1
|
McLellan H, Rijnhout TWH, Peterson LM, Stuhlmiller DFE, Edwards J, Jarrouj A, Samanta D, Tager A, Tan ECTH. Prehospital Active and Passive Warming in Trauma Patients. Air Med J 2023; 42:252-258. [PMID: 37356885 DOI: 10.1016/j.amj.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Hypothermia is common among trauma patients and can lead to a serious rise in morbidity and mortality. This study was performed to investigate the effect of active and passive warming measures implemented in the prehospital phase on the body temperature of trauma patients. METHODS In a multicenter, multinational prospective observational design, the effect of active and passive warming measures on the incidence of hypothermia was investigated. Adult trauma patients who were transported by helicopter emergency medical services (HEMS) or ground emergency medical services with an HEMS physician directly from the scene of injury were included. Four HEMS/ground emergency medical services programs from Canada, the United States, and the Netherlands participated. RESULTS A total of 80 patients (n = 20 per site) were included. Eleven percent had hypothermia on presentation, and the initial evaluation occurred predominantly within 60 minutes after injury. In-line fluid warmers and blankets were the most frequently used active and passive warming measures, respectively. Independent risk factors for a negative change in body temperature were transportation by ground ambulance (odds ratio = 3.20; 95% confidence interval, 1.06-11.49; P = .03) and being wet on initial presentation (odds ratio = 3.64; 95% confidence interval, 0.99-13.36; P = .05). CONCLUSION For adult patients transported from the scene of injury to a trauma center, active and passive warming measures, most notably the removal of wet clothing, were associated with a favorable outcome, whereas wet patients and ground ambulance transport were associated with an unfavorable outcome with respect to temperature.
Collapse
Affiliation(s)
- Heather McLellan
- Advanced Studies in Critical Care Nursing, Mount Royal University, Mount Royal Gate, Calgary, Alberta, Canada.
| | - Tim W H Rijnhout
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Michael Peterson
- Charleston Area Medical Center, Institute for Academic Medicine, Charleston, WV; HealthNet Aeromedical Services, Charleston, WV
| | | | - Jerry Edwards
- Charleston Area Medical Center, Institute for Academic Medicine, Charleston, WV
| | - Aous Jarrouj
- Charleston Area Medical Center, Institute for Academic Medicine, Charleston, WV
| | - Damayanti Samanta
- Charleston Area Medical Center, Institute for Academic Medicine, Charleston, WV
| | - Alfred Tager
- Charleston Area Medical Center, Institute for Academic Medicine, Charleston, WV
| | - Edward C T H Tan
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Powner DJ, Reich HS. Regulation of Coagulation Abnormalities and Temperature in Organ Donors. Prog Transplant 2016; 10:146-51; quiz 152-3. [PMID: 11216273 DOI: 10.1177/152692480001000304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The 3 most common reasons for abnormal coagulation of blood in organ donors result from prior medications, consumption or dilution of coagulation factors and platelets during massive transfusion, and disseminated intravascular coagulation. Evaluation and treatment of these conditions are reviewed, and recommendations are provided for ordering appropriate laboratory tests and blood bank products.
Collapse
Affiliation(s)
- D J Powner
- Rutland Regional Medical Center, Rutland, Vt., USA
| | | |
Collapse
|
3
|
Puertos E. Extended stability of intravenous 0.9% sodium chloride solution after prolonged heating or cooling. Hosp Pharm 2014; 49:269-72. [PMID: 24715747 DOI: 10.1310/hpj4903-269] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The primary objective of this study was to evaluate the stability and sterility of an intravenous 0.9% sodium chloride solution that had been cooled or heated for an extended period of time. METHODS Fifteen sterile 1 L bags of 0.9% sodium chloride solution were randomly selected for this experiment. Five bags were refrigerated at an average temperature of 5.2°C, 5 bags were heated at an average temperature of 39.2°C, and 5 bags were stored at an average room temperature of 21.8°C to serve as controls. All samples were protected from light and stored for a period of 199 days prior to being assayed and analyzed for microbial and fungal growth. RESULTS There was no clinically significant difference in the mean sodium values between the refrigerated samples, the heated samples, and the control group. There were no signs of microbial or fungal growth for the duration of the study. CONCLUSION A sterile intravenous solution of 0.9% sodium chloride that was heated or cooled remained stable and showed no signs of microbial or fungal growth for a period of 199 days. This finding will allow hospitals and emergency medical technicians to significantly extend the expiration date assigned to these fluids and therefore obviate the need to change out these fluids every 28 days as recommended by the manufacturer.
