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Thomsen JH, Kjaergaard J, Graff C, Pehrson S, Erlinge D, Wanscher M, Køber L, Bro-Jeppesen J, Søholm H, Winther-Jensen M, Hassager C. Ventricular ectopic burden in comatose survivors of out-of-hospital cardiac arrest treated with targeted temperature management at 33°C and 36°C. Resuscitation 2016; 102:98-104. [DOI: 10.1016/j.resuscitation.2016.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/18/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
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252
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Cheshire WP. Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci 2016; 196:91-104. [DOI: 10.1016/j.autneu.2016.01.001] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 01/22/2023]
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253
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Schaible N, Han YS, Hoang T, Arteaga G, Tveita T, Sieck G. Hypothermia/rewarming disrupts excitation-contraction coupling in cardiomyocytes. Am J Physiol Heart Circ Physiol 2016; 310:H1533-40. [PMID: 26993227 DOI: 10.1152/ajpheart.00840.2015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/16/2016] [Indexed: 12/25/2022]
Abstract
Hypothermia/rewarming (H/R) is poorly tolerated by the myocardium; however, the underlying intracellular basis of H/R-induced cardiac dysfunction remains elusive. We hypothesized that in cardiomyocytes, H/R disrupts excitation-contraction coupling by reducing myofilament Ca(2+) sensitivity due to an increase in cardiac troponin I (cTnI) phosphorylation. To test this hypothesis, isolated rat cardiomyocytes (13-15 cells from 6 rats per group) were electrically stimulated to evoke both cytosolic Ca(2+) ([Ca(2+)]cyto) and contractile (sarcomere shortening) responses that were simultaneously measured using an IonOptix system. Cardiomyocytes were divided into two groups: 1) those exposed to hypothermia (15°C for 2 h) followed by rewarming (35°C; H/R); or 2) time-matched normothermic (35°C) controls (CTL). Contractile dysfunction after H/R was indicated by reduced velocity and extent of sarcomere length (SL) shortening compared with time-matched controls. Throughout hypothermia, basal [Ca(2+)]cyto increased and the duration of evoked [Ca(2+)]cyto transients was prolonged. Phase-loop plots of [Ca(2+)]cyto vs. contraction were shifted rightward in cardiomyocytes during hypothermia compared with CTL, indicating a decrease in Ca(2+) sensitivity. Using Western blot, we found that H/R increases cTnI phosphorylation. These results support our overall hypothesis and suggest that H/R disrupts excitation-contraction coupling of cardiomyocytes due to increased cTnI phosphorylation and reduced Ca(2+) sensitivity.
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Affiliation(s)
- Niccole Schaible
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota; and
| | - Young Soo Han
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota; and
| | - Thuy Hoang
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota; and
| | - Grace Arteaga
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota; and
| | - Torkjel Tveita
- Departments of Anesthesiology and Physiology, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Gary Sieck
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota; and
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254
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The impact of exercise-induced core body temperature elevations on coagulation responses. J Sci Med Sport 2016; 20:202-207. [PMID: 27036711 DOI: 10.1016/j.jsams.2016.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/22/2015] [Accepted: 01/11/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Exercise induces changes in haemostatic parameters and core body temperature (CBT). We aimed to assess whether exercise-induced elevations in CBT induce pro-thrombotic changes in a dose-dependent manner. DESIGN Observational study. METHODS CBT and haemostatic responses were measured in 62 participants of a 15-km road race at baseline and immediately after finishing. As haemostasis assays are routinely performed at 37°C, we corrected the assay temperature for the individual's actual CBT at baseline and finish in a subgroup of n=25. RESULTS All subjects (44±11 years, 69% male) completed the race at a speed of 12.1±1.8km/h. CBT increased significantly from 37.6±0.4°C to 39.4±0.8°C (p<0.001). Post-exercise, haemostatic activity was increased, as expressed by accelerated thrombin generation and an attenuated plasmin response. Synchronizing assay temperature to the subjects' actual CBT resulted in additional differences and stronger acceleration of thrombin generation parameters. CONCLUSIONS This study demonstrates that exercise induces a prothrombotic state, which might be partially dependent on the magnitude of the exercise-induced CBT rise. Synchronizing the assay temperature to approximate the subject's CBT is essential to obtain more accurate insight in the haemostatic balance during thermoregulatory challenging situations. Finally, this study shows that short-lasting exposure to a CBT of 41.2°C does not result in clinical symptoms of severe coagulation. We therefore hypothesize that prolonged exposure to a high CBT or an individual-specific CBT threshold needs to be exceeded before derailment of the haemostatic balance occurs.
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255
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Li S, Qiu C, Shi W, Huang Y, Gui L. A Survey of Accidental Hypothermia Knowledge among Navy Members in China and the Implications for Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E315. [PMID: 26978382 PMCID: PMC4808978 DOI: 10.3390/ijerph13030315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Accidental hypothermia (AH) is a potentially life-threatening condition that can lead to significant morbidity and life-long effects. Navy personnel are always at a greater risk of AH due to frequent outdoor work, wilderness exposure, prolonged immobility and exhaustion. The purpose of the survey was to assess Chinese Navy members' awareness of AH and to make recommendations with regard to better measures for improving it. METHODS 111 Navy members completed a written questionnaire that was subsequently analyzed. RESULTS 30.6% of the respondents have experienced AH and 64.9% rated their knowledge of AH as "low" or "none". Over half of them identified the initial symptom of AH as obvious shivering (69.4%) and apathy (45.0%). As for the aggravate symptoms, 60.9% chose the wrong answer of more obvious shivering instead of the right one-absence of shivering (5.4%). In the case of the treatment of mild AH, more than half of the respondents chose the wrong answers. CONCLUSIONS This study suggests that the basic skills of recognition and treatment of AH are inadequate in the Chinese Navy. Further work is required to develop a systematical, comprehensive and corresponding education method that would promote correct actions during AH.
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Affiliation(s)
- Shuang Li
- Emergency Nursing Department, School of Nursing, 2nd Military Medical University, Shanghai 200433, China.
| | - Chen Qiu
- Emergency Nursing Department, School of Nursing, 2nd Military Medical University, Shanghai 200433, China.
| | - Wenwen Shi
- Emergency Nursing Department, School of Nursing, 2nd Military Medical University, Shanghai 200433, China.
| | - Yan Huang
- Emergency Nursing Department, School of Nursing, 2nd Military Medical University, Shanghai 200433, China.
| | - Li Gui
- Emergency Nursing Department, School of Nursing, 2nd Military Medical University, Shanghai 200433, China.
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256
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Feyissa AM, Pochettino A, Bower TC, Nuttall GA, Britton JW. Rhythmic electrographic discharges during deep hypothermic circulatory arrest. Clin Neurophysiol 2016; 127:1901-6. [DOI: 10.1016/j.clinph.2015.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
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257
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Abstract
CONTEXT Hypothermia and frostbite injuries occur in cold weather activities and sporting events. EVIDENCE ACQUISITION A PubMed search was used to identify original research and review articles related to cold, frostbite, and hypothermia. Inclusion was based on their relevance to prevention and treatment of cold-related injuries in sports and outdoor activities. Dates of review articles were limited to those published after 2010. No date limit was set for the most recent consensus statements or original research. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS Frostbite and hypothermia are well-documented entities with good prevention strategies and prehospital treatment recommendations that have changed very little with time. A layered approach to clothing is the best way to prevent injury and respond to weather changes. Each athlete, defined as a participant in a cold weather sport or activity, will respond to cold differently depending on anthropometric measurements and underlying medical risk factors. An understanding of wind-chill temperatures, wetness, and the weather forecast allows athletes and event coordinators to properly respond to changing weather conditions. At the first sign of a freezing cold injury, ensure warm, dry clothes and move to a protected environment. CONCLUSION Cold injuries can be prevented, and cold weather activities are safe with proper education, preparation, and response to changing weather conditions or injury.
