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Soumagnac T, Raphalen JH, Bougouin W, Vimpere D, Ammar H, Yahiaoui S, Dagron C, An K, Mungur A, Carli P, Hutin A, Lamhaut L. Extracorporeal cardiopulmonary resuscitation for hypothermic refractory cardiac arrests in urban areas with temperate climates. Scand J Trauma Resusc Emerg Med 2023; 31:68. [PMID: 37907994 PMCID: PMC10619216 DOI: 10.1186/s13049-023-01126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Accidental hypothermia designates an unintentional drop in body temperature below 35 °C. There is a major risk of ventricular fibrillation below 28 °C and cardiac arrest is almost inevitable below 24 °C. In such cases, conventional cardiopulmonary resuscitation is often inefficient. In urban areas with temperate climates, characterized by mild year-round temperatures, the outcome of patients with refractory hypothermic out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) remains uncertain. METHODS We conducted a retrospective monocentric observational study involving patients admitted to a university hospital in Paris, France. We reviewed patients admitted between January 1, 2011 and April 30, 2022. The primary outcome was survival at 28 days with good neurological outcomes, defined as Cerebral Performance Category 1 or 2. We performed a subgroup analysis distinguishing hypothermic refractory OHCA as either asphyxic or non-asphyxic. RESULTS A total of 36 patients were analysed, 15 of whom (42%) survived at 28 days, including 13 (36%) with good neurological outcomes. Within the asphyxic subgroup, only 1 (10%) patient survived at 28 days, with poor neurological outcomes. A low-flow time of less than 60 min was not significantly associated with good neurological outcomes (P = 0.25). Prehospital ECPR demonstrated no statistically significant difference in terms of survival with good neurological outcomes compared with inhospital ECPR (P = 0.55). Among patients treated with inhospital ECPR, the HOPE score predicted a 30% survival rate and the observed survival was 6/19 (32%). CONCLUSION Hypothermic refractory OHCA occurred even in urban areas with temperate climates, and survival with good neurological outcomes at 28 days stood at 36% for all patients treated with ECPR. We found no survivors with good neurological outcomes at 28 days in submersed patients.
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Affiliation(s)
- Tal Soumagnac
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
- Sorbonne University, 21 rue de l'école de médecine, 75006, Paris, France
| | - Jean-Herlé Raphalen
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Wulfran Bougouin
- Jacques Cartier Hospital, 6 avenue du Noyer Lambert, Massy, 91300, France
- INSERM U970, Team 4 "Sudden Death Expertise Center"; 56 rue Leblanc, Paris, 75015, France
| | - Damien Vimpere
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Hatem Ammar
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Samraa Yahiaoui
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Christelle Dagron
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Kim An
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Akshay Mungur
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
| | - Pierre Carli
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
- Paris Cité University, 15 rue de l'Ecole de Médecine, Paris, 75006, France
| | - Alice Hutin
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France
- INSERM U955, Team 3; 1 rue Gustave Eiffel, Créteil, 94000, France
| | - Lionel Lamhaut
- SAMU de Paris-ICU, Necker University Hospital, 149 rue des Sèvres, Paris, 75015, France.
- INSERM U970, Team 4 "Sudden Death Expertise Center"; 56 rue Leblanc, Paris, 75015, France.
- Paris Cité University, 15 rue de l'Ecole de Médecine, Paris, 75006, France.
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Prekker ME, Rischall M, Carlson M, Driver BE, Touroutoutoudis M, Boland J, Hu M, Heather B, Simpson NS. Extracorporeal membrane oxygenation versus conventional rewarming for severe hypothermia in an urban emergency department. Acad Emerg Med 2023; 30:6-15. [PMID: 36000288 DOI: 10.1111/acem.14585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/28/2022] [Accepted: 08/19/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Severe hypothermia (core body temperature < 28°C) is life-threatening and predisposes to cardiac arrest. The comparative effectiveness of different active internal rewarming methods in an urban U.S. population is unknown. We aim to compare outcomes between hypothermic emergency department (ED) patients rewarmed conventionally using an intravascular rewarming catheter or warm fluid lavage versus those rewarmed using extracorporeal membrane oxygenation (ECMO). METHODS We performed a retrospective cohort analysis of adults with severe hypothermia due to outdoor exposure presenting to an urban ED in Minnesota, 2007-2021. The primary outcome was hospital survival. We also calculated the rewarming rate in the 4 h after ED arrival and compared these data between patients rewarmed with ECMO (the extracorporeal rewarming group) versus without ECMO (the conventional rewarming group). We repeated these analyses in the subgroup of patients with cardiac arrest. RESULTS We analyzed 44 hypothermic ED patients: 25 patients in the extracorporeal rewarming group (median temperature 24.1°C, 84% with cardiac arrest) and 19 patients in the conventional rewarming group (median temperature 26.3°C, 37% with cardiac arrest; 89% received an intravascular rewarming catheter). The median rewarming rate was greater in the extracorporeal versus conventional group (2.3°C/h vs. 1.5°C/h, absolute difference 0.8°C/h, 95% confidence interval [CI] 0.3-1.2°C/h) yet hospital survival was similar (68% vs. 74%). Among patients with cardiac arrest, hospital survival was greater in the extracorporeal versus conventional group (71% vs. 29%, absolute difference 42%, 95% CI 4%-82%). CONCLUSIONS Among ED patients with severe hypothermia and cardiac arrest, survival was significantly higher with ECMO versus conventional rewarming. Among all hypothermic patients, ECMO use was associated with faster rewarming than conventional methods.