Collapse
Affiliation(s)
- Enrique Puertos
- Clinical Pharmacist, Department of Pharmacy, Stephens County Hospital , 163 Hospital Drive, Toccoa, GA 30528 ; phone: 706-282-4268 ; fax: 706-282-4458 ; e-mail:
| |
Collapse
|
4
|
Rocklöv J, Forsberg B, Ebi K, Bellander T. Susceptibility to mortality related to temperature and heat and cold wave duration in the population of Stockholm County, Sweden. Glob Health Action 2014; 7:22737. [PMID: 24647126 PMCID: PMC3955771 DOI: 10.3402/gha.v7.22737] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 01/03/2023] Open
Abstract
Background Ambient temperatures can cause an increase in mortality. A better understanding is needed of how health status and other factors modify the risk associated with high and low temperatures, to improve the basis of preventive measures. Differences in susceptibility to temperature and to heat and cold wave duration are relatively unexplored. Objectives We studied the associations between mortality and temperature and heat and cold wave duration, stratified by age and individual and medical factors. Methods Deaths among all residents of Stockholm County between 1990 and 2002 were linked to discharge diagnosis data from hospital admissions, and associations were examined using the time stratified case-crossover design. Analyses were stratified by gender, age, pre-existing disease, country of origin, and municipality level wealth, and adjusted for potential confounding factors. Results The effect on mortality by heat wave duration was higher for lower ages, in areas with lower wealth, for hospitalized patients younger than age 65. Odds were elevated among females younger than age 65, in groups with a previous hospital admission for mental disorders, and in persons with previous cardiovascular disease. Gradual increases in summer temperatures were associated with mortality in people older than 80 years, and with mortality in groups with a previous myocardial infarction and with chronic obstructive pulmonary disease (COPD) in the population younger than 65 years. During winter, mortality was associated with a decrease in temperature particularly in men and with the duration of cold spells for the population older than 80. A history of hospitalization for myocardial infarction increased the odds associated with cold temperatures among the population older than 65. Previous mental disease or substance abuse increased the odds of death among the population younger than 65. Conclusion To increase effectiveness, we suggest preventive efforts should not assume susceptible groups are the same for warm and cold days and heat and cold waves, respectively.
Collapse
Affiliation(s)
- Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden;
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Kristie Ebi
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
5
|
Kobbe P, Lichte P, Wellmann M, Hildebrand F, Nast-Kolb D, Waydhas C, Oberbeck R. Techniken der Wiedererwärmung bei hypothermen Schwerverletzten. Unfallchirurg 2009; 112:1062-5. [DOI: 10.1007/s00113-009-1719-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
Chen LL, Fang JT, Lin JL. Chronic Renal Disease Patients with Severe Star Fruit Poisoning: Hemoperfusion May Be an Effective Alternative Therapy. Clin Toxicol (Phila) 2009. [DOI: 10.1081/clt-57872] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
7
|
Maisch S, Ntalakoura K, Boettcher H, Helmke K, Friederich P, Goetz AE. [Severe accidental hypothermia with cardiac arrest and extracorporeal rewarming. A case report of a 2-year-old child]. Anaesthesist 2007; 56:25-9. [PMID: 17096105 DOI: 10.1007/s00101-006-1110-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In patients with severe hypothermia and cardiac arrest, active rewarming is recommended by extracorporeal circulation with cardiopulmonary bypass. The current guidelines for resuscitation of the European Resuscitation Council now include the recommendation regarding patients with hypothermia remaining comatose after initial resuscitation to accomplish an active rewarming only up to a temperature of 32-34 degrees C and to maintain a mild hypothermia for 12-24 h. We report the case of a 2-year-old boy who suffered from severe hypothermia after falling into ice-cold water. On discovery cardiac arrest with asystole was present and the first measured temperature was 23.8 degrees C. Resuscitation led to restoration of spontaneous circulation. The patient was rewarmed by extracorporeal circulation with cardiopulmonary bypass to 33 degrees C then mild hypothermia was maintained for a further 12 h. On the third day after the accident the patient was extubated and after a further 9 days was discharged without any sequelae.