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Affiliation(s)
- Jessie Fudge
- Activity, Sports and Exercise Medicine Department, Group Health Cooperative, Everett, Washington
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258
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Deslarzes T, Rousson V, Yersin B, Durrer B, Pasquier M. An evaluation of the Swiss staging model for hypothermia using case reports from the literature. Scand J Trauma Resusc Emerg Med 2016; 24:16. [PMID: 26887573 PMCID: PMC4756507 DOI: 10.1186/s13049-016-0210-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Core body temperature is used to stage and guide the management of hypothermic patients, however obtaining accurate measurements of core temperature is challenging, especially in the pre-hospital context. The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia. The proposed temperature range for clinical stage 1 is <35-32 °C (95-90 °F), for stage 2, <32-28 °C (<90-82 °F) for stage 3, <28-24 °C (<82-75 °F), and for stage 4 below 24 °C (75 °F). However, the evidence relating these temperature ranges to the clinical stages needs to be strengthened. METHODS Medline was used to retrieve data on as many cases of accidental hypothermia (core body temperature <35 °C (95 °F)) as possible. Cases of therapeutic or neonatal hypothermia and those with confounders or insufficient data were excluded. To evaluate the Swiss staging model for hypothermia, we estimated the percentage of those patients who were correctly classified and compared the theoretical with the observed ranges of temperatures for each clinical stage. The number of rescue collapses was also recorded. RESULTS We analysed 183 cases; the median temperature for the sample was 25.2 °C (IQR 22-28). 95 of the 183 patients (51.9%; 95% CI = 44.7%-59.2%) were correctly classified, while the temperature was overestimated in 36 patients (19.7%; 95% CI = 13.9%-25.4%). We observed important overlaps among the four stage groups with respect to core temperature, the lowest observed temperature being 28.1 °C for Stage 1, 22 °C for Stage 2, 19.3 °C for Stage 3, and 13.7 °C for stage 4. CONCLUSION Predicting core body temperature using clinical indicators is a difficult task. Despite the inherent limitations of our study, it increases the strength of the evidence linking the clinical hypothermia stage to core temperature. Decreasing the thresholds of temperatures distinguishing the different stages would allow a reduction in the number of cases where body temperature is overestimated, avoiding some potentially negative consequences for the management of hypothermic patients.
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Affiliation(s)
- T Deslarzes
- University of Lausanne, Lausanne, Switzerland. .,Emergency Service, University Hospital Centre, Lausanne, Switzerland.
| | - V Rousson
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - B Yersin
- University of Lausanne, Lausanne, Switzerland. .,Emergency Service, University Hospital Centre, Lausanne, Switzerland.
| | - B Durrer
- Alpine Rescue Service, Air Glaciers, International Mountaineering and Climbing Federation (UIAA), Lauterbrunnen, Switzerland.
| | - M Pasquier
- University of Lausanne, Lausanne, Switzerland. .,Emergency Service, University Hospital Centre, Lausanne, Switzerland.
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259
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Excellent Outcome With Extracorporeal Membrane Oxygenation After Accidental Profound Hypothermia (13.8°C) and Drowning. Crit Care Med 2016; 43:e521-5. [PMID: 26317568 DOI: 10.1097/ccm.0000000000001283] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report outcome and intensive care strategy in a 7-year-old girl with accidental profound hypothermia and drowning. DATA SOURCES AND EXTRACTION Patient records and interviews with search-and-rescue personnel. STUDY SELECTION Case report. DATA SYNTHESIS The girl was rescued after an estimated submersion time of at least 83 minutes in icy sea water. She presented with cardiac arrest, ice in her upper airways, a first-documented nasopharyngeal temperature of 13.8°C, and a serum potassium of 11.3 mmol/L. The patient was slowly rewarmed with extracorporeal membrane oxygenation and made an exceptional recovery after intensive care and a long rehabilitation time. CONCLUSION Excellent outcome is possible in children with body temperature and serum potassium reaching the far limits of previously reported human survival and prolonged submersion time.
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260
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261
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Meytes V, Schulberg SP, Amaturo M, Kilaru M. An uncommon case of severe accidental hypothermia in an urban setting. Oxf Med Case Reports 2015; 2015:371-3. [PMID: 26664726 PMCID: PMC4672235 DOI: 10.1093/omcr/omv067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/26/2015] [Accepted: 11/04/2015] [Indexed: 11/14/2022] Open
Abstract
Accidental hypothermia is an uncommon presentation in urban settings. Here we present a patient admitted with a core temperature of 26.6°C (80°F) and a serum potassium of 8.5 mmol/l who subsequently went into cardiac arrest. After > 90 min of active cardiopulmonary resuscitation and peak serum potassium of >12 mmol/l, the patient had a spontaneous return of circulation. The patient's hospital course was complicated by compartment syndrome of his forearm; however, he was discharged home without any lasting neurological damage.
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Affiliation(s)
- Vadim Meytes
- Department of Surgery , NYU Lutheran Medical Center , Brooklyn, NY , USA
| | - Steven P Schulberg
- Department of Surgery , NYU Lutheran Medical Center , Brooklyn, NY , USA ; NYIT College of Osteopathic Medicine , Old Westbury, NY , USA
| | - Michael Amaturo
- Department of Surgery , NYU Lutheran Medical Center , Brooklyn, NY , USA
| | - Mohan Kilaru
- Department of Surgery , NYU Lutheran Medical Center , Brooklyn, NY , USA
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262
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Tsai LK, Chen CL, Tsai YC, Ting CH, Chien YH, Lee NC, Hwu WL. Hypothermia improves disease manifestations in SMA mice via SMN augmentation. Hum Mol Genet 2015; 25:631-41. [PMID: 26647309 DOI: 10.1093/hmg/ddv500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/01/2015] [Indexed: 11/13/2022] Open
Abstract
Spinal muscular atrophy (SMA) is a progressive motor neuron disease caused by a deficiency of survival motor neuron (SMN) protein. In this study, we evaluated the efficacy of intermittent transient hypothermia in a mouse model of SMA. SMA mice were exposed to ice for 50 s to achieve transient hypothermia (below 25°C) daily beginning on postnatal day 1. Neonatal SMA mice (Smn(-/-)SMN2(+/-)) who received daily transient hypothermia exhibited reduced motor neuron degeneration and muscle atrophy and preserved the architecture of neuromuscular junction when compared with untreated controls at day 8 post-treatment. Daily hypothermia also prolonged the lifespan, increased body weight and improved motor coordination in SMA mice. Quantitative polymerase chain reaction and western blot analyses showed that transient hypothermia led to an increase in SMN transcript and protein levels in the spinal cord and brain. In in vitro studies using an SMN knockdown motor neuron-like cell-line, transient hypothermia increased intracellular SMN protein expression and length of neurites, confirming the direct effect of hypothermia on motor neurons. These data indicate that the efficacy of intermittent transient hypothermia in improving outcome in an SMA mouse model may be mediated, in part, via an upregulation of SMN levels in the motor neurons.
