, Japan
| | - Arata Kurokochi
- Department of Internal Medicine, Keio University School of Medicine, Japan
| | | | - Yu Teranishi
- Department of Urology, Keio University School of Medicine, Japan
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Japan
| | - Satoshi Tamaki
- Department of Urology, Keio University School of Medicine, Japan
- Apheresis and Dialysis Center, Keio University School of Medicine, Japan
| | - Shinya Morita
- Department of Urology, Keio University School of Medicine, Japan
- Apheresis and Dialysis Center, Keio University School of Medicine, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Japan
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158
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Ting DK, Brown DJA. Use of extracorporeal life support for active rewarming in a hypothermic, nonarrested patient with multiple trauma. CMAJ 2019; 190:E718-E721. [PMID: 29891476 DOI: 10.1503/cmaj.180117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Daniel K Ting
- Department of Emergency Medicine (Ting), University of British Columbia, Kelowna, BC; Department of Emergency Medicine (Brown), University of British Columbia, Vancouver BC
| | - Douglas J A Brown
- Department of Emergency Medicine (Ting), University of British Columbia, Kelowna, BC; Department of Emergency Medicine (Brown), University of British Columbia, Vancouver BC
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159
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Abstract
L’hypothermie accidentelle est définie comme une baisse non intentionnelle de la température centrale du corps en dessous de 35 °C. La prévention de l’hypothermie est essentielle. La mesure de la température centrale est nécessaire au diagnostic d’hypothermie et permet d’en juger la sévérité. En présence de signes de vie, et en présence d’une hypothermie pure, l’instabilité hémodynamique apparente ne devrait en principe pas faire l’objet d’une prise en charge spécifique. Un risque d’arrêt cardiaque (AC) est présent si la température chute en dessous de 30–32 °C. En raison du risque d’AC, un patient hypotherme devrait bénéficier de l’application d’un monitoring avant toute mobilisation, laquelle devra être prudente. En cas d’AC, seule la mesure de la température oesophagienne est fiable. Si l’hypothermie est suspectée comme étant potentiellement responsable de l’AC du patient, celui-ci doit être transporté sous réanimation cardiopulmonaire vers un hôpital disposant d’une méthode de réchauffement par circulation extracorporelle (CEC). La valeur de la kaliémie ainsi que les autres paramètres à disposition (âge, sexe, valeur de la température corporelle, durée du low flow, présence d’une asphyxie) permettront de décider de l’indication d’une CEC de réchauffement. Le pronostic des patients victimes d’un AC sur hypothermie est potentiellement excellent, y compris sur le plan neurologique.
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160
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Podsiadło P, Darocha T, Kosiński S, Sanak T, Gałązkowski R. Body temperature measurement in ambulance: a challenge of 21-st century? BMC Emerg Med 2019; 19:44. [PMID: 31395033 PMCID: PMC6686239 DOI: 10.1186/s12873-019-0261-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 08/01/2019] [Indexed: 12/04/2022] Open
Abstract
Background Some crucial decisions in treatment of hypothermic patients are closely linked to core body temperature. They concern modification of resuscitation algorithms and choosing the target hospital. Under- as well as over-estimation of a patient’s temperature may limit his chances for survival. Only thermometers designed for core temperature measurement can serve as a guide in such decision making. The aim of the study was to assess whether ambulance teams are equipped properly to measure core temperature. Methods A survey study was conducted in collaboration with the Health Ministry in April 2018. Questionnaires regarding the model, number, and year of production of thermometers were sent to each pre-hospital unit of the National Emergency Medical System in Poland. Results A total of 1523 ground ambulances are equipped with 1582 thermometers. 53.57% are infrared-based ear thermometers, 23.02% are infrared-based surface thermometers, and 20.13% are conventional medical thermometers. Only 3.28% of devices are able to measure core body temperature. Most of analyzed thermometers (91.4%) are not allowed to operate in ambient temperature below 10 °C. Conclusions There are only 3.28% of ground ambulances that are able to follow precisely international guidelines regarding a patient’s core body temperature. A light, reliable thermometer designed to measure core temperature in pre-hospital conditions is needed.
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Affiliation(s)
- Paweł Podsiadło
- Department of Emergency Medicine, Jan Kochanowski University, IX Wieków Kielc, 19, Kielce, Poland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Medyków, 16, Katowice, Poland.
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Michałowskiego 12, Krakow, Poland
| | - Tomasz Sanak
- Department of Disaster Medicine and Emergency Care, Jagiellonian University Medical College, Kopernika 19, Krakow, Poland
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Medical University of Warsaw, Żwirki i Wigury 81a, Warsaw, Poland
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161
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Schanche T, Kondratiev T, Tveita T. Extracorporeal rewarming from experimental hypothermia: Effects of hydroxyethyl starch versus saline priming on fluid balance and blood flow distribution. Exp Physiol 2019; 104:1353-1362. [PMID: 31219201 DOI: 10.1113/ep087786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/18/2019] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Mortality in accidental hypothermia patients rewarmed by extracorporeal circulation remains high. Knowledge concerning optimal fluid additions for extracorporeal rewarming is lacking, with no apparent consensus. Does colloid versus crystalloid priming have different effects on fluid balance and blood flow distribution during extracorporeal rewarming? What is the main finding and its importance? In our rat model of extracorporeal rewarming from hypothermic cardiac arrest, hydroxyethyl starch generates less tissue oedema and increases circulating blood volume and organ blood flow, compared with saline. The composition of fluid additions appears to be important during extracorporeal rewarming from hypothermia. ABSTRACT Rewarming by extracorporeal circulation (ECC) is the recommended treatment for accidental hypothermia patients with cardiac instability. Hypothermia, along with initiation of ECC, introduces major changes in fluid homeostasis and blood flow. Scientific data to recommend best practice use of ECC for rewarming these patients is lacking, and no current guidelines exist concerning the choice of priming fluid for the extracorporeal circuit. The primary aim of this study was to compare the effects of different fluid protocols on fluid balance and blood flow distribution during rewarming from deep hypothermic cardiac arrest. Sixteen anaesthetized rats were cooled to deep hypothermic cardiac arrest and rewarmed by ECC. During cooling, rats were equally randomized into two groups: an extracorporeal circuit primed with saline or primed with hydroxyethyl starch (HES). Calculations of plasma volume (PV), circulating blood volume (CBV), organ blood flow, total tissue water content, global O2 delivery and consumption were made. During and after rewarming, the pump flow rate, mean arterial pressure, PV and CBV were significantly higher in HES-treated compared with saline-treated rats. After rewarming, the HES group had significantly increased global O2 delivery and blood flow to the brain and kidneys compared with the saline group. Rats in the saline group demonstrated a significantly higher total tissue water content in the kidneys, skeletal muscle and lung. Compared with crystalloid priming, the use of an iso-oncotic colloid prime generates less tissue oedema and increases PV, CBV and organ blood flow during ECC rewarming. The composition of fluid additions appears to be an important factor during ECC rewarming from hypothermia.