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Affiliation(s)
- Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.,Division of Pulmonary and Critical Care, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Megan Rischall
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Michelle Carlson
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | | | - Jessica Boland
- Department of Critical Care Medicine, Allina Health, Minneapolis, Minnesota, USA
| | - Michael Hu
- Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Beth Heather
- Critical Care Nursing and the Extracorporeal Life Support Program, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Nicholas S Simpson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.,Hennepin Emergency Medical Services, Minneapolis, Minnesota, USA
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3
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Yoshimura S, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Yagi Y, Kishimoto M, Kim SH, Hayashi Y, Sogabe T, Morooka T, Sakamoto H, Suzuki K, Nakamura F, Matsuyama T, Okada Y, Nishioka N, Matsui S, Kimata S, Kawai S, Makino Y, Kitamura T, Iwami T. Association between initial body temperature on hospital arrival and neurological outcome among patients with out-of-hospital cardiac arrest: a multicenter cohort study (the CRITICAL study in Osaka, Japan). BMC Emerg Med 2022; 22:84. [PMID: 35568800 PMCID: PMC9107729 DOI: 10.1186/s12873-022-00641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background The association between spontaneous initial body temperature on hospital arrival and neurological outcomes has not been sufficiently studied in patients after out-of-hospital cardiac arrest (OHCA). Methods From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all patients with OHCA of medical origin aged > 18 years for whom resuscitation was attempted and who were transported to participating hospitals between 2012 and 2019. We excluded patients who were not witnessed by bystanders and treated by a doctor car or helicopter, which is a car/helicopter with a physician. The patients were categorized into three groups according to their temperature on hospital arrival: ≤35.9 °C, 36.0–36.9 °C (normothermia), and ≥ 37.0 °C. The primary outcome was 1-month survival, with a cerebral performance category of 1 or 2. Multivariable logistic regression analyses were performed to evaluate the association between temperature and outcomes (normothermia was used as the reference). We also assessed this association using cubic spline regression analysis. Results Of the 18,379 patients in our database, 5014 witnessed adult OHCA patients of medical origin from 16 hospitals were included. When analyzing 3318 patients, OHCA patients with an initial body temperature of ≥37.0 °C upon hospital arrival were associated with decreased favorable neurological outcomes (6.6% [19/286] odds ratio, 0.51; 95% confidence interval, 0.27–0.95) compared to patients with normothermia (16.4% [180/1100]), whereas those with an initial body temperature of ≤35.9 °C were not associated with decreased favorable neurological outcomes (11.1% [214/1932]; odds ratio, 0.78; 95% confidence interval, 0.56–1.07). The cubic regression splines demonstrated that a higher body temperature on arrival was associated with decreased favorable neurological outcomes, and a lower body temperature was not associated with decreased favorable neurological outcomes. Conclusions In adult patients with OHCA of medical origin, a higher body temperature on arrival was associated with decreased favorable neurologic outcomes.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan
| | - Changhwi Park
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Tetsuro Nishimura
- Department of Critical Care Medicine, Osaka City University, Osaka, Japan
| | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka-, Sayama, Japan
| | - Yoshiki Yagi
- Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-, Osaka, Japan
| | - Sung-Ho Kim
- Senshu Trauma and Critical Care Center, Osaka, Japan
| | - Yasuyuki Hayashi
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Haruko Sakamoto
- Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan
| | - Keitaro Suzuki
- Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yohei Okada
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shunsuke Kimata
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Shunsuke Kawai
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Yuto Makino
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taku Iwami
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan, Postal code: 606-8501, YoshidaHonmachi, Sakyo, Kyoto, Japan.
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Liu C, Yuan D, Crawford R, Sarkar R, Hu B. Directly Cooling Gut Prevents Mortality in the Rat Model of Reboa Management of Lethal Hemorrhage. Shock 2021; 56:813-823. [PMID: 33555843 PMCID: PMC8329109 DOI: 10.1097/shk.0000000000001744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving technique for the management of lethal torso hemorrhage. Its benefit, however, must be weighed against the lethal distal organ ischemia-reperfusion injury (IRI). This study uses a novel direct gut cooling technique to manage the distal organ IRI. METHODS A rat lethal hemorrhage model was established by bleeding of 50% of the estimated total blood volume via inferior vena cava. A novel TransRectal Intra-Colon (TRIC) temperature management device was positioned in the descending colon either to maintain intra-colon temperature at 37°C or 12°C. The upper body temperature was maintained at as close to 37°C as possible in both groups. A 2F Fogarty balloon catheter was inserted via the femoral artery into the descending thoracic aorta for the implementation of REBOA. After REBOA, the balloon was deflated, and the shed blood was returned. The temperature managements were continued for additional 180 to 270 min during the post-REBOA period. RESULTS All rats subjected to REBOA management of lethal hemorrhage at 37°C had severe histopathological gut and abdominal organ IRI, severe functional deficits, and died within 24 h with 100% mortality. By contrast, directly cooling the colon to 10°C to 12°C with the novel TRIC device abolished mortality, and dramatically improved ABG parameters, prevented the abdominal organ injury, and reduced the functional deficits during the 7-day post-REBOA period. CONCLUSIONS Direct trans-rectal colon cooling during REBOA management of lethal hemorrhage offers extraordinary functional improvement and amazing tissue protection, and abolishes mortality.