Collapse
Affiliation(s)
- S Maisch
- Klinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg.
| | | | | | | | | | | |
Collapse
|
8
|
Garraway N, Brown DR, Nash D, Kirkpatrick A, Schneidereit NP, Van Heest R, Hwang H, Simons R. Active internal re-warming using a centrifugal pump and heat exchanger following haemorrhagic shock, surgical trauma and hypothermia in a porcine model. Injury 2007; 38:1039-46. [PMID: 17585913 DOI: 10.1016/j.injury.2007.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 03/08/2007] [Accepted: 03/10/2007] [Indexed: 02/02/2023]
Abstract
BACKGROUND The centrifugal vortex blood pump (CVBP) using heparin-bonded circuitry allows re-warming of hypothermic trauma patients without anticoagulation. Study objectives were to confirm efficacy, and to characterise the physiology of CVBP re-warming in a porcine model. METHODS Sixteen pigs were randomised to conventional or CVBP re-warming. They were bled to a mean arterial pressure of 30 mmHg and cooled to 29 degrees C. A physiological analysis was recorded during resuscitation to normo-tension and re-warming back to 37 degrees C. RESULTS CVBP animals re-warmed significantly faster: 85.0+16.4 min versus 217.4+49.3 min (p<0.0001). Activated clotting time was significantly elevated in both groups at 29 degrees C with a marked trend to normalise faster in CVBP pigs. The peak cardiac index (CI) was significantly lower (1.14+0.68 versus 4.83+1.50 L/(min m2), while the systemic vascular resistance (SVR) was significantly higher (4239.9+1173.0 versus 1472.6+451.2 dyn x S x m2/cm5) with CVBP (p<0.001). CONCLUSION CVBP is simple and very effective at re-warming hypothermic animals and may also reverse coagulopathy more quickly. Physiological derangements of elevated SVR and diminished CI require further study to elaborate underlying aetiology, and define optimal re-warming strategies.
Collapse
Affiliation(s)
- Naisan Garraway
- Section of Trauma, Division of General Surgery, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Platzer M, Trampitsch E, Likar R, Breschan C, Schalk HV. Kardiopulmonale Reanimation nach Heroinintoxikation und Hypothermie. Anaesthesist 2007; 56:141-4. [PMID: 17268794 DOI: 10.1007/s00101-006-1116-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present the case of a 21-year-old female drug addict with severe accidental hypothermia (core body temperature 27.5 degrees C) and cardiorespiratory arrest. After successful cardiopulmonary resuscitation the patient was actively internally rewarmed without the use of extracorporal circulation. Although at the first clinical presentation the patient appeared to be dead, an excellent neurological outcome was achieved. This case report reviews the epidemiology, pathophysiology, prognostic markers and the therapeutic approaches of severe hypothermia.
Collapse
Affiliation(s)
- M Platzer
- Abteilung für Anästhesiologie und Intensivmedizin, Landeskrankenhaus, St. Veiterstrasse 47, 9020, Klagenfurt, Osterreich.
| | | | | | | | | |
Collapse
|
10
|
Culic S. Cold Injury Syndrome and Neurodevelopmental Changes in Survivors. Arch Med Res 2005; 36:532-8. [PMID: 16099334 DOI: 10.1016/j.arcmed.2005.03.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Accepted: 03/18/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of this study was to extend and develop knowledge of the clinical parameters of cold injury syndrome (CIS) in hypothermic infants and newborns, so that morbidity, mortality, and neurodevelopmental disturbances associated with the condition can be reduced. METHODS This retrospective, 10-year cohort study investigated 103 hypothermic infant and newborn patients (aged 0-60 days) admitted to the Pediatric Department between January 1, 1976 and December 31, 1985. Medical records of 67 survivors and 36 children who died were analyzed. Of the survivors, 24 consented to undergo assessment of neuropsychological and neurodevelopmental outcomes. RESULTS At presentation, all patients manifested cold skin and limbs, while 96 (93.2%) were sleepy, hypotonic and inactive. Cyanosis with bradycardia, bradypnea, and apneic crisis (AC) was observed in 80 (77.7%) patients, and 65 (63.1%) demonstrated diffuse intravascular coagulation (DIC). Pulmonary hemorrhage, AC, respiratory distress syndrome, and DIC represented the primary causes of death. Higher body temperatures on admission reduced the risk of death. Of the 24 patients assessed for neuropsychological and neurodevelopmental outcomes, all but one had normal intellectual capabilities, whereas 16 (66.7%) showed signs of neurodevelopmental disturbances. CONCLUSIONS The severity of hypothermia, leukopenia, and thrombocytopenia with DIC correlates with prognosis and death rate. Hypothermia in infants and newborns can cause psychological and neurodevelopmental disturbances in survivors.