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Affiliation(s)
- Torstein Schanche
- Anaesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Timofei Kondratiev
- Anaesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Torkjel Tveita
- Anaesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.,Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
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162
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Pasquier M, Carron PN, Rodrigues A, Dami F, Frochaux V, Sartori C, Deslarzes T, Rousson V. An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature. Scand J Trauma Resusc Emerg Med 2019; 27:60. [PMID: 31171019 PMCID: PMC6555718 DOI: 10.1186/s13049-019-0636-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia and guide the management of hypothermic patients. The proposed temperature range for clinical stage 1 is < 35-32 °C, for stage 2 is < 32-28 °C, for stage 3 is < 28-24 °C, and for stage 4 is below 24 °C. Our previous study using 183 case reports from the literature showed that the measured temperature only corresponded to the clinical stage in the Swiss staging model in approximately 50% of cases. This study, however, included few patients with moderate hypothermia. We aimed to expand this database by adding cases of hypothermic patients admitted to hospital to perform a more comprehensive evaluation of the staging model. METHODS We retrospectively included patients aged ≥18 y admitted to hospital between 1.1.1994 and 15.7.2016 with a core temperature below 35 °C. We added the cases identified through our previously published literature review to estimate the percentage of those patients who were correctly classified and compare the theoretical with the observed temperature ranges for each clinical stage. RESULTS We included 305 cases (122 patients from the hospital sampling and the 183 previously published). Using the theoretically derived temperature ranges for clinical stages resulted in 185/305 (61%) patients being assigned to the correct temperature range. Temperature was overestimated using the clinical stage in 55/305 cases (18%) and underestimated in 65/305 cases (21%); important overlaps in temperature existed among the four stage groups. The optimal temperature thresholds for discriminating between the four stages (32.1 °C, 27.5 °C, and 24.1 °C) were close to those proposed historically (32 °C, 28 °C, and 24 °C). CONCLUSIONS Our results provide further evidence of the relationship between the clinical state of patients and their temperature. The historical proposed temperature thresholds were almost optimal for discriminating between the different stages. Adding overlapping temperature ranges for each clinical stage might help clinicians to make appropriate decisions when using clinical signs to infer temperature. An update of the Swiss staging model for hypothermia including our methodology and findings could positively impact clinical care and future research.
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Affiliation(s)
- M Pasquier
- Emergency Department, Lausanne University Hospital, and University of Lausanne, BH 09, CHUV, 1011, Lausanne, Switzerland.
| | - P N Carron
- Emergency Department, Lausanne University Hospital, and University of Lausanne, BH 09, CHUV, 1011, Lausanne, Switzerland
| | - A Rodrigues
- Medical School of the University of Lausanne, Bugnon 21, 1011, Lausanne, Switzerland
| | - F Dami
- Emergency Department, Lausanne University Hospital, and University of Lausanne, BH 09, CHUV, 1011, Lausanne, Switzerland
| | - V Frochaux
- Emergency Service, Hôpital du Valais, 1951, Sion, Switzerland
| | - C Sartori
- Department of Internal Medicine, Lausanne University Hospital, BH 10, CHUV, 1011, Lausanne, Switzerland
| | - T Deslarzes
- Emergency Service, Hôpital du Valais, 1951, Sion, Switzerland
| | - V Rousson
- Institute of Social and Preventive Medicine, Lausanne University Hospital, route de la Corniche 10, 1010, Lausanne, Switzerland
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163
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Okada Y, Matsuyama T, Morita S, Ehara N, Miyamae N, Jo T, Sumida Y, Okada N, Watanabe M, Nozawa M, Tsuruoka A, Fujimoto Y, Okumura Y, Kitamura T, Yamamoto S, Iiduka R, Koike K. The development and validation of a "5A" severity scale for predicting in-hospital mortality after accidental hypothermia from J-point registry data. J Intensive Care 2019; 7:27. [PMID: 31073406 PMCID: PMC6499959 DOI: 10.1186/s40560-019-0384-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/23/2019] [Indexed: 12/23/2022] Open
Abstract
Background Accidental hypothermia is a serious condition that requires immediate and accurate assessment to determine severity and treatment. Currently, accidental hypothermia is evaluated using the Swiss grading system which uses core body temperature and clinical findings; however, research has shown that core body temperature is not associated with in-hospital mortality in urban settings. Therefore, we developed and validated a severity scale for predicting in-hospital mortality among urban Japanese patients with accidental hypothermia. Methods Data for this multi-center retrospective cohort study were obtained from the J-point registry. We included patients with accidental hypothermia who were admitted to an emergency department. The total cohort was divided into a development cohort and validation cohort, based on the location of each institution. We developed a logistic regression model for predicting in-hospital mortality using the development cohort and assessed its internal validity using bootstrapping. The model was then subjected to external validation using the validation cohorts. Results Among the 572 patients in the J-point registry, 532 were ultimately included and divided into the development cohort (N = 288, six hospitals, in-hospital mortality 22.0%) and the validation cohort (N = 244, six hospitals, in-hospital mortality 27.0%). The 5 “A” scoring system based on age, activities-of-daily-living status, near arrest, acidemia, and serum albumin level was developed based on the variables’ coefficients in the development cohort. In the validation cohort, the prediction performance was validated. Conclusion Our “5A” severity scoring system could accurately predict the risk of in-hospital mortality among patients with accidental hypothermia. Electronic supplementary material The online version of this article (10.1186/s40560-019-0384-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yohei Okada
- 1Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, 606-8501, Yoshidakonoe-cho, Sakyo, Kyoto, Japan.,2Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, Kyoto, Japan
| | - Tasuku Matsuyama
- 3Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Morita
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Naoki Ehara
- Department of Emergency, Japanese Red Cross Society, Kyoto Daiichi Red Cross Hospital, Kyoto, Japan
| | - Nobuhiro Miyamae
- 6Department of Emergency Medicine, Rakuwa-kai Otowa Hospital, Kyoto, Japan
| | - Takaaki Jo
- Department of Emergency Medicine, Uji-Tokushukai Medical Center, Uji, Japan
| | - Yasuyuki Sumida
- 8Department of Emergency Medicine, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobunaga Okada
- 3Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,9Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Makoto Watanabe
- 3Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Nozawa
- 10Department of Emergency and Critical Care Medicine, Saiseikai Shiga Hospital, Ritto, Japan
| | - Ayumu Tsuruoka
- Department of Emergency and Critical Care Medicine, Kyoto Min-Iren Chuo Hospital, Kyoto, Japan
| | - Yoshihiro Fujimoto
- 12Department of Emergency Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Yoshiki Okumura
- Department of Emergency Medicine, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Tetsuhisa Kitamura
- 14Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shungo Yamamoto
- 15Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryoji Iiduka
- 2Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, Kyoto, Japan
| | - Kaoru Koike
- 1Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, 606-8501, Yoshidakonoe-cho, Sakyo, Kyoto, Japan
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Xu H, Xu G, Ren C, Liu L, Wei L. Effect of forced-air warming system in prevention of postoperative hypothermia in elderly patients: A Prospective controlled trial. Medicine (Baltimore) 2019; 98:e15895. [PMID: 31145350 PMCID: PMC6708676 DOI: 10.1097/md.0000000000015895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postoperative hypothermia in elderly patients is a well-known serious complication as it impairs wound healing, induces coagulopathy, increases the risk of blood loss, enhances oxygen consumption, and precipitates cardiac arrhythmias. We conducted this randomized controlled trial to evaluate the effect of a forced-air warming system on rewarming elderly patients undergoing total knee or hip arthroplasty. METHODS We recruited 243 elderly patients undergoing total knee or hip arthroplasty between May and December 2016. They were divided into three groups according to a computer-generated randomization table: group C (n = 78, rewarmed with only a regular blanket), group F1 (n = 82, rewarmed with a forced-air warming system set at 38°C), and group F2 (n = 83, rewarmed with a forced-air warming system set at 42°C). The nasopharyngeal temperature was recorded every 5 min for the first half hour, then every 10 min up to the end of the PACU (postanesthesia care unit) stay. The primary outcome was the rewarming time. The rewarming rate, increase in nasopharyngeal temperature (compared to the start of rewarming), hemodynamics, recovery time, and incidences of adverse effects were recorded. RESULTS No significant differences were found among the three groups in terms of the baseline clinical characteristics, use of narcotic drugs, intraoperative temperature, and hemodynamics (P > .05). Compared with the elderly patients in groups C and F1, both the heart rate and mean arterial pressure of those in group F2 were significantly increased 20 min after arrival at the PACU (P < .05). Patients in group F2 had the shortest rewarming time (35.89 ± 6.45 min, P < .001), highest rewarming efficiency (0.028 ± 0.001°C/min, P < .001), and fastest increased nasopharyngeal temperature among the three groups. Moreover, the elderly patients in group F2 had lower incidences of arrhythmia and shivering (P < .05). CONCLUSIONS The use of a forced-air warming system set at 42°C was shown to be the most effective way of rewarming elderly patients with postoperative hypothermia.