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Affiliation(s)
- Chunli Liu
- Veterans Affairs Maryland Health Center System,10 North Greene Street, Baltimore, MD 21201
| | - Dong Yuan
- Departments of Anesthesiology and Surgery, Shock Trauma and Anesthesiology Research Center University of Maryland School of Medicine, Baltimore, MD
| | - Robert Crawford
- Departments of Anesthesiology and Surgery, Shock Trauma and Anesthesiology Research Center University of Maryland School of Medicine, Baltimore, MD
| | - Rajabrata Sarkar
- Departments of Anesthesiology and Surgery, Shock Trauma and Anesthesiology Research Center University of Maryland School of Medicine, Baltimore, MD
| | - Bingren Hu
- Departments of Anesthesiology and Surgery, Shock Trauma and Anesthesiology Research Center University of Maryland School of Medicine, Baltimore, MD
- Veterans Affairs Maryland Health Center System,10 North Greene Street, Baltimore, MD 21201
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5
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Walpoth BH, Maeder MB, Courvoisier DS, Meyer M, Cools E, Darocha T, Blancher M, Champly F, Mantovani L, Lovis C, Mair P. Hypothermic Cardiac Arrest - Retrospective cohort study from the International Hypothermia Registry. Resuscitation 2021; 167:58-65. [PMID: 34416307 DOI: 10.1016/j.resuscitation.2021.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/01/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
AIM The International Hypothermia Registry (IHR) was created to increase knowledge of accidental hypothermia, particularly to develop evidence-based guidelines and find reliable outcome predictors. The present study compares hypothermic patients with and without cardiac arrest included in the IHR. METHODS Demographic, pre-hospital and in-hospital data, method of rewarming and outcome data were collected anonymously in the IHR between 2010 and 2020. RESULTS Two hundred and one non-consecutive cases were included. The major causeof hypothermia was mountain accidents, predominantly in young men. Hypothermic Cardiac Arrest (HCA) occurred in 73 of 201 patients. Core temperature was significantly lower in the patients in cardiac arrest (25.0 vs. 30.0 °C, p < 0.001). One hundred and fifteen patients were rewarmed externally (93% with ROSC), 53 by extra-corporeal life support (ECLS) (40% with ROSC) and 21 with invasive internal techniques (71% with ROSC). The overall survival rate was 95% for patients with preserved circulation and 36% for those in cardiac arrest. Witnessed cardiac arrest and ROSC before rewarming were positive outcome predictors, asphyxia, coagulopathy, high potassium and lactate negative outcome predictors. CONCLUSIONS This first analysis of 201 IHR patients with moderate to severe accidental hypothermia shows an excellent 95% survival rate for patients with preserved circulation and 36% for HCA patients. Witnessed cardiac arrest, restoration of spontaneous circulation, low potassium and lactate and absence of asphyxia were positive survival predictors despite hypothermia in young, healthy adults after mountaineering accidents. However, accidental hypothermia is a heterogenous entity that should be considered in both treatment strategies and prognostication.
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Affiliation(s)
- Beat H Walpoth
- Dept. of Cardiovascular Surgery, University Hospitals, Geneva, Switzerland (Emeritus).
| | - Monika Brodmann Maeder
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland; Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | | | - Marie Meyer
- Dept. of Anesthesia, University Hospital, Lausanne, Switzerland
| | - Evelien Cools
- Division of Anesthesia, University Hospitals, Geneva, Switzerland
| | - Tomasz Darocha
- Dept. Anesthesiology & Intensive Care, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Christian Lovis
- Division of Medical Information Sciences, University Hospitals, Geneva, Switzerland
| | - Peter Mair
- Dept. of Anesthesia, University Hospitals, Innsbruck, Austria
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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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7
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Friess JO, Gisler F, Kadner A, Jenni H, Eberle B, Erdoes G. The use of minimal invasive extracorporeal circulation for rewarming after accidental hypothermia and circulatory arrest. Acta Anaesthesiol Scand 2021; 65:633-638. [PMID: 33529359 DOI: 10.1111/aas.13790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/04/2021] [Accepted: 01/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation has become a recommended treatment option for patients with severe hypothermia with cardiac arrest. Minimal invasive extracorporeal circulation (MiECC) may offer advantages over the current standard extracorporeal membrane oxygenation (ECMO). METHODS Retrospective cohort analysis of hospital database for patients with accidental hypothermia and extracorporeal rewarming with MiECC admitted between 2010 and 2019. RESULTS Overall, six of 17 patients survived to hospital discharge. Eleven patients suffered accidental hypothermia in an alpine and six in an urban setting. Sixteen patients arrived at the hospital under ongoing cardiopulmonary resuscitation (CPR). CPR time was 90 minutes (0-150). Four patients survived from an alpine setting and two from an urban setting with CPR duration of 90 minutes (0-150) and 85 minutes (25-100), respectively. Asphyctic patients tended to have lower survival (one of seven patients). Two patients of six with major trauma survived. CONCLUSION MiECC for extracorporeal rewarming from severe accidental hypothermia is a feasible alternative to ECMO, with comparable survival rates.
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Affiliation(s)
- Jan O. Friess
- Department of Anaesthesiology and Pain Medicine InselspitalBern University HospitalUniversity of Bern Bern Switzerland
| | - Fabian Gisler
- Department of Cardiovascular Surgery, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - Hansjoerg Jenni
- Department of Cardiovascular Surgery, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine InselspitalBern University HospitalUniversity of Bern Bern Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine InselspitalBern University HospitalUniversity of Bern Bern Switzerland
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8
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Podsiadło P, Darocha T, Svendsen ØS, Kosiński S, Silfvast T, Blancher M, Sawamoto K, Pasquier M. Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review. Artif Organs 2020; 45:222-229. [PMID: 32920881 DOI: 10.1111/aor.13818] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/12/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
Prolonged cardiac arrest (CA) may lead to neurologic deficit in survivors. Good outcome is especially rare when CA was unwitnessed. However, accidental hypothermia is a very specific cause of CA. Our goal was to describe the outcomes of patients who suffered from unwitnessed hypothermic cardiac arrest (UHCA) supported with Extracorporeal Life Support (ECLS). We included consecutive patients' cohorts identified by systematic literature review concerning patients suffering from UHCA and rewarmed with ECLS. Patients were divided into four subgroups regarding the mechanism of cooling, namely: air exposure; immersion; submersion; and avalanche. A statistical analysis was performed in order to identify the clinical parameters associated with good outcome (survival and absence of neurologic impairment). A total of 221 patients were included into the study. The overall survival rate was 27%. Most of the survivors (83%), had no neurologic deficit. Asystole was the presenting CA rhythm in 48% survivors, of which 79% survived with good neurologic outcome. Variables associated with survival included the following: female gender (P < .001); low core temperature (P = .005); non-asphyxia-related mechanism of cooling (P < .001); pulseless electrical activity as an initial rhythm (P < .001); high blood pH (P < .001); low lactate levels (P = .003); low serum potassium concentration (P < .001); and short resuscitation duration (P = .004). Severely hypothermic patients with unwitnessed CA may survive with good neurologic outcome, including those presenting as asystole. The initial blood pH, potassium, and lactate concentration may help predict outcome in hypothermic CA.