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Affiliation(s)
- Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan,
| | - Chien-Lin Chen
- Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Yi-Chieh Tsai
- Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Chen-Hung Ting
- Marine Research Station, Institute of Cellular and Organismic Biology, Academia Sinica, 23-10 Dahuen Road, Jiaushi, Ilan 262, Taiwan and
| | - Yin-Hsio Chien
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Ni-Chong Lee
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Wuh-Liang Hwu
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100, Taiwan
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263
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Darocha T, Sobczyk D, Kosiński S, Jarosz A, Gałązkowski R, Nycz K, Drwiła R. Electrocardiographic Changes Caused by Severe Accidental Hypothermia. J Cardiothorac Vasc Anesth 2015; 29:e83-6. [DOI: 10.1053/j.jvca.2015.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Indexed: 01/14/2023]
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264
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Manual versus Mechanical Chest Compressions on Surfaces of Varying Softness with or without Backboards: A Randomized, Crossover Manikin Study. J Emerg Med 2015; 50:594-600.e1. [PMID: 26607696 DOI: 10.1016/j.jemermed.2015.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 08/31/2015] [Accepted: 10/05/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chest compression quality is decisive for overall outcome after cardiac arrest. Chest compression depth may decrease when cardiopulmonary resuscitation (CPR) is performed on a mattress, and the use of a backboard does not necessarily improve compression depth. Mechanical chest compression devices may overcome this problem. OBJECTIVES We sought to investigate the effectiveness of manual chest compressions both with and without a backboard compared to mechanical CPR performed on surfaces of different softness. METHODS Twenty-four advanced life support (ALS)-certified rescuers were enrolled. LUCAS2 (Physio-Control, Redmond, WA) delivers 52 ± 2 mm deep chest compressions and active decompressions back to the neutral position (frequency 102 min(-1); duty cycle, 50%). This simulated CPR scenario was performed on a Resusci-Anne manikin (Laerdal, Stavanger, Norway) that was lying on 3 different surfaces: 1) a concrete floor, 2) a firm standard mattress, and 3) a pressure-relieving mattress. Data were recorded by the Laerdal Skill Reporting System. RESULTS Manual chest compression with or without a backboard were performed correctly less often than mechanical chest compressions (floor: 33% [interquartile range {IQR}, 27-48%] vs. 90% [IQR, 86-94%], p < 0.001; standard mattress: 32% [IQR, 20-45%] vs. 27% [IQR, 14-46%] vs. 91% [IQR, 51-94%], p < 0.001; and pressure-relieving mattress 29% [IQR, 17-49%] vs. 30% [IQR, 17-52%] vs. 91% [IQR, 87-95%], p < 0.001). The mean compression depth on both mattresses was deeper with mechanical chest compressions (floor: 53 mm [range, 47-57 mm] vs. 56 mm [range, 54-57 mm], p = 0.003; standard mattress: 50 mm [range, 44-55 mm] vs. 51 mm [range, 47-55 mm] vs. 55 mm [range, 54-58 mm], p < 0.001; and pressure-relieving mattress: 49 mm [range, 44-55 mm] vs. 50 mm [range, 44-53 mm] vs. 55 mm [range, 55-56 mm], p < 0.001). In this ∼6-min scenario, the mean hands-off time was ∼15 to 20 s shorter in the manual CPR scenarios. CONCLUSIONS In this experimental study, only ∼30% of manual chest compressions were performed correctly compared to ∼90% of mechanical chest compressions, regardless of the underlying surface. Backboard use did not influence the mean compression depth during manual CPR. Chest compressions were deeper with mechanical CPR. The mean hands-off time was shorter with manual CPR.
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266
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Strapazzon G, Procter E, Putzer G, Avancini G, Dal Cappello T, Überbacher N, Hofer G, Rainer B, Rammlmair G, Brugger H. Influence of low ambient temperature on epitympanic temperature measurement: a prospective randomized clinical study. Scand J Trauma Resusc Emerg Med 2015; 23:90. [PMID: 26542476 PMCID: PMC4635596 DOI: 10.1186/s13049-015-0172-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epitympanic temperature (Tty) measured with thermistor probes correlates with core body temperature (Tcore), but the reliability of measurements at low ambient temperature is unknown. The aim of this study was to determine if commercially-available thermistor-based Tty reflects Tcore in low ambient temperature and if Tty is influenced by insulation of the ear. METHODS Thirty-one participants (two females) were exposed to room (23.2 ± 0.4 °C) and low (-18.7 ± 1.0 °C) ambient temperature for 10 min using a randomized cross-over design. Tty was measured using an epitympanic probe (M1024233, GE Healthcare Finland Oy) and oesophageal temperature (Tes) with an oesophageal probe (M1024229, GE Healthcare Finland Oy) inserted into the lower third of the oesophagus. Ten participants wore ear protectors (Arton 2200, Emil Lux GmbH & Co. KG, Wermelskirchen, Switzerland) to insulate the ear from ambient air. RESULTS During exposure to room temperature, mean Tty increased from 33.4 ± 1.5 to 34.2 ± 0.8 °C without insulation of the ear and from 35.0 ± 0.8 to 35.5 ± 0.7 °C with insulation. During exposure to low ambient temperature, mean Tty decreased from 32.4 ± 1.6 to 28.5 ± 2.0 °C without insulation and from 35.6 ± 0.6 to 35.2 ± 0.9 °C with insulation. The difference between Tty and Tes at low ambient temperature was reduced by 82% (from 7.2 to 1.3 °C) with insulation of the ear. CONCLUSIONS Epitympanic temperature measurements are influenced by ambient temperature and deviate from Tes at room and low ambient temperature. Insulating the ear with ear protectors markedly reduced the difference between Tty and Tes and improved the stability of measurements. The use of models to correct Tty may be possible, but results should be validated in larger studies.
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Affiliation(s)
| | - Emily Procter
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Gabriel Putzer
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
| | | | | | - Norbert Überbacher
- Department of Otolaryngology, General Hospital of Bressanone, Bressanone, Italy
| | - Georg Hofer
- Department of Anesthesiology and Critical Care Medicine, General Hospital of Silandro, Silandro, Italy
| | | | - Georg Rammlmair
- Department of Anaesthesiology and Critical Care Medicine, General Hospital of Bressanone, Bressanone, Italy
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy
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267
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Putzer G, Mair B, Hangler H, Ströhle M, Mair P. Emergency extracorporeal life support after prolonged out-of-hospital cardiac arrest. J Cardiothorac Vasc Anesth 2015; 28:1024-6. [PMID: 25107718 DOI: 10.1053/j.jvca.2013.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Indexed: 01/04/2023]
Affiliation(s)
- Gabriel Putzer
- Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Inssbruck, Austria.
| | - Birgit Mair
- Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Inssbruck, Austria
| | - Herbert Hangler
- Department of Cardiac Surgery, Medical University Innsbruck, Inssbruck, Austria
| | - Mathias Ströhle
- Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Inssbruck, Austria
| | - Peter Mair
- Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Inssbruck, Austria
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268
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 532] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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269
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Skaiaa SC, Brattebø G, Aßmus J, Thomassen Ø. The impact of environmental factors in pre-hospital thermistor-based tympanic temperature measurement: a pilot field study. Scand J Trauma Resusc Emerg Med 2015; 23:72. [PMID: 26400226 PMCID: PMC4581419 DOI: 10.1186/s13049-015-0148-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/08/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Few pre-hospital services have the possibility to accurately measure core temperature (T core). Non-invasive estimation of T core will improve pre-hospital decision-making regarding the triage and management of hypothermic patients. Thermistor-based tympanic temperature (T tymp) correlates well with T core in controlled studies; however, little is known about the feasibility of using T tymp under field conditions. This study assessed the impact of pre-hospital environmental factors on the accuracy of T tymp . Deep rectal temperature (T rect) was used as a substitute for T core . METHODS Normothermic volunteers (n = 13) were exposed to four simulated field conditions producing local cooling of the head and ear canal. After exposure, T tymp was recorded every 15 s for 10 min and compared with T rect . Descriptive analysis and Bland-Altman plots were used to assess agreement. RESULTS Immediately after exposure mean T tymp was low, but increased rapidly and reached an apparent steady state after 3-5 min. After 5 and 10 min, the mean temperature difference (∆T rect-tymp) ranged from 1.5-3.2 °C (SD = 0.5) and 1.2-2.0 °C, respectively. T rect remained unchanged throughout the study period. CONCLUSIONS After surface cooling of head and neck, T tymp did not accurately reflect core temperature within the first 10 min of measurement. The variation of ∆T rect-tymp was low after 10 min, regardless of the initial degree of cooling. With the risk of over-triage, T tymp may at this point provide an indication of T core and also exhibit a trend. TRIAL REGISTRATION ClinicalTrials.gov: NCT02274597.