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Balik M, Porizka M, Matousek V, Brestovansky P, Svobodova E, Flaksa M, Rulisek J, Mlejnsky F, Hodkova G, Grus T, Vobruba V, Belohlavek J. Management of accidental hypothermia: an established extracorporeal membrane oxygenation centre experience. Perfusion 2019; 34:74-81. [DOI: 10.1177/0267659119830551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Data on management of severe accidental hypothermia published from an established high-volume extracorporeal membrane oxygenation centre are scarce. Methods: A total of 28 patients with intravesical temperature lower than 28°C on admission were either treated with veno-arterial extracorporeal membrane oxygenation or rewarmed conservatively. Results: A total of 10 patients rewarmed on veno-arterial extracorporeal membrane oxygenation (age: 37 ± 12.6 years) and 18 conservatively (age: 55.2 ± 11.2 years) were collected over a course of 5 years. The dominant cause was alcohol intoxication with exposure to cold (39%), 12 patients were resuscitated prior to admission. The admission temperature in the extracorporeal membrane oxygenation group (23.8 ± 2.6°C) was lower than in the non–extracorporeal membrane oxygenation group (26.0 ± 1.5°C, p = 0.01). The peripheral percutaneous veno-arterial extracorporeal membrane oxygenation was always cannulated in malignant arrhythmias causing refractory cardiac arrest. The typical extracorporeal membrane oxygenation blood flow was 3-4 L/minute and sweep gas flow 2 L/minute, the median extracorporeal membrane oxygenation duration was 48.3 (28.1-86.7) hours. The median rates of rewarming did not differ (0.41 (0.35-0.7)°C/hour in extracorporeal membrane oxygenation and 0.77 (0.54-0.98)°C/hour in non–extracorporeal membrane oxygenation, p = 0.46) as well as the admission arterial lactate, pH and potassium. Their development was not different between the groups except for higher pH between the third and ninth hour of rewarming in the extracorporeal membrane oxygenation group. The hospital mortality was 10% in the extracorporeal membrane oxygenation group and 11.1% in the non–extracorporeal membrane oxygenation group with the median last Glasgow Coma Scale 15 and Cerebral Performance Score 1. Conclusion: Veno-arterial extracorporeal membrane oxygenation for severe hypothermia shows promising outcome data collected in an extracorporeal membrane oxygenation/extracorporeal cardiopulmonary resuscitation centre located in a European urban area. Except for presence of refractory cardiac arrest, the established hypothermia-related prognostic indicators did not differ between patients in need for extracorporeal membrane oxygenation and those rewarmed without extracorporeal membrane oxygenation.
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Affiliation(s)
- Martin Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michal Porizka
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Vojtech Matousek
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Brestovansky
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Svobodova
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Marek Flaksa
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Rulisek
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Frantisek Mlejnsky
- Perfusion Unit, Department of Cardiovascular Surgery, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Gabriela Hodkova
- Perfusion Unit, Department of Cardiovascular Surgery, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Grus
- Department of Cardiovascular Surgery, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Vaclav Vobruba
- Department of Pediatrics, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Internal Medicine – Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Lawthaweesawat C, Harris R, Isara W, Pongpirul K. Prehospital Care of the 13 Hypothermic, Anesthetized Patients in the Thailand Cave Rescue. N Engl J Med 2019; 380:1372-1373. [PMID: 30943344 DOI: 10.1056/nejmc1900831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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167
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Frei C, Darocha T, Debaty G, Dami F, Blancher M, Carron P, Oddo M, Pasquier M. Clinical characteristics and outcomes of witnessed hypothermic cardiac arrest: A systematic review on rescue collapse. Resuscitation 2019; 137:41-48. [DOI: 10.1016/j.resuscitation.2019.02.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 11/27/2022]
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Pasquier M, Rousson V, Darocha T, Bouzat P, Kosiński S, Sawamoto K, Champigneulle B, Wiberg S, Wanscher MCJ, Brodmann Maeder M, Paal P, Hugli O. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: An external validation of the HOPE score. Resuscitation 2019; 139:321-328. [PMID: 30940473 DOI: 10.1016/j.resuscitation.2019.03.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
AIMS The HOPE score, based on covariates available at hospital admission, predicts the probability of in-hospital survival after extracorporeal life support (ECLS) rewarming of a given hypothermic cardiac arrest patient with accidental hypothermia. Our goal was to externally validate the HOPE score. METHODS We included consecutive hypothermic arrested patients who underwent rewarming with ECLS. The sample comprised 122 patients. The six independent predictors of survival included in the HOPE score were collected for each patient: age, sex, mechanism of hypothermia, core temperature at admission, serum potassium level at admission and duration of CPR. The primary outcome parameter was survival to hospital discharge. RESULTS Overall, 51 of the 122 included patients survived, resulting in an empirical (global) probability of survival of 42% (95% CI = [33-51%]). This was close to the average HOPE survival probability of 38% calculated for patients from the validation cohort, while the Hosmer-Lemeshow test comparing empirical and HOPE (i.e. estimated) probabilities of survival was not significant (p = 0.08), suggesting good calibration. The corresponding area under the receiver operating characteristic curve was 0.825 (95% CI = [0.753-0.897]), confirming the excellent discrimination of the model. The negative predictive value of a HOPE score cut-off of <0.10 was excellent (97%). CONCLUSIONS This study provides the first external validation of the HOPE score reaching good calibration and excellent discrimination. Clinically, the prediction of the HOPE score remains accurate in the validation sample. The HOPE score may replace serum potassium in the future as the triage tool when considering ECLS rewarming of a hypothermic cardiac arrest victim.
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Affiliation(s)
- Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - Valentin Rousson
- Institute of Social and Preventive Medicine, Lausanne University Hospital, route de la Corniche 10, 1010 Lausanne, Switzerland.
| | - Tomasz Darocha
- Severe Accidental Hypothermia Center, Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Poniatowskiego 15, 055 Katowice, Poland.
| | - Pierre Bouzat
- Department of anesthesiology and critical care, Grenoble Alps Trauma Center, University Hospital of Grenoble, French Mountain Rescue Association ANMSM, International Commission for Mountain Emergency Medicine ICAR MEDCOM, 38043 Grenoble Cedex 09, France.
| | - Sylweriusz Kosiński
- Severe Accidental Hypothermia Center, Cracow, Faculty of Health Sciences, Jagiellonian University, Cracow, Poland.
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuoku Sapporo, 060-8543 Hokkaido, Japan.
| | - Benoit Champigneulle
- Surgical Intensive Care Unit, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Sebastian Wiberg
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
| | - Michael C Jaeger Wanscher
- Dept. of Cardiothoracic Anaesthesia, 4142 The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Peter Paal
- Department of Anesthesiology and Intensive Care Medicine, Hospitaller Brothers Hospital, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
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Mair P, Gasteiger L, Mair B, Stroehle M, Walpoth B. Successful Defibrillation of Four Hypothermic Patients with Witnessed Cardiac Arrest. High Alt Med Biol 2019; 20:71-77. [DOI: 10.1089/ham.2018.0084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter Mair
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Gasteiger
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Mair
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Mathias Stroehle
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Beat Walpoth
- Emeritus, Department of Cardiovascular Surgery, Geneva University, Geneva, Switzerland
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Kakizaki R, Bunya N, Uemura S, Odagiri A, Kasai T, Narimatsu E. Takotsubo cardiomyopathy developed during rewarming of accidental hypothermia with extracorporeal membrane oxygenation. Acute Med Surg 2019; 6:201-205. [PMID: 30976450 PMCID: PMC6442525 DOI: 10.1002/ams2.399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/30/2019] [Indexed: 11/09/2022] Open
Abstract
Background We here present the first case report of takotsubo cardiomyopathy that developed during rewarming of a patient with severe accidental hypothermia with extracorporeal membrane oxygenation. Case A 74-year-old woman was found unresponsive outdoors and suffered cardiopulmonary arrest during transfer to our hospital. On arrival, she was still in cardiopulmonary arrest. Veno-arterial extracorporeal membrane oxygenation was initiated for resuscitation and rewarming. After admission to the intensive care unit, her blood pressure suddenly dropped, and coronary angiography on day 2 indicated intact coronary arteries. Left ventriculography showed typical takotsubo-like dysfunction in the end-systolic phase, which led to the diagnosis of takotsubo cardiomyopathy. Left ventricular wall motion gradually improved, and echocardiography on day 6 revealed that abnormalities in the left ventricular wall motion had almost disappeared. Conclusion Takotsubo cardiomyopathy might arise during rewarming of patients with severe accidental hypothermia.