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Affiliation(s)
- Paweł Podsiadło
- Department of Emergency Medicine, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Øyvind S Svendsen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Tom Silfvast
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marc Blancher
- Department of Emergency Medicine, SAMU 38, University Hospital of Grenoble Alps, Grenoble, France
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
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9
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Puzio TJ, Chrobak D, Jawed Y, Tripathy P, Carlos W. Severe Accidental Hypothermia Managed with Continuous Venovenous Hemofiltration. Am Surg 2020. [DOI: 10.1177/000313482008600131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thaddeus J. Puzio
- Division of Acute Care Surgery University of Texas Health Science Center at Houston Houston, Texas
| | - David Chrobak
- Department of Internal Medicine Indiana University School of Medicine Indianapolis, Indiana
| | - Yameena Jawed
- Department of Internal Medicine Indiana University School of Medicine Indianapolis, Indiana
| | - Purnima Tripathy
- Department of Internal Medicine Indiana University School of Medicine Indianapolis, Indiana
| | - William Carlos
- Department of Internal Medicine Indiana University School of Medicine Indianapolis, Indiana
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10
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Willmore R. Cardiac Arrest Secondary to Accidental Hypothermia: Who Should We Resuscitate? Air Med J 2020; 39:205-211. [PMID: 32540113 DOI: 10.1016/j.amj.2019.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 06/11/2023]
Abstract
Cardiac arrest with a degree of concurrent hypothermia is not a rare presentation. This presentation, often in remote areas, poses a challenge for the prehospital physician because the cause of the arrest will significantly alter decision making and prognostication. Survival from cardiac arrest secondary to accidental hypothermia is significantly greater than that of normothermic arrests when appropriate triage and management decisions are made. The complexity of this decision benefits from a specific algorithm to follow in the event of such a casualty presenting. This article systematically reviews the literature on cardiac arrest secondary to accidental hypothermia and provides recommendations in addition to a novel algorithm to aid the responding prehospital clinician in deciding if a hypothermic resuscitation standard operating procedure should be implemented.
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Affiliation(s)
- Robert Willmore
- Institute of Pre-Hospital Care at London's Air Ambulance, The Royal London Hospital, London, UK.
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11
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Willmore R. Cardiac Arrest Secondary to Accidental Hypothermia: The Physiology Leading to Hypothermic Arrest. Air Med J 2020; 39:133-136. [PMID: 32197691 DOI: 10.1016/j.amj.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
Cardiac arrest secondary to accidental hypothermia is rare in the United Kingdom. However, some evidence suggests that it is under-reported; furthermore, recognizing hypothermia as the cause of death is difficult in the postmortem setting. Urban and rural residents are exposed to cold winter conditions both at home and while undertaking recreational activities. Understanding the physiology underpinning hypothermic cardiac arrest is crucial in order to make informed clinical decisions in regard to triage and management by air ambulance services and in prevention of this rare presentation. This article discusses the epidemiology and pathophysiology of accidental hypothermic to explain how personnel can survive after 8 hours 40 minutes of cardiac arrest.
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Affiliation(s)
- Robert Willmore
- Institute of Pre-Hospital Care at London's Air Ambulance, The Royal London Hospital, London, United Kingdom.
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12
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Kandori K, Okada Y, Matsuyama T, Morita S, Ehara N, Miyamae N, Jo T, Sumida Y, Okada N, Watanabe M, Nozawa M, Tsuruoka A, Fujimoto Y, Okumura Y, Kitamura T, Iiduka R. Prognostic ability of the sequential organ failure assessment score in accidental hypothermia: a multi-institutional retrospective cohort study. Scand J Trauma Resusc Emerg Med 2019; 27:103. [PMID: 31718708 PMCID: PMC6849316 DOI: 10.1186/s13049-019-0681-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/31/2019] [Indexed: 12/05/2022] Open
Abstract
Background Severe accidental hypothermia (AH) is life threatening. Thus, prognostic prediction in AH is essential to rapidly initiate intensive care. Several studies on prognostic factors for AH are known, but none have been established. We clarified the prognostic ability of the Sequential Organ Failure Assessment (SOFA) score in comparison with previously reported prognostic factors among patients with AH. Methods The J-point registry database is a multi-institutional retrospective cohort study for AH in 12 Japanese emergency departments. From this registry, we enrolled patients who were treated at the intensive care unit (ICU) in various critical care medical centers. In-hospital mortality was the primary outcome. We investigated the discrimination ability of each candidate prognostic factor and the in-hospital mortality by applying the logistic regression models with areas under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI). Results Of the 572 patients with AH registered in the J-point registry, 220 were eligible for the analyses. The in-hospital mortality was 23.2%. The AUROC of the SOFA score (0.80; 95% CI: 0.72–0.86) was the highest among all factors. The other factors were serum potassium (0.65; 95% CI: 0.55–0.73), lactate (0.67; 95% CI: 0.57–0.75), quick SOFA (qSOFA) (0.55; 95% CI: 0.46–0.65), systemic inflammatory response syndrome (SIRS) (0.60; 95% CI: 0.50–0.69), and 5A severity scale (0.77; 95% CI: 0.68–0.84). Discussion Although serum potassium and lactate had relatively good discrimination ability as mortality predictors, the SOFA score had slightly better discrimination ability. The reason is that lactate and serum potassium were mainly reflected by the hemodynamic state; conversely, the SOFA score is a comprehensive score of organ failure, basing on six different scores from the respiratory, cardiovascular, hepatic, coagulation, renal, and neurological systems. Meanwhile, the qSOFA and SIRS scores underestimated the severity, with low discrimination abilities for mortality. Conclusions The SOFA score demonstrated better discrimination ability as a mortality predictor among all known prognostic factors in patients with AH.