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Affiliation(s)
- Sven Christjar Skaiaa
- Department of Anaesthesia & Intensive Care, Oslo University Hospital, N 0424, Oslo, Norway.
| | - Guttorm Brattebø
- Department of Anaesthesia & Intensive Care, Haukeland University Hospital, N 5021, Bergen, Norway.
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, N 5021, Bergen, Norway.
| | - Øyvind Thomassen
- Department of Anaesthesia & Intensive Care, Haukeland University Hospital, N 5021, Bergen, Norway.
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270
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Mair P, Brugger H, Mair B, Moroder L, Ruttmann E. Is extracorporeal rewarming indicated in avalanche victims with unwitnessed hypothermic cardiorespiratory arrest? High Alt Med Biol 2015; 15:500-3. [PMID: 25531463 DOI: 10.1089/ham.2014.1066] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
International guidelines recommend using extracorporeal rewarming in all hypothermic avalanche victims with prolonged cardiac arrest if they have patent airways and a plasma potassium level≤12 mmol/L. The aim of this study was to evaluate outcome data to determine if available experience with extracorporeal rewarming of avalanche victims supports this recommendation. At Innsbruck Medical University Hospital, 28 patients with hypothermic cardiac arrest following an avalanche accident were resuscitated using extracorporeal circulation. Of these patients, 25 were extricated from the snow masses with no vital signs and did not survive to hospital discharge. Three patients had witnessed cardiac arrest after extrication and a core temperature of 21.7°C, 22°C, and 24.0°C, two of whom survived long-term with full neurological recovery. A search of the literature revealed only one asystolic avalanche victim with unwitnessed hypothermic cardiac arrest (core temperature 19°C) surviving long-term. All other avalanche victims in the medical literature surviving prolonged hypothermic cardiac arrest suffered witnessed arrest after extrication with a core temperature below 24°C. Our results suggest that prognosis of hypothermic avalanche victims with unwitnessed asystolic cardiac arrest and a core temperature>24°C is extremely poor. Available outcome data do not support the use of extracorporeal rewarming in these patients.
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Affiliation(s)
- Peter Mair
- 1 Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University Hospital , Innsbruck, Austria
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271
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Derkenne C, Demaison X, Martinez JY, David JS. Apports de la médecine de l’avant militaire en situation préhospitalière civile. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0569-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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272
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Kang MY. Blood electrolyte disturbances during severe hypoglycemia in Korean patients with type 2 diabetes. Korean J Intern Med 2015; 30:648-56. [PMID: 26354059 PMCID: PMC4578021 DOI: 10.3904/kjim.2015.30.5.648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/26/2014] [Accepted: 04/05/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To investigate abnormalities in blood electrolyte levels during severe hypoglycemia in Korean patients with type 2 diabetes mellitus (T2DM) in a clinical setting. METHODS Blood electrolyte levels in adult T2DM patients during severe hypoglycemia were collected from January 1, 2008 to December 31, 2012. Patients who maintained normal serum creatinine and blood urea nitrogen levels were utilized in the study. Severe hypoglycemia was defined as a condition requiring medical assistance, such as administering carbohydrates when serum glucose levels less than 70 mg/dL were observed, in conjunction with other symptoms of hypoglycemia. RESULTS A total of 1,068 patients who visited the emergency room with severe hypoglycemia were screened, of which 219 patients were included in this study. The incidence of abnormal levels for any electrolyte was 47%. Hypokalemia (< 3.5 mmol/L) was the most common type of electrolyte disturbance observed at 21.9%. A decrease in serum potassium levels was associated with decreases in blood glucose levels (r = 0.151, p = 0.025). During severe hypoglycemia, median blood glucose levels, incidence of tachycardia (> 100 beats per minute) and severe hypertension (≥ 180/120 mmHg) were 30 mg/dL (range, 14 to 62) and 35 mg/dL (range, 10 to 69; p = 0.04), 18.8% and 7.2% (p = 0.02), and 20.8% and 10.2% (p = 0.05) in the hypokalemia and normokalemia groups, respectively. CONCLUSIONS During severe hypoglycemia, hypokalemia occurred in 21.9% of T2DM patients and was associated with tachycardia and severe hypertension. Therefore, the results suggest that severe hypoglycemia may increase cardiovascular events in T2DM.
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Affiliation(s)
- Mi Yeon Kang
- Correspondence to Mi Yeon Kang, M.D. Department of Internal Medicine, Saint Carollo Hospital, 221 Sungwang-ro, Suncheon 57931, Korea Tel: +82-61-720-2428 Fax: +82-61-720-6000 E-mail:
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273
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Westrol MS, Awad NI, Bridgeman PJ, Page E, McCoy JV, Jeges J. Use of an Intravascular Heat Exchange Catheter and Intravenous Lipid Emulsion for Hypothermic Cardiac Arrest After Cyclobenzaprine Overdose. Ther Hypothermia Temp Manag 2015; 5:171-6. [DOI: 10.1089/ther.2015.0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael S. Westrol
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Nadia I. Awad
- Department of Pharmacy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Patrick J. Bridgeman
- Department of Pharmacy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Erika Page
- Robert Wood Johnson Medical School at Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Jonathan V. McCoy
- Department of Emergency Medicine, Robert Wood Johnson Medical School at Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Janos Jeges
- Department of Emergency Medicine, Robert Wood Johnson Medical School at Rutgers, The State University of New Jersey, New Brunswick, New Jersey
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274
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Mitchell J, Bogar L, Burton N. Cardiothoracic surgical emergencies in the intensive care unit. Crit Care Clin 2015; 30:499-525. [PMID: 24996607 DOI: 10.1016/j.ccc.2014.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with cardiothoracic surgical emergencies are frequently admitted to the ICU, either prior to operative intervention or after surgery. Recognition and appropriate timing of operative intervention are key factors in improving outcomes. A collaborative team approach with the cardiothoracic service is imperative in managing this patient population.
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Affiliation(s)
- Jessica Mitchell
- Department of Critical Care Medicine, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103, USA.
| | - Linda Bogar
- Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA; Cardiac Vascular & Thoracic Surgery Associates, Inova Fairfax Hospital, 2921 Telestar Court, Falls Church, VA 22042, USA
| | - Nelson Burton
- Cardiac Vascular & Thoracic Surgery Associates, Inova Fairfax Hospital, 2921 Telestar Court, Falls Church, VA 22042, USA
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275
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Darocha T, Kosinski S, Moskwa M, Jarosz A, Sobczyk D, Galazkowski R, Slowik M, Drwila R. The Role of Hypothermia Coordinator: A Case of Hypothermic Cardiac Arrest Treated with ECMO. High Alt Med Biol 2015; 16:352-5. [PMID: 26301723 PMCID: PMC4685480 DOI: 10.1089/ham.2015.0055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Darocha, Tomasz, Sylweriusz Kosinski, Maciej Moskwa, Anna Jarosz, Dorota Sobczyk, Robert Galazkowski, Marcin Slowik, and Rafal Drwila. The role of hypothermia coordinator: A case of hypothermic cardiac arrest treated with ECMO. High Alt Biol Med 16:352-355, 2015.—We present a description of emergency medical rescue procedures in a patient suffering from severe hypothermia who was found in the Babia Gora mountain range (Poland). After diagnosing the symptoms of II/III stage hypothermia according to the Swiss Staging System, the Mountain Rescue Service notified the coordinator from the Severe Accidental Hypothermia Center (CLHG) Coordinator in Krakow and then kept in constant touch with him. In accordance with the protocol for managing such situations, the coordinator started the procedure for patients in severe hypothermia with the option of extracorporeal warming and secured access to a device for continuous mechanical chest compression. After reaching the hospital, extracorporeal warming with ECMO support in the arteriovenuous configuration was started. The total duration of circulatory arrest was 150 minutes. The rescue procedures were supervised by the coordinator, who was on 24-hour duty and was reached by means of an alarm phone. The task of the coordinator is to consult the management of hypothermia cases, use his knowledge and experience to help in the diagnosis and treatment. and if the need arises refer the patient for ECMO at CLHG. Good coordination, planning, predicting possible problems, and acting in accordance with the agreed procedures in the scheme, make it possible to shorten the time of reaching the destination hospital and implement effective treatment.