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Affiliation(s)
- Ryuichiro Kakizaki
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Naofumi Bunya
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Shuji Uemura
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Arisa Odagiri
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
| | - Takehiko Kasai
- Emergency and Critical Care Center Hakodate Municipal Hospital Hokkaido Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine Sapporo Medical University Hokkaido Japan
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171
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Jang MS, Oh SK, Lee SW, Jeong SH, Kim H. Moderate brain hypothermia started before resuscitation improves survival and neurobehavioral outcomes after CA/CPR in mice. Am J Emerg Med 2019; 37:1942-1948. [PMID: 30679007 DOI: 10.1016/j.ajem.2019.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/04/2018] [Accepted: 01/16/2019] [Indexed: 11/30/2022] Open
Abstract
AIM OF THE STUDY No definitive experimental or clinical evidence exists whether brain hypothermia before, rather than during or after, resuscitation can reduce hypoxic-ischemic brain injury following cardiac arrest/cardiopulmonary resuscitation (CA/CPR) and improve outcomes. We examined the effects of moderate brain hypothermia before resuscitation on survival and histopathological and neurobehavioral outcomes in a mouse model. METHODS Adult C57BL/6 male mice (age: 8-12 weeks) were subjected to 8-min CA followed by CPR. The animals were randomly divided into sham, normothermia (NT; brain temperature 37.5 °C), and extracranial hypothermia (HT; brain temperature 28-32 °C) groups. The hippocampal CA1 was assessed 7 day after resuscitation by histochemical staining. Neurobehavioral outcomes were evaluated by the Barnes maze (BMT), openfield (OFT), rotarod, and light/dark (LDT) tests. Cleaved caspase-3 and heat shock protein 60 (HSP70) levels were investigated by western blotting. RESULTS The HT group exhibited higher survival and lower CA1 neuronal injury than did the NT group. HT mice showed improved spatial memory in the BMT compared with NT mice. NT mice travelled a shorter distance in the OFT and tended to spend more time in the light compartment in the LDT than did sham and HT mice. The levels of cleaved caspase-3 and HSP70 were non-significantly higher in the NT than in the sham and HT groups. CONCLUSIONS Moderate brain hypothermia before resuscitation improved survival and reduced histological neuronal injury, spatial memory impairment, and anxiety-like behaviours after CA/CPR in mice.
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Affiliation(s)
- Mun-Sun Jang
- Department of Emergency Medical Technology, Chungbuk Health & Science University, 10, Deogam-gil, Naesu-eup, Cheongwon-gu, Cheongju, Republic of Korea; Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea
| | - Se Kwang Oh
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Suk Woo Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea; Department of emergency medicine, College of Medicine, Chungbuk National University, 1, Chungdae-ro, Seowon-gu, Cheongju, Republic of Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Hoon Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea; Department of emergency medicine, College of Medicine, Chungbuk National University, 1, Chungdae-ro, Seowon-gu, Cheongju, Republic of Korea.
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Mazur P, Kosiński S, Podsiadło P, Jarosz A, Przybylski R, Litiwnowicz R, Piątek J, Konstanty-Kalandyk J, Gałązkowski R, Darocha T. Extracorporeal membrane oxygenation for accidental deep hypothermia-current challenges and future perspectives. Ann Cardiothorac Surg 2019; 8:137-142. [PMID: 30854323 DOI: 10.21037/acs.2018.10.12] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The incidence of accidental hypothermia (core temperature ≤35 °C) is difficult to estimate, as the affected population is heterogeneous. Both temperature and clinical presentation should be considered while determining severity, which is difficult in a prehospital setting. Extracorporeal rewarming is advocated for all Swiss Staging System class IV (hypothermic cardiac arrest) and class III (hypothermic cardiac instability) patients. Veno-arterial extracorporeal membrane oxygenation (ECMO) is the method of choice, as it not only allows a gradual, controlled increase of core body temperature, but also provides respiratory and hemodynamic support during the unstable period of rewarming and reperfusion. This poses difficulties with the coordination of patient management, as usually only cardiac referral centers can deliver such advanced treatment. Further special considerations apply to subgroups of patients, including drowning or avalanche victims. The principle of ECMO implantation in severely hypothermic patients is no different from any other indication, although establishing vascular access in a timely manner during ongoing resuscitation and maintaining adequate flow may require modification of the operating technique, as well as aggressive fluid resuscitation. Further studies are needed in order to determine the optimal rewarming rate and flow that would favor brain and lung protection. Recent analysis shows an overall survival rate of 40.3%, while additional prognostic factors are being sought for determining those patients in whom the treatment is futile. New cannulas, along with ready-to-use ECMO sets, are being developed that would enable easy, safe and efficient out-reach ECMO implantation, thus shortening resuscitation times. Moreover, national guidelines for the management of accidental hypothermia are needed in order that all patients that would benefit from extracorporeal rewarming would be provided with such treatment. In this perspective article, we discuss burning problems in ECMO therapy in hypothermic patients, outlining the important research goals to improve the outcomes.
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Affiliation(s)
- Piotr Mazur
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Podsiadło
- Emergency Medicine Department, Jan Kochanowski University, Kielce, Poland
| | - Anna Jarosz
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland
| | - Roman Przybylski
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland
| | - Radosław Litiwnowicz
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland
| | - Jacek Piątek
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland
| | - Janusz Konstanty-Kalandyk
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Silesia, Katowice, Poland
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Procter E, Brugger H, Burtscher M. Accidental hypothermia in recreational activities in the mountains: A narrative review. Scand J Med Sci Sports 2018; 28:2464-2472. [PMID: 30203539 DOI: 10.1111/sms.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 01/16/2023]
Abstract
The popularity of recreational activities in the mountains worldwide has led to an increase in the total number of persons exposed to cold and extreme environments through recreation. There is little conclusive evidence about the risk of hypothermia for specific activities or populations, nor is it clear which activities are represented in the literature. This is a non-systematic review of accidental hypothermia in different recreational activities in the mountains, with a specific focus on outdoor or winter activities that potentially involve cold exposure. Cases of hypothermia have been reported in the literature in mountaineering, trekking, hiking, skiing, activities performed in the backcountry, ultra-endurance events, and databases from search and rescue services that include various types of recreation. Of these activities, hypothermia as a primary illness occurs most commonly during mountaineering in the highest elevation areas in the world and during recreation practiced in more northern or remote areas. Hypothermia in skiers, snowboarders, and glacier-based activities is most often associated with accidents occurring off-piste or in the backcountry (crevasse, avalanche). Organizers of outdoor events also have a role in reducing the incidence of hypothermia through medical screening and other preparedness measures. More complete collection and reporting of data on mild hypothermia and temperature measurement would improve our understanding of the incidence of hypothermia in outdoor recreation in future.
