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Bjertnæs LJ, Hindberg K, Næsheim TO, Suborov EV, Reierth E, Kirov MY, Lebedinskii KM, Tveita T. Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:641633. [PMID: 34055829 PMCID: PMC8155640 DOI: 10.3389/fmed.2021.641633] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/04/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: This systematic review and meta-analysis aims at comparing outcomes of rewarming after accidental hypothermic cardiac arrest (HCA) with cardiopulmonary bypass (CPB) or/and extracorporeal membrane oxygenation (ECMO). Material and Methods: Literature searches were limited to references with an abstract in English, French or German. Additionally, we searched reference lists of included papers. Primary outcome was survival to hospital discharge. We assessed neurological outcome, differences in relative risks (RR) of surviving, as related to the applied rewarming technique, sex, asphyxia, and witnessed or unwitnessed HCA. We calculated hypothermia outcome prediction probability score after extracorporeal life support (HOPE) in patients in whom we found individual data. P < 0.05 considered significant. Results: Twenty-three case observation studies comprising 464 patients were included in a meta-analysis comparing outcomes of rewarming with CPB or/and ECMO. One-hundred-and-seventy-two patients (37%) survived to hospital discharge, 76 of 245 (31%) after CPB and 96 of 219 (44 %) after ECMO; 87 and 75%, respectively, had good neurological outcomes. Overall chance of surviving was 41% higher (P = 0.005) with ECMO as compared with CPB. A man and a woman had 46% (P = 0.043) and 31% (P = 0.115) higher chance, respectively, of surviving with ECMO as compared with CPB. Avalanche victims had the lowest chance of surviving, followed by drowning and people losing consciousness in cold environments. Assessed by logistic regression, asphyxia, unwitnessed HCA, male sex, high initial body temperature, low pH and high serum potassium (s-K+) levels were associated with reduced chance of surviving. In patients displaying individual data, overall mean predictive surviving probability (HOPE score; n = 134) was 33.9 ± 33.6% with no significant difference between ECMO and CPB-treated patients. We also surveyed 80 case reports with 96 victims of HCA, who underwent resuscitation with CPB or ECMO, without including them in the meta-analysis. Conclusions: The chance of surviving was significantly higher after rewarming with ECMO, as compared to CPB, and in patients with witnessed compared to unwitnessed HCA. Avalanche victims had the lowest probability of surviving. Male sex, high initial body temperature, low pH, and high s-K+ were factors associated with low surviving chances.
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Affiliation(s)
- Lars J. Bjertnæs
- Anesthesia and Critical Care Research Group, University of Tromsø (UiT), The Arctic University of Norway, Tromsø, Norway
| | - Kristian Hindberg
- K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø (UiT), The Arctic University of Norway, Tromsø, Norway
| | - Torvind O. Næsheim
- Cardiovascular Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø (UiT), The Arctic University of Norway, Tromsø, Norway
| | - Evgeny V. Suborov
- The Nikiforov Russian Federation Center of Emergency and Radiation Medicine, St. Petersburg, Russia
| | - Eirik Reierth
- Science and Health Library, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Mikhail Y. Kirov
- Department of Anesthesiology and Intensive Care, Northern State Medical University, Arkhangelsk, Russia
| | - Konstantin M. Lebedinskii
- Department of Anesthesiology and Intensive Care, North-Western State Medical University Named After I. I. Mechnikov, St. Petersburg, Russia
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Torkjel Tveita
- Anesthesia and Critical Care Research Group, University of Tromsø (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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Abstract
Within the next 15 years, 1 in 5 Americans will be over age 65. $34 billion will be spent yearly on trauma care of this age group. This section covers situations in trauma unique to the geriatric population, who are often under-triaged and have significant injuries underestimated. Topics covered include age-related pathophysiological changes, underlying existing medical conditions and certain daily medications that increase the risk of serious injury in elderly trauma patients. Diagnostic evaluation of this group requires liberal testing, imaging, and a multidisciplinary team approach. Topics germane to geriatric trauma including hypothermia, elder abuse, and depression and suicide are also covered.