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Affiliation(s)
- Kenji Kandori
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, Kyoto, Japan
| | - Yohei Okada
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, Kyoto, Japan. .,Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Morita
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Naoki Ehara
- Department of Emergency, Japanese Red Cross Society, Kyoto Daiichi Red Cross Hospital, Kyoto, Japan
| | - Nobuhiro Miyamae
- Department of Emergency Medicine, Rakuwa-kai Otowa Hospital, Kyoto, Japan
| | - Takaaki Jo
- Department of Emergency Medicine, Uji-Tokushukai Medical Center, Uji, Japan
| | - Yasuyuki Sumida
- Department of Emergency Medicine, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Makoto Watanabe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Nozawa
- Department of Emergency and Critical Care Medicine, Saiseikai Shiga Hospital, Ritto, Japan
| | - Ayumu Tsuruoka
- Department of Emergency and Critical Care Medicine, Kyoto Min-Iren Chuo Hospital, Kyoto, Japan
| | - Yoshihiro Fujimoto
- Department of Emergency Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Yoshiki Okumura
- Department of Emergency Medicine, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ryoji Iiduka
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, Kyoto, Japan
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13
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Mwaura L, Rubino A, Vuylsteke A. No Cold Death-Extracorporeal Life Support for All Victims of Accidental Hypothermia. J Cardiothorac Vasc Anesth 2019; 34:372-373. [PMID: 31587930 DOI: 10.1053/j.jvca.2019.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/07/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Lucy Mwaura
- Department of Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Antonio Rubino
- Department of Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Alain Vuylsteke
- Department of Anesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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14
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Ting DK, Brown DJA. Use of extracorporeal life support for active rewarming in a hypothermic, nonarrested patient with multiple trauma. CMAJ 2019; 190:E718-E721. [PMID: 29891476 DOI: 10.1503/cmaj.180117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Daniel K Ting
- Department of Emergency Medicine (Ting), University of British Columbia, Kelowna, BC; Department of Emergency Medicine (Brown), University of British Columbia, Vancouver BC
| | - Douglas J A Brown
- Department of Emergency Medicine (Ting), University of British Columbia, Kelowna, BC; Department of Emergency Medicine (Brown), University of British Columbia, Vancouver BC
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15
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Mazur P, Kosiński S, Podsiadło P, Jarosz A, Przybylski R, Litiwnowicz R, Piątek J, Konstanty-Kalandyk J, Gałązkowski R, Darocha T. Extracorporeal membrane oxygenation for accidental deep hypothermia-current challenges and future perspectives. Ann Cardiothorac Surg 2019; 8:137-142. [PMID: 30854323 DOI: 10.21037/acs.2018.10.12] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The incidence of accidental hypothermia (core temperature ≤35 °C) is difficult to estimate, as the affected population is heterogeneous. Both temperature and clinical presentation should be considered while determining severity, which is difficult in a prehospital setting. Extracorporeal rewarming is advocated for all Swiss Staging System class IV (hypothermic cardiac arrest) and class III (hypothermic cardiac instability) patients. Veno-arterial extracorporeal membrane oxygenation (ECMO) is the method of choice, as it not only allows a gradual, controlled increase of core body temperature, but also provides respiratory and hemodynamic support during the unstable period of rewarming and reperfusion. This poses difficulties with the coordination of patient management, as usually only cardiac referral centers can deliver such advanced treatment. Further special considerations apply to subgroups of patients, including drowning or avalanche victims. The principle of ECMO implantation in severely hypothermic patients is no different from any other indication, although establishing vascular access in a timely manner during ongoing resuscitation and maintaining adequate flow may require modification of the operating technique, as well as aggressive fluid resuscitation. Further studies are needed in order to determine the optimal rewarming rate and flow that would favor brain and lung protection. Recent analysis shows an overall survival rate of 40.3%, while additional prognostic factors are being sought for determining those patients in whom the treatment is futile. New cannulas, along with ready-to-use ECMO sets, are being developed that would enable easy, safe and efficient out-reach ECMO implantation, thus shortening resuscitation times. Moreover, national guidelines for the management of accidental hypothermia are needed in order that all patients that would benefit from extracorporeal rewarming would be provided with such treatment. In this perspective article, we discuss burning problems in ECMO therapy in hypothermic patients, outlining the important research goals to improve the outcomes.
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Affiliation(s)
- Piotr Mazur
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Paweł Podsiadło
- Emergency Medicine Department, Jan Kochanowski University, Kielce, Poland
| | - Anna Jarosz
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland
| | - Roman Przybylski
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland
| | - Radosław Litiwnowicz
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland
| | - Jacek Piątek
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland
| | - Janusz Konstanty-Kalandyk
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Cracow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Silesia, Katowice, Poland
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16
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Beyond the limits - ECPR in putative fatal circumstances. CAN J EMERG MED 2018; 20:S70-S73. [DOI: 10.1017/cem.2018.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe eligibility criteria for applying extracorporeal cardiopulmonary resuscitation (ECPR) in patients with cardiac arrest are currently unclear. For those patients with hypothermic cardiac arrest, the European Resuscitation Council (ERC) Guidelines recommend considering ECPR only for patients with potassium <8 mmol/L and a body temperature below 32°C, whereas the American Heart Association Guidelines (AHA) do not express this in a specific manner.We report the case of an urban unwitnessed out-of-hospital cardiac arrest patient found with her head immersed in water at a temperature of 23°C. The patient presented an unclear history and a dire combination of clinical and laboratory parameters (asystole, arterial blood gas: pH 6.8, potassium 8.3 mmol/L, lactate 16.0 mmol/L). Despite these poor prognostic indicators, ECPR was initiated after 95 minutes of CPR and the patient survived with a good neurological outcome.This case highlights the uncertainty in ECPR eligibility and prognostication, especially in those with hypothermia and water immersion for whom aggressive therapies may be warranted. Further data and improved strategies are required to delineate candidacy for this resource-intensive procedure better.