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Affiliation(s)
- Emily Procter
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen/Bolzano, Italy
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine and Mountain Medicine, Innsbruck, Austria
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Bunya N, Sawamoto K, Kakizaki R, Wada K, Katayama Y, Mizuno H, Inoue H, Uemura S, Harada K, Narimatsu E. Successful resuscitation for cardiac arrest due to severe accidental hypothermia accompanied by mandibular rigidity: a case of cold stiffening mimicking rigor mortis. Int J Emerg Med 2018; 11:46. [PMID: 31179929 PMCID: PMC6326142 DOI: 10.1186/s12245-018-0205-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/11/2018] [Indexed: 11/24/2022] Open
Abstract
Background In cases of severe accidental hypothermia, it was recommended that resuscitation should be continued until the patient has rewarmed, as hypothermia itself can preserve cerebral function, and hypothermic cardiac arrest is reversible. During cardiopulmonary resuscitation for normothermic patients, muscle rigidity suggests the initiation of postmortem changes such as rigor mortis and can lead to the termination of resuscitation. Currently, the prognosis of cardiac arrest due to severe accidental hypothermia accompanied by rigidity is unknown. Case presentation A 29-year-old woman was found unresponsive near a snowy mountain trail. Upon discovery, she was found to be in cardiac arrest with an initial asystole rhythm and exhibited mandibular rigidity. On admission, her core temperature was 22 °C. Although cardiac arrest continued, and she showed no response to normal resuscitation, blood gas analysis revealed that her initial serum potassium level was 5.4 mmol/L. Extracorporeal membrane oxygenation (ECMO) for systemic perfusion and rewarming was initiated. After ECMO was introduced, return of spontaneous circulation was achieved. She showed no neurological impairments at discharge. Conclusions Muscle rigidity does not rule out the possibility of resuscitation in patients with severe accidental hypothermia under cardiac arrest. Serum potassium levels may assist in deciding whether ECMO should be introduced, even if a patient is in asystole. This knowledge may help emergency physicians to save the lives of such patients.
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Affiliation(s)
- Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Kenshiro Wada
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yoichi Katayama
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hirotoshi Mizuno
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hiroyuki Inoue
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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176
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Pasquier M, de Riedmatten M, Paal P. The Reply. Am J Med 2018; 131:e481-e482. [PMID: 30392644 DOI: 10.1016/j.amjmed.2018.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Mathieu Pasquier
- Emergency Department, Lausanne University Hospital Lausanne, Switzerland.
| | | | - Peter Paal
- Department of Anesthesiology and Intensive Care MedicineHospitaller Brothers HospitalParacelsus Medical UniversitySalzburg, Austria
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177
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Misleading symptoms and successful noninvasive rewarming of a patient with severe hypothermia (23.1 °C). Anaesthesist 2018; 67:931-935. [DOI: 10.1007/s00101-018-0508-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
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178
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Knapp J, Pietsch U, Kreuzer O, Hossfeld B, Bernhard M, Lier H. Prehospital Blood Product Transfusion in Mountain Rescue Operations. Air Med J 2018; 37:392-399. [PMID: 30424860 DOI: 10.1016/j.amj.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/08/2018] [Accepted: 08/24/2018] [Indexed: 12/13/2022]
Abstract
Severely injured patients with hemorrhage present major challenges for emergency medical services, especially during mountain rescue missions in which harsh environmental conditions and long out-of-hospital times are frequent. Because uncontrolled hemorrhage is the leading cause of death within the first 48 hours after severe trauma, initiating damage control resuscitation (DCR) as early as possible after severe trauma and exporting the concept of DCR to the out-of-hospital arena is pivotal for patient survival. Appropriate bleeding control, management of coagulopathy, and transfusion of blood products are core aspects of DCR. This review summarizes the available evidence on out-of-hospital blood product transfusion and the management of coagulopathy with a special focus on mountain rescue missions. An overview of upcoming trials and possible future trends in the management of coagulopathy during rescue operations is provided.
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Affiliation(s)
- Jürgen Knapp
- Department of Anaesthesiology and Pain Therapy, University Hospital of Bern, Bern, Switzerland; Air Zermatt, Emergency Medical Service, Zermatt, Switzerland.
| | - Urs Pietsch
- Air Zermatt, Emergency Medical Service, Zermatt, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Oliver Kreuzer
- Air Zermatt, Emergency Medical Service, Zermatt, Switzerland
| | - Björn Hossfeld
- Department of Anaesthesiology and Intensive Care Medicine, Armed Forces Hospital Ulm, Ulm, Germany; Task Force "Tactical Medicine" of the Scientific Working Group Emergency Medicine of the German Society of Anaesthesiology and Intensive Care Medicine, Nürnberg, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital of Düsseldorf, Düsseldorf, Germany; Task Force "Trauma and Resuscitation Room Management" of the Scientific Working Group Emergency Medicine of the German Society of Anaesthesiology and Intensive Care Medicine, Nürnberg, Germany
| | - Heiko Lier
- Task Force "Tactical Medicine" of the Scientific Working Group Emergency Medicine of the German Society of Anaesthesiology and Intensive Care Medicine, Nürnberg, Germany; Department of Anaesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Köln, Germany
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179
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Kosiński S, Darocha T, Czerw A, Paal P, Pasquier M, Krawczyk P, Drwiła R, Gałązkowski R. Cost-utility of extracorporeal membrane oxygenation rewarming in accidentally hypothermic patients-A single-centre retrospective study. Acta Anaesthesiol Scand 2018; 62:1105-1111. [PMID: 29687446 DOI: 10.1111/aas.13137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/22/2018] [Accepted: 04/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has become the treatment of choice for severely hypothermic patients in cardiac arrest or acute cardiac failure. Highly specialized ECMO centres have been established, however, no centre has ever reported the costs of extracorporeal rewarming. The aim of this study was to assess the costs of the treatment of patients in Swiss Stage III and IV rewarmed with veno-arterial ECMO. METHODS A retrospective exploratory cohort study analysed twenty-nine consecutive patients treated for hypothermia in the Severe Accidental Hypothermia Centre in Cracow, Poland. The main outcome parameters were the overall and specific costs of the ICU treatment of patients rewarmed with veno-arterial ECMO. The secondary outcome parameter was cost utility, determined by the costs involved for every year of life gained. Costs were processed using the bottom-up method and classified into six categories. Survivors were followed up after 1 year. RESULTS The mean cost of VA-ECMO was $5133 USD, which equalled 35% of all ICU expenditures ($14 668 USD). One year after discharge, 13 of 29 patients were still alive (45%). The overall gain of life of the thirteen 1-year survivors was 28 years, while the mean cost related to treatment with VA-ECMO for each year of life gained was 1138 USD. CONCLUSIONS In this study, the costs of VA-ECMO rewarming and intensive care treatment per patient were substantially lower than in other studies reporting ECMO and intensive care treatment of other causes.
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Affiliation(s)
- S Kosiński
- Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Hospital, Zakopane, Poland
| | - T Darocha
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Silesia, Katowice, Poland
| | - A Czerw
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
- National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - P Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitaller Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
- Barts Heart Centre, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - M Pasquier
- Emergency Service, University Hospital Centre, Lausanne, Switzerland
| | - P Krawczyk
- Department of Anaesthesiology and Intensive Care, John Paul II Hospital, Medical College of Jagiellonian University, Krakow, Poland
| | - R Drwiła
- Department of Anaesthesiology and Intensive Care, John Paul II Hospital, Medical College of Jagiellonian University, Krakow, Poland
| | - R Gałązkowski
- Department of Emergency Medical Services, Medical University of Warsaw, Warsaw, Poland
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180
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Pourrezaei S, Dinmohammadi M, Jafari rouhi A. The Effect of Thermal Care Workshop on EMS Staff Readiness in managing Accidental Hypothermia in Trauma Patients. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2018. [DOI: 10.29252/pcnm.8.2.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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181
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182
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Paal P, Rauch S. Indoor accidental hypothermia in the elderly: an emerging lethal entity in the 21st century. Emerg Med J 2018; 35:667-668. [PMID: 30158146 DOI: 10.1136/emermed-2018-207804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, EURAC research, Bolzano, Italy.,Department of Anaesthesiology, University Hospital LMU, Munich, Germany.,Department of Sports Science, Medical Section, University of Innsbruck, Innsbruck, Austria
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183
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Morita S, Matsuyama T, Ehara N, Miyamae N, Okada Y, Jo T, Sumida Y, Okada N, Watanabe M, Nozawa M, Tsuruoka A, Fujimoto Y, Okumura Y, Kitamura T, Hayashi Y. Prevalence and outcomes of accidental hypothermia among elderly patients in Japan: Data from the J-Point registry. Geriatr Gerontol Int 2018; 18:1427-1432. [PMID: 30094918 DOI: 10.1111/ggi.13502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/11/2018] [Accepted: 07/02/2018] [Indexed: 12/01/2022]
Abstract
AIM We aimed to evaluate the prevalence and outcomes of accidental hypothermia (AH) among elderly patients in Japan. METHODS This was a multicenter chart review study of patients with AH (Japanese accidental hypothermia network registry; J-Point registry) that included patients with a body temperature ≤35 °C and those aged ≥18 years who visited the emergency department of 12 institutions in Japan from 1 April 2011 to 31 March 2016. The patients were classified into three groups: adult (aged 18-64 years), young-old (aged 65-79 years) and old-old (aged ≥80 years). The association between each age category and in-hospital mortality from AH was examined through a multivariable logistic regression analysis. RESULTS In total, 572 patients were registered in the J-Point registry database, of which 537 were included. The proportion of individuals who developed AH in an indoor setting was higher in the old-old group than in the adult group (86.9% [226/260] vs 61.1% [87/113]). The in-hospital mortality rates of the adult, young-old and old-old groups were 15.0% (17/113), 21.3% (35/164) and 30.4% (79/260), respectively. In the multivariable analysis, the in-hospital mortality rate was higher in the young-old and old-old groups than in the adult group (young-old vs adult, adjusted odds ratio: 2.31 and 95% confidence interval 1.16-4.64; old-old vs adult, adjusted odds ratio: 2.91 and 95% confidence interval 1.41-6.02). CONCLUSIONS Approximately 80% of patients with AH were aged ≥65 years. The in-hospital mortality rate of patients aged ≥65 years was significantly higher than that of those aged <65 years. Geriatr Gerontol Int 2018; 18: 1427-1432.