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Affiliation(s)
- Tomasz Darocha
- 1 Department of Anesthesiology and Intensive Care, John Paul II Hospital, Medical College of Jagiellonian University , Cracow, Poland .,2 Polish Medical Air Rescue , Warsaw, Poland
| | - Sylweriusz Kosinski
- 3 Department of Anesthesiology and Intensive Care, Pulmonary Hospital , and Tatra Mountain Rescue Service, Zakopane, Poland
| | - Maciej Moskwa
- 4 Polish Mountain Rescue , Beskidy Group, Szczyrk, Poland
| | - Anna Jarosz
- 1 Department of Anesthesiology and Intensive Care, John Paul II Hospital, Medical College of Jagiellonian University , Cracow, Poland
| | - Dorota Sobczyk
- 5 Department of Admission and Emergency, John Paul II Hospital, Medical College of Jagiellonian University , Cracow, Poland
| | - Robert Galazkowski
- 2 Polish Medical Air Rescue , Warsaw, Poland .,6 Department of Emergency Medical Services, Medical University of Warsaw , Warsaw, Poland
| | - Marcin Slowik
- 7 Dispatch Center , Emergency Services Cracow, Cracow, Poland
| | - Rafal Drwila
- 1 Department of Anesthesiology and Intensive Care, John Paul II Hospital, Medical College of Jagiellonian University , Cracow, Poland
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276
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Hoffman MD, Rogers IR, Joslin J, Asplund CA, Roberts WO, Levine BD. Managing collapsed or seriously ill participants of ultra-endurance events in remote environments. Sports Med 2015; 45:201-12. [PMID: 25326844 DOI: 10.1007/s40279-014-0270-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Increasing participation in ultramarathons and other ultra-endurance events amplifies the potential for serious medical issues during and immediately following these competitions. Since these events are often located in remote settings where access may be extremely limited; the diagnostic capabilities, treatment options, and expectations of medical care may differ from those of urban events. This work outlines a process for assessment and treatment of athletes presenting for medical attention in remote environments, with a focus on potentially serious conditions such as major trauma, acute coronary syndrome, exertional heat stroke, hypothermia, hypoglycemia, exercise-associated hyponatremic encephalopathy, severe dehydration, altitude illness, envenomation, anaphylaxis, and bronchospasm. A list of suggested medical supplies is provided and discussed. But, given that diagnostic and treatment options may be extremely limited in remote settings, it is important for medical providers to understand how to assess and manage the most common serious medical issues with limited resources, and to be prepared to make presumptive diagnoses when necessary.
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Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA,
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277
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Outcome after severe accidental hypothermia in the French Alps: A 10-year review. Resuscitation 2015; 93:118-23. [DOI: 10.1016/j.resuscitation.2015.06.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 11/21/2022]
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278
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Ströhle M, Putzer G, Procter E, Paal P. Apparent Cooling Rate of 7°C per Hour in an Avalanche Victim. High Alt Med Biol 2015. [PMID: 26217979 DOI: 10.1089/ham.2015.0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Avalanche victims can become hypothermic within 35 minutes of snow burial. However, reported cooling rates for avalanche victims are highly variable and it is poorly understood how much cooling is influenced by general factors (body composition, clothing, ambient conditions, duration of burial, and metabolism), unknown inter-individual factors or other phenomena (e.g., afterdrop). We report an apparent cooling rate of ∼7°C in ∼60 minutes in a healthy backcountry skier who was rewarmed with forced air and warm fluids and was discharged after 2 weeks without neurological sequelae.
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Affiliation(s)
- Mathias Ströhle
- 1 Department of General and Surgical Critical Care Medicine, Innsbruck Medical University , Innsbruck, Austria
| | - Gabriel Putzer
- 2 Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University , Innsbruck, Austria
| | - Emily Procter
- 3 EURAC Institute of Mountain Emergency Medicine , Bolzano, Italy
| | - Peter Paal
- 2 Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University , Innsbruck, Austria
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279
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Darocha T, Sobczyk D, Kosiński S, Jarosz A, Gałązkowski R, Nycz K, Drwiła R. New diastolic cardiomyopathy in patients with severe accidental hypothermia after ECMO rewarming: a case-series observational study. Cardiovasc Ultrasound 2015; 13:31. [PMID: 26174320 PMCID: PMC4502559 DOI: 10.1186/s12947-015-0027-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 07/09/2015] [Indexed: 01/22/2023] Open
Abstract
Introduction Accidental hypothermia is a condition associated with significant morbidity and mortality. Hypothermia has been reported to affect left ventricular systolic and diastolic function. However, most of the data come from animal experimental studies. Aim of the study The purpose of the present study was to assess the impact of severe accidental hypothermia on systolic and diastolic ventricular function in patients treated using veno-arterial extracorporeal membrane oxygenation (ECMO). Methods We prospectively assessed nine hypothermic patients (8 male, age 25–78 years) who were transferred to the Severe Accidental Hypothermia Center and treated with ECMO. Transthoracic echocardiography was performed on admission (in patients without cardiac arrest) and on discharge from ICU after achieving cardiovascular stability. Cardiorespiratory stability and full neurologic recovery was achieved in all patients. Results Biomarkers of myocardial damage (CK, CKMB, hsTnT) were significantly elevated in all study patients. Admission echocardiography performed in patients in sinus rhythm, revealed moderate-severe bi-ventricular systolic dysfunction and moderate bi-ventricular diastolic dysfunction. Discharge echocardiography showed persistent mild bi-ventricular diastolic dysfunction, although systolic function of both ventricles returned to normal. Discharge echocardiography in patients admitted with cardiac arrest showed normal (5 patients) or moderately impaired (1 patient) global LV systolic function on discharge. However, mild or moderate LV diastolic dysfunction was observed in all 6 patients. Discharge RV systolic function was normal, whereas mild RV diastolic dysfunction was present in these patients. Conclusion After severe accidental hypothermia bi-ventricular diastolic dysfunction persists despite systolic function recovery in survivors treated with ECMO.
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Affiliation(s)
- Tomasz Darocha
- Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
| | - Dorota Sobczyk
- Department of Interventional Cardiology, The John Paul II Hospital, Pradnicka 80, 31 202, Cracow, Poland.
| | - Sylweriusz Kosiński
- Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland. .,Tatra Mountain Rescue Service, Zakopane, Poland.
| | - Anna Jarosz
- Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Medical University of Warsaw, Polish Medical Air Rescue, Warsaw, Poland.
| | - Krzysztof Nycz
- Department of Interventional Cardiology, The John Paul II Hospital, Pradnicka 80, 31 202, Cracow, Poland.
| | - Rafał Drwiła
- Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
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280
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van Breukelen F, Martin SL. The Hibernation Continuum: Physiological and Molecular Aspects of Metabolic Plasticity in Mammals. Physiology (Bethesda) 2015; 30:273-81. [DOI: 10.1152/physiol.00010.2015] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mammals are often considered to be masters of homeostasis, with the ability to maintain a constant internal milieu, despite marked changes in the environment; however, many species exhibit striking physiological and biochemical plasticity in the face of environmental fluctuations. Here, we review metabolic depression and body temperature fluctuation in mammals, with a focus on the extreme example of hibernation in small-bodied eutherian species. Careful exploitation of the phenotypic plasticity of mammals with metabolic flexibility may provide the key to unlocking the molecular secrets of orchestrating and surviving reversible metabolic depression in less plastic species, including humans.