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17
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Paal P, Rauch S. Indoor accidental hypothermia in the elderly: an emerging lethal entity in the 21st century. Emerg Med J 2018; 35:667-668. [PMID: 30158146 DOI: 10.1136/emermed-2018-207804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, EURAC research, Bolzano, Italy.,Department of Anaesthesiology, University Hospital LMU, Munich, Germany.,Department of Sports Science, Medical Section, University of Innsbruck, Innsbruck, Austria
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18
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Hadziselimovic E, Thomsen JH, Kjaergaard J, Køber L, Graff C, Pehrson S, Nielsen N, Erlinge D, Frydland M, Wiberg S, Hassager C. Osborn waves following out-of-hospital cardiac arrest—Effect of level of temperature management and risk of arrhythmia and death. Resuscitation 2018; 128:119-125. [DOI: 10.1016/j.resuscitation.2018.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/15/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
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19
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Okada Y, Matsuyama T, Morita S, Ehara N, Miyamae N, Jo T, Sumida Y, Okada N, Kitamura T, Iiduka R. Prognostic factors for patients with accidental hypothermia: A multi-institutional retrospective cohort study. Am J Emerg Med 2018; 37:565-570. [PMID: 29950275 DOI: 10.1016/j.ajem.2018.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION In cases of severe accidental hypothermia (AH) in urban areas, the prognostic factors are unknown. We identified factors associated with in-hospital mortality in patients with moderate-to-severe AH in urban areas of Japan. METHOD The J-Point registry database is a multi-institutional retrospective cohort study for AH in 12 Japanese emergency departments. From this registry, we enrolled patients whose core body temperature was 32 °C or less on admission. In-hospital death was the primary outcome of this study. We investigated the association between each candidate prognostic factor and in-hospital death by applying the multivariate logistic regression analyses with adjusted odds ratios (AORs) and their 95% confidence interval [CI] as the effect variables. RESULTS Of 572 patients registered in the J-point registry, 358 hypothermic patients were eligible for analyses. Median body temperature was 29.2 °C (interquartile range, 27.0 °C-30.8 °C). In-hospital deaths comprised 26.3% (94/358) of all study patients. Factors associated with in-hospital death were age ≥ 75 years (AOR, 3.09; 95% CI, 1.31-7.27), need for assistance with activities of daily living (ADL; AOR, 3.06; 95% CI, 1.68-5.59), hemodynamic instability (AOR, 2.49; 95% CI, 1.32-4.68), and hyperkalemia (≥5.6 mEq/L; AOR, 2.65; 95% CI, 1.13-6.21). CONCLUSION The independent prognostic factors associated with in-hospital mortality of patients with moderate-to-severe AH in urban areas of Japan were age ≥ 75 years, need for assistance with ADL, hemodynamic instability, and hyperkalemia.
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Affiliation(s)
- Yohei Okada
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Red Cross Hospital, Japan.
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Morita
- Senri Critical Care Medical Center, SaiseikaiSenri Hospital, Suita, Japan
| | - Naoki Ehara
- Department of Emergency, Japanese Red Cross Society Kyoto Daiichi Red Cross Hospital, Kyoto, Japan
| | - Nobuhiro Miyamae
- Department of Emergency Medicine, Rakuwa-kai Otowa Hospital, Kyoto, Japan
| | - Takaaki Jo
- Department of Emergency Medicine, Uji-Tokushukai Medical Center, Uji, Japan
| | - Yasuyuki Sumida
- Department of Emergency Medicine, North Medical Center, Kyoto Prefectural University of Medicine, Japan
| | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan
| | - Ryoji Iiduka
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Red Cross Hospital, Japan
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20
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Pasquier M, Hugli O, Paal P, Darocha T, Blancher M, Husby P, Silfvast T, Carron PN, Rousson V. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score. Resuscitation 2018; 126:58-64. [DOI: 10.1016/j.resuscitation.2018.02.026] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
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21
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Pirnes J, Ala-Kokko T. Accidental hypothermia: factors related to long-term hospitalization. A retrospective study from northern Finland. Intern Emerg Med 2017; 12:1225-1233. [PMID: 27677616 DOI: 10.1007/s11739-016-1547-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
Accidental hypothermia has a low incidence, but is associated with a high mortality rate. Knowledge about concomitant factors, complications, and length of hospital stay is limited. A retrospective cohort study on patients with accidental hypothermia admitted to Oulu University Hospital in Finland, over a 5-year period. Patients were categorized as short-stay patients (7 days or less) and long-stay patients (more than 7 days) according to their length of stay in hospital. From a total of 105 patients, 67 patients were included in the analyses. Alcohol abuse was the most common concomitant factor (54 %). Median length of hospital stay was 4 days, and 16 patients (24 %) stayed in hospital over 7 days (median 15 days). Thirty-day mortality was low (14/105, 13 %). Patients with long-term hospitalization had a lower initial temperature (28.4 versus 31.2 °C, p = 0.011), a lower level of consciousness (GCS score 8.4 versus 12.8, p = 0.003), more severe acidosis (pH 7.08 versus 7.28, p = 0.005, and lactate 7.2 versus 3.9, p = 0.043), and a lower level of platelets (183 versus 242, p = 0.041) on admission compared with short-stay patients. Thirty-six patients (54 %) had at least one complication, and this prolonged median hospital treatment for 2.5 days (p < 0.001). Alcohol is the most common concomitant factor and every fourth patient spends more than 7 days in hospital. Long-term hospitalization is related to a lower core temperature, lower consciousness, more severe lactic acidosis, lower platelet level and infections, rhabdomyolysis, and renal failure.