Collapse
Affiliation(s)
- Srdjana Culic
- Department of Pediatrics, Clinical Hospital Split, Spinciceva, Croatia.
| |
Collapse
|
11
|
Tiruvoipati R, Balasubramanian SK, Khoshbin E, Hadjinikolaou L, Sosnowski AW, Firmin RK. Successful use of venovenous extracorporeal membrane oxygenation in accidental hypothermic cardiac arrest. ASAIO J 2005; 51:474-6. [PMID: 16156316 DOI: 10.1097/01.mat.0000169124.32865.d6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cardiopulmonary bypass is usually used for rewarming and for providing cardiac support in patients with severe hypothermia and cardiovascular instability. We report the first case of accidental severe hypothermia associated with prolonged cardiac arrest that was successfully managed by venovenous extracorporeal membrane oxygenation.
Collapse
Affiliation(s)
- Ravindranath Tiruvoipati
- Department of ECMO and Cardiac Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom
| | | | | | | | | | | |
Collapse
|
12
|
Mulpur AK, Mirsadraee S, Hassan TB, McKeague H, Kaul P. Refractory ventricular fibrillation in accidental hypothermia: salvage with cardiopulmonary bypass. Perfusion 2005; 19:311-4. [PMID: 15506037 DOI: 10.1191/0267659104pf760oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 20-year old woman presented with prolonged refractory ventricular fibrillation and pulmonary oedema following hypothermia while she was under self-administered heroin in an attempt to commit suicide. She was successfully resuscitated with cardiopulmonary bypass for core rewarming and internal defibrillation.
Collapse
|
13
|
Kirkpatrick AW, Garraway N, Brown DR, Nash D, Ng A, Lawless B, Cunningham J, Chun R, Simons RK. Use of a Centrifugal Vortex Blood Pump and Heparin-Bonded Circuit for Extracorporeal Rewarming of Severe Hypothermia in Acutely Injured and Coagulopathic Patients. ACTA ACUST UNITED AC 2003; 55:407-12. [PMID: 14501879 DOI: 10.1097/01.ta.0000078693.35083.20] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Standard rewarming methods for posttraumatic hypothermia are ineffective or require systemic heparinization. Centrifugal vortex blood pumps (CVBPs), heparin-bonded circuits, and, potentially, percutaneous access techniques, facilitate the institution of an extracorporeal circulation by noncardiac surgeons. METHODS Seven severely hypothermic patients requiring emergent operative intervention were rewarmed intraoperatively using the CVBP with heparin-bonded circuitry. RESULTS Patients were critically ill (average Injury Severity Score of 43.5 [SD, 13.6] for the traumatized patients). The mean temperature before rewarming was 31.5 degrees C (SD, 1.6 degrees C). The CVBP outflow site was the common femoral vein in all patients, with the inflow into the superficial femoral artery (n = 2), contralateral common femoral vein (n = 2), and internal jugular vein (n = 3). The mean time to rewarm to 37 degrees C was 73.3 (SD, 30.5) minutes. All patients survived the initial operation, although the ultimate survival was 43%. CONCLUSION Noncardiac surgeons can effectively use an extracorporeal rewarming strategy incorporating a heparin-bonded CVBP to rapidly rewarm hypothermic coagulopathic patients undergoing surgery.