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Affiliation(s)
| | - Sandra L. Martin
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, Colorado
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281
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Darocha T, Kosiński S, Jarosz A, Drwila R. Extracorporeal Rewarming From Accidental Hypothermia of Patient With Suspected Trauma. Medicine (Baltimore) 2015; 94:e1086. [PMID: 26166091 PMCID: PMC4504651 DOI: 10.1097/md.0000000000001086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The use of extracorporeal membrane oxygenation is a new approach to rewarming patients with severe hypothermia and hemodynamic instability. There are, however, many questions regarding qualification for this technique in case of suspected or confirmed trauma.A male with confirmed accidental hypothermia (25°C) and after successful cardiopulmonary resuscitation from in-hospital cardiac arrest was subjected to a protocol of extracorporeal rewarming from profound hypothermia. Because of unclear history, a full trauma computed tomography was performed that showed pericerebral hematoma and signs of previously undergone right craniotomy, multiple right-sided rib fractures and the presence of intraperitoneal fluid. Based on repeated imaging and specialist consultation, no life-threatening injuries were identified and rewarming with extracorporeal membrane oxygenation was safely performed. In a year follow-up, the patient was found to be alive, with no neurologic deficits.Although this case highlights the first successful utilization of extracorporeal rewarming in a trauma patient at our center there are several limitations to its widespread use.
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Affiliation(s)
- Tomasz Darocha
- From the Department of Anesthesiology and Intensive Care, John Paul II Hospital, Collegium Medicum, Jagiellonian University, Cracow, Poland (TD, AJ, RD) and Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland (SK)
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282
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Storey KB. The Gray Mouse Lemur: A Model for Studies of Primate Metabolic Rate Depression. Preface. GENOMICS PROTEOMICS & BIOINFORMATICS 2015; 13:77-80. [PMID: 26102318 PMCID: PMC4511782 DOI: 10.1016/j.gpb.2015.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/11/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Kenneth B Storey
- Institute of Biochemistry and Department of Biology, Carleton University, Ottawa, ON K1S 5B6, Canada.
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283
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Kornhall DK, Martens-Nielsen J. The prehospital management of avalanche victims. J ROY ARMY MED CORPS 2015; 162:406-412. [PMID: 26092971 DOI: 10.1136/jramc-2015-000441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 12/26/2022]
Abstract
Avalanche accidents are frequently lethal events with an overall mortality of 23%. Mortality increases dramatically to 50% in instances of complete burial. With modern day dense networks of ambulance services and rescue helicopters, health workers often become involved during the early stages of avalanche rescue. Historically, some of the most devastating avalanche accidents have involved military personnel. Armed forces are frequently deployed to mountain regions in order to train for mountain warfare or as part of ongoing conflicts. Furthermore, military units are frequently called to assist civilian organised rescue in avalanche rescue operations. It is therefore important that clinicians associated with units operating in mountain regions have an understanding of, the medical management of avalanche victims, and of the preceding rescue phase. The ensuing review of the available literature aims to describe the pathophysiology particular to avalanche victims and to outline a structured approach to the search, rescue and prehospital medical management.
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Affiliation(s)
- Daniel K Kornhall
- Anesthesia and Critical Care Research Group, UIT-The Arctic University of Norway, Tromsø, Norway.,Department of Internal Medicine, Helgeland Hospital Trust, Sandnessjoen, Norway.,East Anglian Air Ambulance, Marshall Airfield, Cambridge, UK.,Department of Anaesthesiology, University Hospital of North Norway, Tromsoe, Norway.,Svolvaer Alpine Rescue Group, Svolvaer, Norway
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284
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Lubana SS, Genin DI, Singh N, De La Cruz A. Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:353-6. [PMID: 26054008 PMCID: PMC4464095 DOI: 10.12659/ajcr.893880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Opioid addiction and overdose is a serious problem worldwide. Fatal overdoses from opioids are responsible for numerous deaths and are increasing, especially if taken in combination with other psychoactive substances. Combined with environmental exposure, opioid overdose can cause profound hypothermia. Opioid abuse and other drugs of abuse impair thermoregulation, leading to severe hypothermia. Both drug overdose and severe hypothermia can cause cardiac arrest. CASE REPORT We report a case of 20-year-old man with history of polysubstance abuse presenting with severe hypothermia and asystole of unknown duration with return of spontaneous circulation (ROSC) achieved after 28 minutes of cardiopulmonary resuscitation (CPR). Urine toxicology was positive for cocaine, heroin, and benzodiazepine, along with positive blood alcohol level. The patient was rewarmed using non-invasive techniques. Hospital course was complicated by acute renal failure (ARF), severe rhabdomyolysis, severe hyperkalemia, ST-elevation myocardial infarction (STEMI), shock liver, coagulopathy, and aspiration pneumonia. CONCLUSIONS Survival with full cardiovascular and neurologic recovery after a cardiac arrest caused by drug overdose in the setting of severe hypothermia is still possible, even if the cardiac arrest is of unknown or prolonged duration. Patients with severe hypothermia experiencing cardiac arrest/hemodynamic instability can be rewarmed using non-invasive methods and may not necessarily need invasive rewarming techniques.
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Affiliation(s)
- Sandeep Singh Lubana
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Dennis Iilya Genin
- Department of Pulmonary and Critical Care, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Navdeep Singh
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Angel De La Cruz
- Department of Pulmonary and Critical Care, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
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285
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Delayed and intermittent CPR for severe accidental hypothermia. Resuscitation 2015; 90:46-9. [DOI: 10.1016/j.resuscitation.2015.02.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/20/2015] [Accepted: 02/07/2015] [Indexed: 01/10/2023]
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286
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Tsujimoto T, Yamamoto-Honda R, Kajio H, Kishimoto M, Noto H, Hachiya R, Kimura A, Kakei M, Noda M. Prediction of 90-day mortality in patients without diabetes by severe hypoglycemia: blood glucose level as a novel marker of severity of underlying disease. Acta Diabetol 2015; 52:307-14. [PMID: 25192953 PMCID: PMC4374114 DOI: 10.1007/s00592-014-0640-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/13/2014] [Indexed: 02/03/2023]
Abstract
AIM The present study examined the clinical conditions and predictors of death in non-diabetic patients with pre-hospital severe hypoglycemia. MATERIALS AND METHODS From January 2006 to March 2012, we retrospectively reviewed the medical records to assess the patients with pre-hospital severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms requiring the medical assistance of another person. The patients were followed up for 90 days after the severe hypoglycemia episode. RESULTS A total of 59,602 consecutive cases that visited the emergency room were screened, and 530 patients with severe hypoglycemia were included in the subsequent analysis. The mean blood glucose levels in the non-diabetes (non-DM, n = 163) and diabetes (DM, n = 367) groups were 42.9 and 33.7 mg/dL, respectively. The incidence of extremely abnormal QT prolongation (corrected QT interval ≥0.50 s) was high in both groups [22.1 vs. 14.7 % (P = 0.11)]. Mortalities within 90 days after severe hypoglycemia were significantly higher in the non-DM group than in the DM group [20.3 vs. 1.6 % (P < 0.001)]. In addition to patient age, preexisting advanced liver disease and cancer, and the coexistence of sepsis, a blood glucose level of <40 mg/dL was identified as a strong predictor of death in the non-DM group using multivariate Cox proportional hazards models (hazard ratio 3.75; 95 % confidence interval 1.52-9.27; P = 0.004). CONCLUSIONS Death in non-diabetic patients with severe hypoglycemia was independently associated not only with age, advanced liver disease, cancer, and sepsis, but also with the blood glucose level upon arrival.