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Affiliation(s)
- Jari Pirnes
- Division of Intensive Care Medicine, and Medical Research Center Oulu, Department of Anaesthesiology, Oulu University Hospital and Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, Box 21, OUH, 90029, Oulu, Finland.
| | - Tero Ala-Kokko
- Division of Intensive Care Medicine, and Medical Research Center Oulu, Department of Anaesthesiology, Oulu University Hospital and Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Faculty, University of Oulu, Box 21, OUH, 90029, Oulu, Finland
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22
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Ruttmann E, Dietl M, Kastenberger T, El Attal R, Ströhle M, Ulmer H, Mair P. Characteristics and outcome of patients with hypothermic out-of-hospital cardiac arrest: Experience from a European trauma center. Resuscitation 2017; 120:57-62. [PMID: 28866108 DOI: 10.1016/j.resuscitation.2017.08.242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/03/2017] [Accepted: 08/29/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Aim of the study was to investigate patient characteristics, survival rates and neurological outcome among hypothermic patients with out-of-hospital cardiac arrest (OHCA) admitted to a trauma center. METHODS A review of patients with OHCA and a core temperature ≤32°C admitted to a trauma center between 2004 and 2016. RESULTS Ninety-six patients (mean temperature 25.8°C±3.9°C) were entered in the study, 37 (39%) of them after avalanche burial. 47% showed return of spontaneous circulation (ROSC) prior to hospital admission. Survival with Glasgow-Pittsburgh Cerebral Performance Category (CPC) scale 1 or 2 was achieved in 25% of all patients and was higher in non-avalanche than in avalanche cases (35.6% vs 8.1%, p=0.002). Witnessed cardiac arrest was the most powerful predictor of favourable neurological outcome (RR: 10.8; 95% Confidence Interval: 3.2-37.1; Wald: 14.3; p<0.001), whereas ROSC prior to admission and body core temperature were not associated with survival with favourable neurological outcome. Cerebral CT scan pathology within 12h of admission increased the risk for unfavourable neurological outcome 11.7 fold (RR: 11.7; 95% CI: 3.1-47.5; p<0.001). Favourable neurological outcome was associated lower S 100-binding protein (0.69±0.5μg/l vs 5.8±4.9μg/l, p 0.002) and neuron-specific enolase (34.7±14.2μg/l vs 88.4±42.7μg/l, p 0.004) concentrations on intensive care unit (ICU) admission. CONCLUSIONS Survival with favourable neurological outcome was found in about a third of all hypothermic non-avalanche patients with OHCA admitted to a trauma center.
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Affiliation(s)
- Elfriede Ruttmann
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Marion Dietl
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Tobias Kastenberger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Rene El Attal
- Department of Trauma Surgery, Academic Teaching Hospital Feldkirch, Carinnagasse 47, 6800 Feldkirch, Austria
| | - Mathias Ströhle
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics, and Health Economy, Medical University of Innsbruck, Schoepfstrasse 41, 6020 Innsbruck, Austria
| | - Peter Mair
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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23
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Benn K, Salman S, Page-Sharp M, Davis TME, Buttery JP. Bradycardia and Hypothermia Complicating Azithromycin Treatment. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:883-886. [PMID: 28798290 PMCID: PMC5562267 DOI: 10.12659/ajcr.905400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Male, 4 Final Diagnosis: Febrile neutropenia Symptoms: Fever Medication: Azithromycin Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Kerri Benn
- Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Sam Salman
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Madhu Page-Sharp
- School of Pharmacy, Curtin University of Technology, Bentley, Western Australia, Australia
| | - Timothy M E Davis
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Jim P Buttery
- Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
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24
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Little G. Accidental hypothermic cardiac arrest and rapid mediastinal warming with pleural lavage: a survivor after 3.5 hours of manual CPR. BMJ Case Rep 2017; 2017:bcr-2017-220900. [PMID: 28754760 DOI: 10.1136/bcr-2017-220900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 30-year-old man suffered post-traumatic hypothermic cardiac arrest. On arrival in the emergency department, rectal core temperature was 23°C. Manual cardiopulmonary resuscitation (CPR) was continued as no mechanical chest compression device was available, and active and passive rewarming was undertaken. Bilateral thoracostomies confirmed good lung inflation. Defibrillation and intravenous epinephrine were discontinued until core temperature was elevated above 30°C. Extracorporeal rewarming was unavailable. When no increase in rectal temperature was achieved after 90 min, an alternative oesophageal probe confirmed mediastinal temperature as 23°C. Bilateral chest drain insertion, followed by microwave-heated saline pleural lavage, rapidly raised the oesophageal temperature above 30°C with subsequent successful defibrillation, initially to pulseless electrical activity and finally return of spontaneous circulation 3.5 hours after the commencement of CPR. The patient recovered fully and was discharged without neurological deficit. Rapid mediastinal warming with pleural lavage should be considered in units with no access to extracorporeal rewarming service.
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Suen KF, Leung R, Leung LP. Therapeutic Hypothermia for Asphyxial Out-of-Hospital Cardiac Arrest Due to Drowning: A Systematic Review of Case Series and Case Reports. Ther Hypothermia Temp Manag 2017; 7:210-221. [PMID: 28570829 DOI: 10.1089/ther.2017.0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The objective of this review was to summarize published evidence of the effectiveness of therapeutic hypothermia in patients with drowning-associated asphyxial out-of-hospital cardiac arrest (OHCA) and to explore any preliminary favorable factors in the management of therapeutic hypothermia to improve survival and neurological outcome. Drowning may result in asphyxial OHCA or hypothermic OHCA, but the former does not provide any potential neuroprotective effect as the latter may do. Electronic literature searches of Ovid Medline, Embase, Cochrane Library, and Scopus were performed for all years from inception to July 2016. Primary studies in the form of case reports, letters to the editor, and others with higher quality are included, but guidelines, reviews, editorials, textbook chapters, conference abstracts, and nonhuman studies are excluded. Non-English articles are excluded. Relevant studies are then deemed eligible if the drowning OHCA patient's initial temperature was above 28°C, which implies asphyxial cardiac arrest, and intentional therapeutic hypothermia was instituted. Because of the narrow scope of interest and strict definition of the condition, limited studies addressed it, and no randomized controlled trials (RCT) could be selected. Thirteen studies covering 35 patients are included. No quantitative synthesis, assessment of study quality, or assessment of bias was performed. It is conjectured that extended therapeutic hypothermia of 48-72 hours might help prevent reperfusion injury during the intermediate phase of postcardiac arrest care to benefit patients of drowning-associated asphyxial OHCA, but this finding only serves as preliminary observation for future research. No conclusive recommendation could be made regarding the duration of and the time of onset of therapeutic hypothermia. Future research should put effort on RCT, particularly the effect of extended duration of 48-72 hours. Important parameters should be reported in detail. Asphyxial and hypothermic OHCA should be differentiated.