Collapse
Affiliation(s)
- Andrew W Kirkpatrick
- Department of Critical Care Medicine and Surgery, Foothills Medical Centre, Calgary, Alberta, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Ichiba S, Killer HM, Firmin RK, Kotecha S, Edwards AD, Field D. Pilot investigation of hypothermia in neonates receiving extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 2003; 88:F128-33. [PMID: 12598502 PMCID: PMC1721509 DOI: 10.1136/fn.88.2.f128] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Infants requiring extracorporeal membrane oxygenation (ECMO) support represent a high risk group in terms of cerebral injury. Mild hypothermia both during and after cerebral hypoxic ischaemia appears to be a promising strategy for offering neuroprotection. OBJECTIVE To investigate whether mild hypothermia was both feasible and safe in infants receiving ECMO as a prelude to any formal assessment of this approach in a randomised trial. METHODS Twenty infants (body weight less than 5 kg) with severe cardiopulmonary insufficiency, referred for ECMO support at Glenfield Hospital, Leicester, were enrolled in this study. Twenty consecutive infants (compromising four groups of five) were studied. Baseline data were obtained from a control group who were run throughout their course at 37 degrees C. The patients in the next group were managed with a core temperature of 36 degrees C for the first 12 hours of their ECMO run, before being warmed up to 37 degrees C. After successful completion, the next group of five were cared for at 35 degrees C for the first 12 hours, and, there having been no previous complications, the final group were cared for at 34 degrees C for the first 12 hours. Patients were assessed clinically and biologically. In addition to routine laboratory tests, cytokines (interleukin 6, interleukin 8, tumour necrosis factor alpha, and C reactive protein) were measured and coagulation tests (D-dimer, thrombin-antithrombin III complex, plasmin-alpha(2)-antiplasmin complex) were performed serially for five days. RESULTS There were no significant differences among the four groups in gestational age, birth weight, age at the time of ECMO, Apgar scores at one and five minutes, pH before cannulation, oxygenation index, duration of ECMO, and survival rate to discharge from hospital. No adverse effects of mild hypothermia were found on patient management during ECMO. Laboratory data for up to five days of ECMO also showed no difference among the four groups. CONCLUSION Mild hypothermia (34 degrees C) for the initial 12 hours of an ECMO run is feasible.
Collapse
Affiliation(s)
- S Ichiba
- Heart Link ECMO Centre, Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK
| | | | | | | | | | | |
Collapse
|
15
|
McInerney JJ, Breakell A, Madira W, Davies TG, Evans PA. Accidental hypothermia and active rewarming: the metabolic and inflammatory changes observed above and below 32 degrees C. Emerg Med J 2002; 19:219-23. [PMID: 11971831 PMCID: PMC1725881 DOI: 10.1136/emj.19.3.219] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In accidental hypothermia the underlying physiological mechanisms responsible for poor outcome during rewarming through 32 degrees C remain obscure, although possible associations include changes in acid-base balance, divalent cations, and inflammatory markers. This study investigated the metabolic and inflammatory changes that occur during the rewarming of hypothermic patients. METHODS Eight patients, four men and four women, age 45 to 85 years, admitted with core temperatures <35 degrees C were included in the study. Patients were rewarmed with dry warm blankets and fluid replaced by crystalloid at 40 degrees C. Bloods for pH, ionised calcium (Ca(2+)) and magnesium (Mg(2+)), parathyroid hormone (PTH), interleukin 1 (IL1), interleukin 6 (IL6), tissue necrosis factor alpha (TNFalpha), were collected at presentation, during rewarming, and at 24 hours. RESULTS Four patients were admitted with mild (32 degrees -35 degrees C) and four with moderate (28 degrees -32 degrees C) hypothermia. Rewarming to 32 degrees C had no significant effect on the presenting acidosis (p=0.1740), although above 32 degrees C pH increased with temperature (p<0.0001). There was a negative correlation between pH and both Ca(2+) (p=0.0005) and Mg(2+) (p=0.0488) below 32 degrees C; above this temperature the relation was significant only for Ca(2+) (p=0.0494). PTH and Ca(2+) correlated positively (p=0.0041) and negatively (p=0.0039) below and above 32 degrees C respectively. There was no relation between IL1 or TNFalpha with Ca(2+) during rewarming, but IL6 and Ca(2+) correlated positively (p=0.0039) and negatively (p=0.0018) when presentation temperature was below and above 32 degrees C respectively. CONCLUSIONS During rewarming pH remains unchanged until patient temperature approaches 32 degrees C. Ca(2+) and Mg(2+) decline is associated with the pH increase above 32 degrees C. Poor outcome is associated with presentation temperature (<32 degrees C), non-physiological correlation between IL6-PTH-Ca(2+), and age (>or=84 years).