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Affiliation(s)
- Sachiko Morita
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoki Ehara
- Department of Emergency, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Nobuhiro Miyamae
- Department of Emergency Medicine, Rakuwa-kai Otowa Hospital, Kyoto, Japan
| | - Yohei Okada
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Red Cross Hospital, Kyoto, Japan
| | - Takaaki Jo
- Department of Emergency Medicine, Uji-Tokushukai Medical Center, Uji, Japan
| | - Yasuyuki Sumida
- Department of Emergency Medicine, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Makoto Watanabe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Nozawa
- Department of Emergency and Critical Care Medicine, Saiseikai Shiga 23 Hospital, Ritto, Japan
| | - Ayumu Tsuruoka
- Department of Emergency and Critical Care Medicine, Kidney and Cardiovascular Center, Kyoto Min-iren Chuo Hospital, Kyoto, Japan.,Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Yoshihiro Fujimoto
- Department of Emergency Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Yoshiki Okumura
- Department of Emergency Medicine, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yasuyuki Hayashi
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
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184
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Darocha T, Kosinski S, Podsiadlo P, Jarosz A, Drwila R. EMS, HEMS, ECMO Center, ICU Team: Are You Ready for Hypothermic Patients?: Extracorporeal Membrane Oxygenation in Severe Accidental Hypothermia. JACC-HEART FAILURE 2018; 4:829-830. [PMID: 27686929 DOI: 10.1016/j.jchf.2016.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 10/20/2022]
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185
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Podsiadło P, Kosiński S, Darocha T, Derkowski T, Krajewski A, Gałązkowski R. Severe Post-Traumatic Hypothermia in a Burned Patient. J Emerg Nurs 2018; 45:82-84. [PMID: 30078615 DOI: 10.1016/j.jen.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/29/2018] [Accepted: 06/14/2018] [Indexed: 11/19/2022]
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186
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Tan JL, Saks M, DelCollo JM, Paryavi M, Visvanathan S, Geller C. Accidental hypothermia cardiac arrest treated successfully with invasive body cavity lavage. QJM 2018; 111:563-564. [PMID: 29660066 DOI: 10.1093/qjmed/hcy075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 03/30/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- J L Tan
- Department of Internal Medicine, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA, USA
| | - M Saks
- Department of Emergency Medicine, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA, USA
| | - J M DelCollo
- Department of Emergency Medicine, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA, USA
| | - M Paryavi
- Department of Emergency Medicine, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA, USA
| | - S Visvanathan
- Department of Internal Medicine, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA, USA
| | - C Geller
- Department of Cardiothoracic Surgery, Crozer-Chester Medical Center, 1 Medical Center Boulevard, Upland, PA, USA
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187
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Gordon L, Paal P. Normothermic and hypothermic cardiac arrest—Beware of Jekyll and Hyde. Resuscitation 2018; 129:e10-e11. [DOI: 10.1016/j.resuscitation.2018.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
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188
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Gordon L, Paal P. Managing accidental hypothermia: progress but still some way to go. Emerg Med J 2018; 35:657-658. [PMID: 29982194 DOI: 10.1136/emermed-2018-207898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Les Gordon
- Department of Anaesthesia, University Hospital Morecambe Bay Trust, Lancaster, UK.,Langdale Ambleside Mountain Rescue Team, Ambleside, UK
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Barmherzige Bruder Salzburg, Teaching Hospital, Paracelsus Medical University, Salzburg, Austria
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189
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Matsuyama T, Morita S, Ehara N, Miyamae N, Okada Y, Jo T, Sumida Y, Okada N, Watanabe M, Nozawa M, Tsuruoka A, Fujimoto Y, Okumura Y, Kitamura T, Ohta B. Characteristics and outcomes of accidental hypothermia in Japan: the J-Point registry. Emerg Med J 2018; 35:659-666. [PMID: 29886414 DOI: 10.1136/emermed-2017-207238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 05/12/2018] [Accepted: 05/18/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Accidental hypothermia (AH) has higher incidence and mortality in geriatric populations. Japan has a rapidly ageing population, and little is known about the epidemiology of hypothermia in this country. METHODS We created an AH registry based on retrospective review of patients visiting the ED of 12 institutions with temperature ≤35°C between April 2011 and March 2016. The severity of AH was classified as mild (≤35, ≥32°C), moderate (<32, ≥28°C) or severe (<28°C). The relationship between in-hospital mortality and severity of AH was assessed using a multivariable logistic regression analysis. RESULTS A total of 572 patients were registered in this registry and 537 patients were eligible for our analysis. The median age was 79 (IQR 66-87) years and the proportion of men was 51.2% (273/537). AH was more likely to occur in elderly patients aged ≥65 years (424/537, 80.0%) and in indoor settings (418/537, 77.8%). The condition most frequently associated with AH, irrespective of severity, was acute medical illness. A lower mean outside temperature was associated with a higher prevalence of AH, and particularly severe AH (p for trend <0.001). The overall proportion of cases resulting in in-hospital death was 24.4% (131/537), with no significant difference between severity levels observed in a multivariable logistic regression analysis (severe group (37/118, 31.4%) vs mild group (42/192, 21.9%), adjusted OR (AOR) 1.01, 95% CI 0.61 to 1.68; and moderate group (52/227, 22.9%) vs mild group, AOR 1.11, 95% CI 0.58 to 2.14). CONCLUSION Active prevention and intervention should occur for this important public health issue.