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Affiliation(s)
- K-F Suen
- 1 School of Medicine, University College Dublin , Dublin, Ireland
| | - Reynold Leung
- 2 Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong, Hong Kong
| | - Ling-Pong Leung
- 2 Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong, Hong Kong
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Good neurological outcome after accidental hyopthermia presenting with asytole. Anaesthesist 2017; 66:186-188. [PMID: 28175939 DOI: 10.1007/s00101-017-0271-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/05/2016] [Accepted: 01/09/2017] [Indexed: 12/26/2022]
Abstract
A 43-year-old woman became exhausted and fainted on descent at 1127 MAMSL altitude and snowfall. A rescue team diagnosed asystole. With manual cardiopulmonary resuscitation (CPR) she was transported to the next extracorporeal life support (ECLS) center. Admission temperature was 20.7 °C. CPR continued until ECLS was initiated. Two days later she was awake, orientated, and with no neurological deficits. With hypothermic cardiac arrest, a favorable outcome depends on early continuous CPR, triage, and ECLS rewarming. It holds true that "nobody is dead until they are warmed and dead" if one cools first and arrests thereafter.
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Monitoring of brain oxygenation during hypothermic CPR – A prospective porcine study. Resuscitation 2016; 104:1-5. [DOI: 10.1016/j.resuscitation.2016.03.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/23/2016] [Accepted: 03/31/2016] [Indexed: 11/20/2022]
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Blancher M, Boussat B, Bouzat P. Blood potassium after avalanche-induced cardiac arrest: sampling method and interpretation. Am J Emerg Med 2016; 34:1317-8. [DOI: 10.1016/j.ajem.2016.04.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022] Open
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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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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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The Osborn wave: what have we learned? Herz 2015; 41:48-56. [DOI: 10.1007/s00059-015-4338-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/22/2015] [Accepted: 06/29/2015] [Indexed: 11/28/2022]
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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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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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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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Boué Y, Payen JF, Brun J, Thomas S, Levrat A, Blancher M, Debaty G, Bouzat P. Survival after avalanche-induced cardiac arrest. Resuscitation 2014; 85:1192-6. [PMID: 24971508 DOI: 10.1016/j.resuscitation.2014.06.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
AIM Criteria to prolong resuscitation after cardiac arrest (CA) induced by complete avalanche burial are critical since profound hypothermia could be involved. We sought parameters associated with survival in a cohort of victims of complete avalanche burial. METHODS Retrospective observational study of patients suffering CA on-scene after avalanche burial in the Northern French Alps between 1994 and 2013. Criteria associated with survival at discharge from the intensive care unit (ICU) were collected on scene and upon admission to Level-1 trauma center. Neurological outcome was assessed at 3 months using cerebral performance category score. RESULTS Forty-eight patients were studied. They were buried for a median time of 43 min (25-76 min; 25-75th percentiles) and had a pre-hospital body core temperature of 28.0°C (26.0-30.7). Eighteen patients (37.5%) had pre-hospital return of spontaneous circulation and 30 had refractory CA. Rewarming of 21 patients (43.7%) was performed using extracorporeal life support. Eight patients (16.7%) survived and were discharged from the ICU, three (6.3%) had favorable neurological outcome at 3 months. Pre-hospital parameters associated with survival were the presence of an air pocket and rescue collapse. On admission, survivors had lower serum potassium concentrations than non-survivors: 3.2 mmol/L (2.7-4.0) versus 5.6 mmol/L (4.2-8.0), respectively (P<0.01). They also had normal values for prothrombin and activated partial thromboplastin compared to non-survivors. CONCLUSIONS Our findings indicate that survival after avalanche burial and on-scene CA is rarely associated with favorable neurological outcome. Among criteria associated with survival, normal blood coagulation on admission warrants further investigation.
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Affiliation(s)
- Yvonnick Boué
- Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France; Université Joseph Fourier, Grenoble Institut des Neurosciences, Grenoble F-38043, France; INSERM, U836, Grenoble F-38042, France
| | - Jean-François Payen
- Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France; Université Joseph Fourier, Grenoble Institut des Neurosciences, Grenoble F-38043, France; INSERM, U836, Grenoble F-38042, France
| | - Julien Brun
- Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France
| | - Sébastien Thomas
- Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France
| | - Albrice Levrat
- Service réanimation, Centre Hospitalier Région d'Annecy, Metz-Tessy, F-74370, France
| | - Marc Blancher
- Service Urgences-SAMU-SMUR, Hopital Michallon, Grenoble F-38043, France
| | - Guillaume Debaty
- Service Urgences-SAMU-SMUR, Hopital Michallon, Grenoble F-38043, France
| | - Pierre Bouzat
- Pole Anesthésie-Réanimation, Hôpital Michallon, Grenoble F-38043, France; Université Joseph Fourier, Grenoble Institut des Neurosciences, Grenoble F-38043, France; INSERM, U836, Grenoble F-38042, France.
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Cardiac arrest from accidental hypothermia, a rare condition with potentially excellent neurological outcome, if you treat it right. Resuscitation 2014; 85:707-8. [PMID: 24686021 DOI: 10.1016/j.resuscitation.2014.03.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 02/02/2023]
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