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Affiliation(s)
- Tetsuro Tsujimoto
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
- Division of General Medicine, Jichi Medical University Graduate School of Medicine, Tochigi, Japan
| | - Ritsuko Yamamoto-Honda
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | - Miyako Kishimoto
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Hiroshi Noto
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Remi Hachiya
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akio Kimura
- Department of Emergency Medicine and Critical Care, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masafumi Kakei
- Division of General Medicine, Jichi Medical University Graduate School of Medicine, Tochigi, Japan
- First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine, Saitama, Japan
| | - Mitsuhiko Noda
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
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287
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Hypothermia Evidence, Afterdrop, and Practical Experience. Wilderness Environ Med 2015; 26:437-9. [PMID: 25823604 DOI: 10.1016/j.wem.2015.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 12/18/2022]
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288
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Champion S, Voicu S, Deye N. Conséquences cardiovasculaires de l’hypothermie. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1054-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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289
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Henriksson O, Lundgren PJ, Kuklane K, Holmér I, Giesbrecht GG, Naredi P, Bjornstig U. Protection Against Cold in Prehospital Care: Wet Clothing Removal or Addition of a Vapor Barrier. Wilderness Environ Med 2015; 26:11-20. [DOI: 10.1016/j.wem.2014.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/28/2014] [Accepted: 07/02/2014] [Indexed: 10/24/2022]
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290
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Champigneulle B, Bellenfant-Zegdi F, Follin A, Lebard C, Guinvarch A, Thomas F, Pirracchio R, Journois D. Extracorporeal life support (ECLS) for refractory cardiac arrest after drowning: An 11-year experience. Resuscitation 2015; 88:126-31. [DOI: 10.1016/j.resuscitation.2014.11.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/19/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
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291
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Nouveautés dans les indications de l’ECMO veino-artérielle périphérique. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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292
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Kieboom JK, Verkade HJ, Burgerhof JG, Bierens JJ, Rheenen PFV, Kneyber MC, Albers MJ. Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia: Dutch nationwide retrospective cohort study. BMJ 2015; 350:h418. [PMID: 25670715 PMCID: PMC4353310 DOI: 10.1136/bmj.h418] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation. DESIGN Nationwide retrospective cohort study. SETTING Emergency departments and paediatric intensive care units of the eight university medical centres in the Netherlands. PARTICIPANTS Children aged up to 16 with cardiac arrest and hypothermia after drowning, who presented at emergency departments and/or were admitted to intensive care. MAIN OUTCOME MEASURE Survival and neurological outcome one year after the drowning incident. Poor outcome was defined as death or survival in a vegetative state or with severe neurological disability (paediatric cerebral performance category (PCPC) ≥ 4). RESULTS From 1993 to 2012, 160 children presented with cardiac arrest and hypothermia after drowning. In 98 (61%) of these children resuscitation was performed for more than 30 minutes (98/160, median duration 60 minutes), of whom 87 (89%) died (95% confidence interval 83% to 95%; 87/98). Eleven of the 98 children survived (11%, 5% to 17%), but all had a PCPC score ≥ 4. In the 62 (39%) children who did not require prolonged resuscitation, 17 (27%, 16% to 38%) survived with a PCPC score ≤ 3 after one year: 10 (6%) had a good neurological outcome (score 1), five (3%) had mild neurological disability (score 2), and two (1%) had moderate neurological disability (score 3). From the original 160 children, only 44 were alive at one year with any outcome. CONCLUSIONS Drowned children in whom return of spontaneous circulation is not achieved within 30 minutes of advanced life support have an extremely poor outcome. Good neurological outcome is more likely when spontaneous circulation returns within 30 minutes of advanced life support, especially when the drowning incident occurs in winter. These findings question the therapeutic value of resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia.
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Affiliation(s)
- J K Kieboom
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands
| | - H J Verkade
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands
| | - J G Burgerhof
- Department of Epidemiology University Medical Centre Groningen, University of Groningen, Netherlands
| | - J J Bierens
- Van Heurnlaan 10-Anaesthesiology, Vught, Netherlands
| | - P F van Rheenen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands
| | - M C Kneyber
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Netherlands
| | - M J Albers
- Department of Paediatrics, St Elizabeth's Hospital, Tilburg, Netherlands
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293
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Kosiński S, Darocha T, Gałązkowski R, Drwiła R. Accidental hypothermia in Poland – estimation of prevalence, diagnostic methods and treatment. Scand J Trauma Resusc Emerg Med 2015; 23:13. [PMID: 25655922 PMCID: PMC4328070 DOI: 10.1186/s13049-014-0086-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of hypothermia is difficult to evaluate, and the data concerning the morbidity and mortality rates do not seem to fully represent the problem. The aim of the study was to estimate the actual prevalence of accidental hypothermia in Poland, as well as the methods of diagnosis and management procedures used in emergency rooms (ERs). METHODS A specially designed questionnaire, consisting of 14 questions, was mailed to all the 223 emergency rooms (ER) in Poland. The questions concerned the incidence, methods of diagnosis and risk factors, as well as the rewarming methods used and available measurement instruments. RESULTS The analysis involved data from 42 ERs providing emergency healthcare for the population of 5,305,000. The prevalence of accidental hypothermia may have been 5.05 cases per 100.000 residents per year. Among the 268 cases listed 25% were diagnosed with codes T68, T69 or X31, and in 75% hypothermia was neither included nor assigned a code in the final diagnosis. The most frequent cause of hypothermia was exposure to cold air alongside ethanol abuse (68%). Peripheral temperature was measured in 57%, core temperature measurement was taken in 29% of the patients. Peripheral temperature was measured most often at the axilla, while core temperature measurement was predominantly taken rectally. Mild hypothermia was diagnosed in 75.5% of the patients, moderate (32-28°C) in 16.5%, while severe hypothermia (less than 28°C) in 8% of the cases. Cardiopulmonary resuscitation was carried out in 7.5% of the patients. The treatment involved mainly warmed intravenous fluids (83.5%) and active external rewarming measures (70%). In no case was extracorporeal rewarming put to use. CONCLUSIONS The actual incidence of accidental hypothermia in Polish emergency departments may exceed up to four times the official data. Core temperature is taken only in one third of the patients, the treatment of hypothermic patients is rarely conducted in intensive care wards and extracorporeal rewarming techniques are not used. It may be expected that personnel education and the development of management procedures will brighten the prognosis and increase the survival rate in accidental hypothermia.
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294
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Afzali M, Viggers S. Full-scale simulation may be used to train medical students in disaster medicine. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2014.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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295
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[A large-scale accident in Alpine terrain]. Med Klin Intensivmed Notfmed 2015; 110:21-6. [PMID: 25680509 DOI: 10.1007/s00063-014-0412-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Due to the geographical conditions, large-scale accidents amounting to mass casualty incidents (MCI) in Alpine terrain regularly present rescue teams with huge challenges. Using an example incident, specific conditions and typical problems associated with such a situation are presented. DISCUSSION The first rescue team members to arrive have the elementary tasks of qualified triage and communication to the control room, which is required to dispatch the necessary additional support. Only with a clear "concept", to which all have to adhere, can the subsequent chaos phase be limited. In this respect, a time factor confounded by adverse weather conditions or darkness represents enormous pressure. Additional hazards are frostbite and hypothermia. If priorities can be established in terms of urgency, then treatment and procedure algorithms have proven successful. For evacuation of causalities, a helicopter should be strived for. Due to the low density of hospitals in Alpine regions, it is often necessary to distribute the patients over a wide area. CONCLUSION Rescue operations in Alpine terrain have to be performed according to the particular conditions and require rescue teams to have specific knowledge and expertise. The possibility of a large-scale accident should be considered when planning events. With respect to optimization of rescue measures, regular training and exercises are rational, as is the analysis of previous large-scale Alpine accidents.