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Affiliation(s)
- Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Morita
- Department of Emergency and Critical Care Medicine, Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Naoki Ehara
- Department of Emergency Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Nobuhiro Miyamae
- Department of Emergency Medicine, Rakuwa-kai Otowa Hospital, Kyoto, Japan
| | - Yohei Okada
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Red Cross Hospital, Kyoto, Japan
| | - Takaaki Jo
- Department of Emergency Medicine, Uji-Tokushukai Medical Center, Uji, Japan
| | - Yasuyuki Sumida
- Department of Emergency Medicine, North Medical Center, Kyoto Prefectural University of Medicine, Yosa-gun, Japan
| | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Makoto Watanabe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Nozawa
- Department of Emergency and Critical Care Medicine, Saiseikai Shiga Hospital, Ritto, Japan
| | - Ayumu Tsuruoka
- Department of Emergency and Critical Care Medicine, Kidney and Cardiovascular Center, Kyoto Min-iren Chuo Hospital, Kyoto, Japan.,Department of Emergency and Critical Care Medicine, Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Yoshihiro Fujimoto
- Department of Emergency Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Yoshiki Okumura
- Department of Emergency Medicine, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University, Suita City, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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190
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Saczkowski RS, Brown DJ, Abu-Laban RB, Fradet G, Schulze CJ, Kuzak ND. Prediction and risk stratification of survival in accidental hypothermia requiring extracorporeal life support: An individual patient data meta-analysis. Resuscitation 2018; 127:51-57. [DOI: 10.1016/j.resuscitation.2018.03.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
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191
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Pasquier M, Hugli O, Paal P, Darocha T, Blancher M, Husby P, Silfvast T, Carron PN, Rousson V. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score. Resuscitation 2018; 126:58-64. [DOI: 10.1016/j.resuscitation.2018.02.026] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
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192
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Foster J, Mauger AR, Govus A, Hewson D, Taylor L. Acetaminophen (Paracetamol) Induces Hypothermia During Acute Cold Stress. Clin Drug Investig 2018; 37:1055-1065. [PMID: 28766264 DOI: 10.1007/s40261-017-0560-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acetaminophen is an over-the-counter drug used to treat pain and fever, but it has also been shown to reduce core temperature (T c) in the absence of fever. However, this side effect is not well examined in humans, and it is unknown if the hypothermic response to acetaminophen is exacerbated with cold exposure. OBJECTIVE To address this question, we mapped the thermoregulatory responses to acetaminophen and placebo administration during exposure to acute cold (10 °C) and thermal neutrality (25 °C). METHODS Nine healthy Caucasian males (aged 20-24 years) participated in the experiment. In a double-blind, randomised, repeated measures design, participants were passively exposed to a thermo-neutral or cold environment for 120 min, with administration of 20 mg/kg lean body mass acetaminophen or a placebo 5 min prior to exposure. T c, skin temperature (T sk), heart rate, and thermal sensation were measured every 10 min, and mean arterial pressure was recorded every 30 min. Data were analysed using linear mixed effects models. Differences in thermal sensation were analysed using a cumulative link mixed model. RESULTS Acetaminophen had no effect on T c in a thermo-neutral environment, but significantly reduced T c during cold exposure, compared with a placebo. T c was lower in the acetaminophen compared with the placebo condition at each 10-min interval from 80 to 120 min into the trial (all p < 0.05). On average, T c decreased by 0.42 ± 0.13 °C from baseline after 120 min of cold exposure (range 0.16-0.57 °C), whereas there was no change in the placebo group (0.01 ± 0.1 °C). T sk, heart rate, thermal sensation, and mean arterial pressure were not different between conditions (p > 0.05). CONCLUSION This preliminary trial suggests that acetaminophen-induced hypothermia is exacerbated during cold stress. Larger scale trials seem warranted to determine if acetaminophen administration is associated with an increased risk of accidental hypothermia, particularly in vulnerable populations such as frail elderly individuals.
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Affiliation(s)
- Josh Foster
- Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedford, UK. .,Environmental Ergonomics Research Centre, Loughborough University, Loughborough, UK.
| | - Alexis R Mauger
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK
| | - Andrew Govus
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| | - David Hewson
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Lee Taylor
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre, Aspire Zone, Doha, Qatar.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Piech M, Ptaszek B, Teległów A, Marchewka J, Mardyła M. Enzyme activity: acetylcholinesterase and glucose-6-phosphate dehydrogenase in winter swimmers. REHABILITACJA MEDYCZNA 2018. [DOI: 10.5604/01.3001.0011.6828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study aim: The aim of the study was to show changes in the activity of acetylcholinesterase (AChE) and glucose-6-phosphate
dehydrogenase (G-6-PD) in winter swimmers between the end (April) and beginning of the consecutive winter swimming season
(November).
Material and methodology: The study group consisted of 16 winter swimmers (non-training males) from the Krakow “Kaloryfer”
[Radiators] Winter Swimming Club, regularly undergoing submersion in cold water at a temperature of 2-7.2ºC for
a maximum of three minutes during the winter swimming season. The tests were carried out at the end and before the beginning
of the following winter season using the method of spectrophotometry.
Results: Analysing the average values of enzymes after (April) and before the next (November) winter bathing season, there
was a decrease in the activity of AChE [U/gHb] by 18.26% and G-6-PD [U/gHb] by 22.11% in men undergoing winter baths.
Conclusions: Regular use of winter bath treatments results in increased enzyme activity: AChE and G-6-PD; and while break
in winter swimming reduces the activity of these enzymes.
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Affiliation(s)
- Michał Piech
- Wydział Rehabilitacji Ruchowej, Akademia Wychowania Fizycznego w Krakowie / Faculty of Motor Rehabilitation, University of Physical Education in Krakow, Poland
| | - Bartłomiej Ptaszek
- Studia doktoranckie, Wydział Wychowania Fizycznego i Sportu, Akademia Wychowania Fizycznego w Krakowie / Ph.D. student, Faculty of Physical Education and Sport, University of Physical Education in Krakow, Poland
| | - Aneta Teległów
- Department of Katedra Rehabilitacji Klinicznej, Akademia Wychowania Fizycznego w Krakowie / Clinical Rehabilitation, University of Physical Education in Krakow, Poland
| | - Jakub Marchewka
- Katedra Fizjoterapii, Akademia Wychowania Fizycznego w Krakowie / Department of Physiotherapy, University of Physical Education in Krakow, Poland
| | - Mateusz Mardyła
- Wydział Rehabilitacji Ruchowej, Akademia Wychowania Fizycznego w Krakowie / Faculty of Motor Rehabilitation, University of Physical Education in Krakow, Poland
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Role of superoxide ion formation in hypothermia/rewarming induced contractile dysfunction in cardiomyocytes. Cryobiology 2018; 81:57-64. [PMID: 29458041 DOI: 10.1016/j.cryobiol.2018.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 01/24/2023]
Abstract
Rewarming following accidental hypothermia is associated with circulatory collapse due primarily to impaired cardiac contractile (systolic) function. Previously, we found that reduced myofilament Ca2+ sensitivity underlies hypothermia/rewarming (H/R)-induced cardiac contractile dysfunction. This reduced Ca2+ sensitivity is associated with troponin I (cTnI) phosphorylation. We hypothesize that H/R induces reactive oxygen species (ROS) formation in cardiomyocytes, which leads to cTnI phosphorylation and reduced myofilament Ca2+ sensitivity. To test this hypothesis, we exposed isolated rat cardiomyocytes to a 2-h period of severe hypothermia (15 °C) followed by rewarming (35 °C) with and without antioxidant (TEMPOL) treatment. Simultaneous measurements of cytosolic Ca2+ ([Ca2+]cyto) and contractile (sarcomere shortening) responses indicated that H/R-induced contractile dysfunction and reduced Ca2+ sensitivity was prevented in cardiomyocytes treated with TEMPOL. In addition, TEMPOL treatment blunted H/R-induced cTnI phosphorylation. These results support our overall hypothesis and suggest that H/R disrupts excitation-contraction coupling of the myocardium through a cascade of event triggered by excessive ROS formation during hypothermia. Antioxidant treatment may improve successful rescue of accidental hypothermia victims.
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Blancher M, Albasini F, Elsensohn F, Zafren K, Hölzl N, McLaughlin K, Wheeler AR, Roy S, Brugger H, Greene M, Paal P. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol 2018; 19:131-140. [PMID: 29446647 PMCID: PMC6014052 DOI: 10.1089/ham.2017.0143] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131–140, 2018. Introduction: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Materials and Methods: Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. Results: We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. Discussion: General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Conclusions: Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.