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Affiliation(s)
- Casper Reske-Nielsen
- Emergency Medicine, Boston Medical Center, Dowling 1 South, One Boston Medical Center Place, Boston, MA 02118, USA
| | - Ron Medzon
- Emergency Medicine, Boston Medical Center, Dowling 1 South, One Boston Medical Center Place, Boston, MA 02118, USA.
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Hatam EM, Cameron A, Petsikas D, Messenger D, Ball IM. A Case of Severe Accidental Hypothermia Successfully Treated with Cardiopulmonary Bypass. Clin Pract Cases Emerg Med 2017; 1:33-36. [PMID: 29849406 PMCID: PMC5965436 DOI: 10.5811/cpcem.2016.11.32919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 10/24/2016] [Accepted: 11/12/2016] [Indexed: 11/21/2022] Open
Abstract
After missing for seven days, a 34-year-old female was found with a rectal temperature of 19.8oC. Instead of attempting aggressive rewarming in the emergency department she was directly transferred to the operating room for extracorporeal rewarming. She received cardiopulmonary bypass (CPB) for 66 minutes at an initial warming rate of 12oC/ hour and warmed to 36.2oC. Her postoperative course was complicated by sepsis, which eventually led to bilateral below-knee amputations after refusing antibiotics. She was discharged 22 days after admission, with full neurologic recovery. This remarkable case highlights the emerging role of CPB as the definitive therapy for severe accidental hypothermia.
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Affiliation(s)
- Erfun M Hatam
- Western University, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Andrew Cameron
- University of Toronto, Department of Emergency Medicine, Toronto, Ontario, Canada
| | - Dimitri Petsikas
- Queen's University, Kingston General Hospital, Division of Cardiac Surgery, Kingston, Ontario, Canada
| | - David Messenger
- Queen's University, Department of Emergency Medicine & Critical Care Medicine, Kingston, Ontario, Canada
| | - Ian M Ball
- Western University, Department of Epidemiology and Biostatistics, Division of Critical Care Medicine, London, Ontario, Canada
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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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Coleman E, Doddakula K, Meeke R, Marshall C, Jahangir S, Hinchion J. An atypical case of successful resuscitation of an accidental profound hypothermia patient, occurring in a temperate climate. Perfusion 2010; 25:103-6. [DOI: 10.1177/0267659110366066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cases of accidental profound hypothermia occur most frequently in cold, northern climates. We describe an atypical case, occurring in a temperate climate, where a hypothermic cardiac—arrested patient was successfully resuscitated using extracorporeal circulation (ECC).
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Affiliation(s)
- E. Coleman
- Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland,
| | - K. Doddakula
- Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - R. Meeke
- Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - C. Marshall
- Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - S. Jahangir
- Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - J. Hinchion
- Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
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Machado C, Perez J, Scherle C, Areu A, Vazquez A. The brain is the target organ in cardiorespiratory reanimation. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.cacc.2009.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bonnet A, Rimmelé T, Afkir M, Baillon JJ, Christin F, Ber CE. Onde J d’Osborn et trouble du rythme cardiaque. Presse Med 2009; 38:1023-7. [DOI: 10.1016/j.lpm.2008.12.007] [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: 08/06/2008] [Revised: 11/25/2008] [Accepted: 12/15/2008] [Indexed: 10/20/2022] Open
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Wira CR, Becker JU, Martin G, Donnino MW. Anti-arrhythmic and vasopressor medications for the treatment of ventricular fibrillation in severe hypothermia: A systematic review of the literature. Resuscitation 2008; 78:21-9. [DOI: 10.1016/j.resuscitation.2008.01.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 01/10/2008] [Accepted: 01/22/2008] [Indexed: 11/30/2022]
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Gillart T, Loiseau S, Azarnoush K, Gonzalez D, Guelon D. Récupération sans séquelle après trois heures d’arrêt cardiaque en hypothermie à 22°C au décours d’un coma toxique. ACTA ACUST UNITED AC 2008; 27:510-3. [DOI: 10.1016/j.annfar.2008.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 04/15/2008] [Indexed: 10/21/2022]
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