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296
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Hypothermia and low body temperature are common and associated with high mortality in hip fracture patients. Hip Int 2015; 24:237-42. [PMID: 24619871 DOI: 10.5301/hipint.5000124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2013] [Indexed: 02/04/2023]
Abstract
Hip fractures remain one of the commonest injuries treated by orthopaedic surgeons. Despite recent initiatives, the fracture engenders a very high mortality. The UK National Hip Fracture Database reports a 30-day mortality of 8%. The pathophysiology that results in such high mortality remains imperfectly understood. The significance of thermal dysregulation in polytrauma is becoming increasingly recognised. Hypothermia is a common feature of polytrauma and is associated with adverse outcomes. No previous studies have explored the prevalence and outcomes of hip fracture patients with hypothermia and/or low body temperature. We sought to evaluate this. We prospectively collected the demographic details and admission tympanic temperature of all patients presenting to our institution with hip fracture. Patient mortality was also recorded. Seven hundred and eighty-one patients were included. The mean age was 80 years. 38% (300) had a temperature below 36.5°C. 4% (30) presented with a tympanic temperature greater than 37.5°C. The 30-day mortality for patients with a normal admission temperature (between 36.5° and 37.5°C) was 5.1%. This value was 15.3% for those whose admission temperature was less than 36.5°C (p<0.0001). Correcting for potential confounders of age and gender, those with an admission temperature of less than 36.5°C had a 2.8 fold increase in the odds of mortality at 30-days compared with those with an admission temperature of between 36.5° and 37.5°C (p<0.0005). Low body temperature is strongly linked to 30-day mortality in hip fracture patients.
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297
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Moroder L, Mair B, Brugger H, Voelckel W, Mair P. Outcome of avalanche victims with out-of-hospital cardiac arrest. Resuscitation 2015; 89:114-8. [PMID: 25625778 DOI: 10.1016/j.resuscitation.2015.01.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
STUDY BACKGROUND Previous studies focused on the outcome of avalanche victims with out-of-hospital cardiac arrest (OHCA) after long duration of burial (>35min); the outcome of victims with short duration (≤35min) remains obscure. AIM OF THE STUDY To investigate outcome of avalanche victims with OHCA. METHODS Retrospective analysis of avalanche victims with OHCA between 2008 and 2013 in the Tyrolean Alps. RESULTS 55 avalanche victims were identified, 32 of whom were declared dead after extrication without cardiopulmonary resuscitation (CPR), all with long duration of burial. In the remaining 23 CPR was initiated at scene; three were partially and 20 completely buried, nine of whom suffered short and 11 long duration of burial. All nine victims with short duration of burial underwent restoration of spontaneous circulation (ROSC) at scene, four of them after bystander CPR, five after advanced life support by the emergency physician. Two patients with ROSC after short duration of burial and bystander CPR survived to hospital discharge with cerebral performance category 1. None of the 11 victims with long duration of burial survived to hospital discharge, although six were transported to hospital with ongoing CPR and three were supported with extracorporeal circulation. CONCLUSIONS In this case series survival with favourable neurological outcome was observed in avalanche victims with short duration of burial only if bystander CPR was immediately performed and ROSC achieved. Strategies for reducing avalanche mortality should focus on prompt extrication from the snow and immediate bystander CPR by uninjured companions.
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Affiliation(s)
- Luca Moroder
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Birgit Mair
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; Christophorus Emergency Medical Helicopter Service, Schubertring 1-3, 1010 Vienna, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Viale Druso 1, 39100 Bolzano, Italy
| | - Wolfgang Voelckel
- Christophorus Emergency Medical Helicopter Service, Schubertring 1-3, 1010 Vienna, Austria; Department of Anesthesiology and Critical Care Medicine, AUVA Trauma Hospital Salzburg, Dr.-Franz-Rehrl-Platz 4, 5010 Salzburg, Austria
| | - Peter Mair
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; Christophorus Emergency Medical Helicopter Service, Schubertring 1-3, 1010 Vienna, Austria.
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298
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Affiliation(s)
- Grant S Lipman
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building, M121, Redwood City, CA, 94305, USA,
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299
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Ginty C, Srivastava A, Rosenbloom M, Fowler S, Filippone L. Extracorporeal membrane oxygenation rewarming in the ED: an opportunity for success. Am J Emerg Med 2014; 33:857.e1-2. [PMID: 25534814 DOI: 10.1016/j.ajem.2014.11.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022] Open
Abstract
On average, approximately 1300 Americans die of hypothermia each year. Although accidental hypothermia is commonly associated with severely cold regions or mountain accident victims, hypothermia also commonly occurs in urban centers. Contributing factors often include homelessness, mental illness, and substance abuse. Hypothermia can profoundly affect the cardiovascular system. As the myocardium cools, the conduction system slows down,which results in prolongation of the QT interval as well as propensity for arrhythmias. Eventually, bradycardia, atrial fibrillation, and ventricular fibrillation (VF) can develop. The risk of cardiac arrest increases as the core temperature drops below 32°C and increases substantially when less than 28°C.
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Affiliation(s)
- Catherine Ginty
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103, USA.
| | - Adarsh Srivastava
- Department of Emergency Medicine, Division of Critical Care, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0769, USA.
| | - Michael Rosenbloom
- Department of Surgery, Division of Cardiothoracic Surgery, Cooper Medical School of Rowan University, Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103, USA.
| | - Sally Fowler
- Cooper University Hospital, Heart Institute, Cardiovascular Perfusion.
| | - Lisa Filippone
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103, USA.
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300
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Faizi M, Farrier AJ, Venkatesan M, Thomas C, Uzoigwe CE, Balasubramanian S, Smith RP. Is body temperature an independent predictor of mortality in hip fracture patients? Injury 2014; 45:1942-5. [PMID: 25458058 DOI: 10.1016/j.injury.2014.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/22/2014] [Accepted: 09/27/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Admission body temperature is a critical parameter in all trauma patients. Low admission temperature is strongly associated with adverse outcomes. We have previously shown, in a prospective study that low admission body temperature is common and associated with high mortality in hip fracture patients (Uzoigwe et al., 2014). However, no previous studies have evaluated whether admission temperature is an independent predictor of mortality in hip fracture patients after adjustment for the 7 recognised independent prognostic indicators (Maxwell et al., 2008). METHODS We retrospectively collated data on all patients presenting to our institution between June 2011 and February 2013 with a hip fracture. This included patients involved in the original prospective study (Uzoigwe et al., 2014). Admission tympanic temperature, measured on initial presentation at triage, was recorded. The prognosticators of age, gender, source of admission, abbreviated mental test score, haemoglobin, co-morbid disease and the presence or absence of malignancy were also recorded. Using multiple logistic regression, adjustment was made for these potentially confounding prognostic indicators of 30-day mortality, to determine if admission low body temperature were independently linked to mortality. RESULTS 1066 patients were included. 781 patients, involved in the original prospective study (Uzoigwe et al., 2014), presented in the relevant time frame and were included in the retrospective study. The mean age was 81. There were 273 (26%) men and 793 (74%) women. 407 (38%) had low body temperature (<36.5 °C). Adjustment was made for age, gender, source of admission, abbreviated mental test score, haemoglobin, co-morbid disease and the presence or absence of malignancy. Those with low body temperature had an adjusted odds ratio of 30-day mortality that was 2.1 times that of the euthermic (36.5–37.5 °C). CONCLUSIONS Low body temperature is strongly and independently associated with 30-day mortality in hip fracture patients.
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