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Affiliation(s)
- Marc Blancher
- 1 Department of Emergency Medicine, University Hospital of Grenoble-Alps , Grenoble, France .,2 The French Mountain Rescue Association (ANMSM) , Grenoble, France
| | - François Albasini
- 2 The French Mountain Rescue Association (ANMSM) , Grenoble, France .,3 Department of Emergency Medicine, St. Jean de Maurienne Hospital , St. Jean de Maurienne, France
| | | | - Ken Zafren
- 4 ICAR MedCom , Roethis, Austria .,5 Department of Emergency Medicine, Stanford University Medical Center , Stanford, California.,6 Alaska Mountain Rescue Group , Anchorage, Alaska
| | - Natalie Hölzl
- 7 Department of Anesthesiology and Intensive Care Medicine, Klinikum Kempten, Germany
| | - Kyle McLaughlin
- 8 Department of Emergency Medicine, Canmore, Canada .,9 Department of Emergency Medicine, University of Calgary , Calgary, Canada
| | - Albert R Wheeler
- 10 Department of Emergency Medicine, St John's Medical Center , Jackson, Wyoming.,11 Search and Rescue Medical Director, Grand Teton National Park , Jackson, Wyoming
| | - Steven Roy
- 12 Quebec Secours SAR, Resident Physician Elective in Wilderness Medicine, McGill University , Montreal, Canada
| | - Hermann Brugger
- 13 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy
| | - Mike Greene
- 14 Emergency Medicine Physician, Medical Officer Mountain Rescue England and Wales , Whitehaven, England
| | - Peter Paal
- 15 Department of Anesthesiology and Intensive Care, Hospitallers Brothers Hospital, Paracelsus Medical University , Salzburg, Austria
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Kim TH, Lee SC, Seo JS, Song KJ, Hong KJ, Song SW, Lee YJ. Characteristics and outcomes of patients with cold-related local injuries and accidental hypothermia from emergency department–based surveillance network in northern region of South Korea. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907917753921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Cold weather has been known to cause various cold-related local injuries as well as accidental hypothermia. Objectives: The aim of this study is to investigate the basal characteristics, outcomes, and risk factors of patients with cold-related comorbidities using prospective emergency department–based surveillance system in high-risk area. Methods: We designed a prospective emergency department–based surveillance system throughout northern part of Gyeonggi province located in the northernmost of South Korea. A total of 20 emergency departments participated in the surveillance system. Patients who visited emergency department with cold-related comorbidities from 1 December 2012 to 28 February 2013 were prospectively enrolled in final analysis. We analyzed risk factors associated with outcome and correlation between climate factor (wind-chill index) and incidence. Results: During the study period, 54 patients with cold-related comorbidities were used for final analysis, including 35 hypothermia, 15 frostbite, and 4 trench foot. Among 35 patients with accidental hypothermia, 11 patients were admitted to intensive care unit and defined to have major adverse outcome. Hypothermic patient with major adverse outcome had lesser possession of coat as outwear when exposed to the cold (9.1% vs 58.3%, p < 0.01). Lower wind-chill index was likely to develop higher incidence of cold-related comorbidities (incidence rate ratio per 1°C decrease in wind-chill index: 1.086 (95% confidence interval: 1.038–1.135)). Conclusion: Patients with cold-related comorbidities were successfully monitored with emergency department–based surveillance system. Absence of coat was associated with major adverse outcomes in patient with accidental hypothermia. Lower wind-chill index was associated with higher incidence of cold-related comorbidities.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seung Chul Lee
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jun Seok Seo
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sung Wook Song
- Department of Emergency Medicine, Jeju National University, Jeju City, Republic of Korea
| | - Yu Jin Lee
- Department of Emergency Medicine, Inha University Hospital, Incheon, Republic of Korea
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197
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Intravenous bags' cooling rates according to their initial temperature, insulation status, composition, and volume: A quasi-experimental study. J Trauma Acute Care Surg 2018; 80:1049-52. [PMID: 27015581 DOI: 10.1097/ta.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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198
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The prehospital management of hypothermia - An up-to-date overview. Injury 2018; 49:149-164. [PMID: 29162267 DOI: 10.1016/j.injury.2017.11.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accidental hypothermia concerns a body core temperature of less than 35°C without a primary defect in the thermoregulatory system. It is a serious threat to prehospital patients and especially injured patients, since it can induce a vicious cycle of the synergistic effects of hypothermia, acidosis and coagulopathy; referred to as the trauma triad of death. To prevent or manage deterioration of a cold patient, treatment of hypothermia should ideally begin prehospital. Little effort has been made to integrate existent literature about prehospital temperature management. The aim of this study is to provide an up-to-date systematic overview of the currently available treatment modalities and their effectiveness for prehospital hypothermia management. DATA SOURCES Databases PubMed, EMbase and MEDLINE were searched using the terms: "hypothermia", "accidental hypothermia", "Emergency Medical Services" and "prehospital". Articles with publications dates up to October 2017 were included and selected by the authors based on relevance. RESULTS The literature search produced 903 articles, out of which 51 focused on passive insulation and/or active heating. The most effective insulation systems combined insulation with a vapor barrier. Active external rewarming interventions include chemical, electrical and charcoal-burning heat packs; chemical or electrical heated blankets; and forced air warming. Mildly hypothermic patients, with significant endogenous heat production from shivering, will likely be able to rewarm themselves with only insulation and a vapor barrier, although active warming will still provide comfort and an energy-saving benefit. For colder, non-shivering patients, the addition of active warming is indicated as a non-shivering patient will not rewarm spontaneously. All intravenous fluids must be reliably warmed before infusion. CONCLUSION Although it is now accepted that prehospital warming is safe and advantageous, especially for a non-shivering hypothermic patient, this review reveals that no insulation/heating combinations stand significantly above all the others. However, modern designs of hypothermia wraps have shown promise and battery-powered inline fluid warmers are practical devices to warm intravenous fluids prior to infusion. Future research in this field is necessary to assess the effectiveness expressed in patient outcomes.
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199
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Abstract
We sought to organize a functional system of recognition and advanced treatment of hypothermic patients with extracorporeal rewarming as a treatment option. All patients with suspected hypothermia are consulted with the hypothermia coordinator (HC), whose role is to provide expertise on hypothermia recognition and treatment to all rescue and medical services. Patients with Swiss staging system of hypothermia class III and IV are subjected to extracorporeal rewarming. Patients with class I and II are managed in local hospitals, after the HC provides instructions. From program initiation (July 29, 2013) to November 1, 2015, HC consulted 104 hypothermic patients; 21 in hypothermia class III and IV were subjected to extracorporeal rewarming in the John Paul II Hospital in Cracow, Poland. The remaining people were rewarmed in the referring hospitals. Cardiac arrest upon referral was present in 10 cases (resuscitation times from arrest to extracorporeal membrane oxygenation implantation ranged 107–345 minutes). Seven patients died, and the remaining 14 have been rewarmed with the restoration of hemodynamic stability. Systematic approach to active recognition and treatment of profound accidental hypothermia patients, on the basis of HC cooperation with emergency medical services, enables advanced management with good outcomes, especially in patients with cardiac arrest.
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200
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Abstract
Accidental hypothermia causes profound changes to the body's physiology. After an initial burst of agitation (e.g., 36-37°C), vital functions will slow down with further cooling, until they vanish (e.g. <20-25°C). Thus, a deeply hypothermic person may appear dead, but may still be able to be resuscitated if treated correctly. The hospital use of minimally invasive rewarming for nonarrested, otherwise healthy patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionized the management of hypothermic cardiac arrest, with survival rates approaching 100%. Hypothermic patients with risk factors for imminent cardiac arrest (i.e., temperature <28°C, ventricular arrhythmia, systolic blood pressure <90 mmHg), and those who have already arrested, should be transferred directly to an ECLS center. Cardiac arrest patients should receive continuous cardiopulmonary resuscitation (CPR) during transfer. If prolonged transport is required or terrain is difficult, mechanic CPR can be helpful. Intermittent CPR may be appropriate in hypothermic arrest when continuous CPR is impossible. Modern postresuscitation care should be implemented following hypothermic arrest. Structured protocols should be in place to optimize prehospital triage, transport, and treatment as well as in-hospital management, including detailed criteria and protocols for the use of ECLS and postresuscitation care.
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Affiliation(s)
- Peter Paal
- Department of Anaesthesia and Intensive Care Medicine, Hospitallers Brothers Hospital, Salzburg, Austria.
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
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