Collapse
Affiliation(s)
- J J McInerney
- Accident and Emergency Department, The Leicester Royal Infirmary, Leicester, UK
| | | | | | | | | |
Collapse
|
16
|
Hiles JM, Schriver JP, Wohltmann CD, Renz EM. A new method of continuous venovenous rewarming. ACTA ACUST UNITED AC 2002; 59:186-9. [PMID: 16093129 DOI: 10.1016/s0149-7944(01)00611-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Hypothermia is a significant problem in medicine and is part of a deadly triad, including hypothermia, acidosis, and coagulopathy. Multiple methods of rewarming are used to treat moderate hypothermia. The purpose of this study was to compare the effectiveness of continuous venovenous rewarming (CVVR) using the FMS 2000 (Belmont Instrument Corp., Billerica, Massachusetts) in conjunction with external rewarming techniques versus external rewarming alone in the porcine model. METHODS Ten subject animals, each weighing approximately 40 kg, were evenly divided and randomly assigned to either a control group using external rewarming techniques alone or the CVVR group utilizing the FMS 2000 in addition to the external rewarming techniques used in the control group. Hypothermia was induced in the swine model using cold water immersion to achieve a core temperature of 30 degrees C. Both esophageal and rectal temperature probes were used to monitor and record core body temperatures every 15 minutes during the experiment. Each study animal was then rewarmed until a core temperature of at least 37 degrees C was recorded in both the esophageal and rectal probes. The animals were observed clinically for 3 days after the study. RESULTS The average time required to rewarm the control group was 253 minutes, compared with 113 minutes in the CVVR group. After 30 minutes of rewarming, the difference between the 2 groups with respect to core temperature was statistically significant (p = 0.002). A drop in core temperature after the initiation of rewarming, or after-drop, was noted in the control group animals, but not in the CVVR group. This difference was statistically significant after 15 minutes of rewarming (p = 0.015) CONCLUSIONS Venovenous rewarming utilizing the FMS 2000 fluid management system is more effective than is standard therapy alone for rewarming in the moderately hypothermic porcine model. This finding may prove clinically useful in the treatment of patients suffering from moderate hypothermia.
Collapse
Affiliation(s)
- Jason M Hiles
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | | | | |
Collapse
|
17
|
Abstract
Hypothermia is a life-threatening condition and can be a significant comorbid factor in a trauma patient. Certain social and medical characteristics can put a person at high risk for hypothermia, and special care must be provided to prevent and treat lower than normal body temperatures. In this article, a literature review was used to describe etiologies, assessment, treatment, and complications of hypothermia in the trauma patient.
Collapse
Affiliation(s)
- D A Cochrane
- Alberta Centre for Injury Control and Research, Dept of Public Health Sciences, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.
| |
Collapse
|
18
|
Dickson EW, Sivilotti ML, Mangolds G, Renzi FP, Heard SO, Mori K, Burns MJ. Core rewarming via warm lavage liquid ventilation in a swine model of hypothermia-associated ventricular fibrillation. Acad Emerg Med 2001; 8:82-4. [PMID: 11136157 DOI: 10.1111/j.1553-2712.2001.tb00561.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether warm lavage liquid ventilation (LV) would provide rapid cardiopulmonary rewarming in swine with severe hypothermia and ventricular fibrillation. METHODS Intubated common swine (n = 3; mean +/- SEM weight 26+/-1.2 kg) were cooled to a mean aortic temperature of 26.4+/-0.9 degrees C. Ventricular fibrillation was induced by transthoracic electrical shock. Rewarming was initiated by continuous endotracheal instillation of warm (44 degrees C) pre-oxygenated, perfluorocarbon liquid at 5 mL/kg/min. Endotracheal instillation of perfluorocarbon occurred while standard gas ventilation continued. Manual chest compressions were performed throughout the 30-minute rewarming process. Outcome measures were the absolute and relative rates of change of all temperatures. RESULTS After 30 minutes of warm lavage LV, the mean aortic and pulmonary artery temperatures increased by 6.6+/-0.6 degrees C, respectively. Esophageal, nasal, and rectal temperatures did not change significantly. In one animal, normal sinus rhythm spontaneously returned after 16 minutes of rewarming. CONCLUSIONS During cardiac arrest, warm lavage liquid ventilation may produce rapid cardiopulmonary rewarming.
Collapse
Affiliation(s)
- E W Dickson
- Department of Physiology, University of Massachusetts Medical School, Worcester MA, USA.
| | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
The 3 most common reasons for abnormal coagulation of blood in organ donors result from prior medications, consumption or dilution of coagulation factors and platelets during massive transfusion, and disseminated intravascular coagulation. Evaluation and treatment of these conditions are reviewed, and recommendations are provided for ordering appropriate laboratory tests and blood bank products.
Collapse
Affiliation(s)
- D J Powner
- Rutland Regional Medical Center, Rutland, Vt., USA
| | | |
Collapse
|
20
|
Henik RA, Dixon RM. Intravenous administration of levothyroxine for treatment of suspected myxedema coma complicated by severe hypothermia in a dog. J Am Vet Med Assoc 2000; 216:713-7, 685. [PMID: 10707687 DOI: 10.2460/javma.2000.216.713] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 7-year-old male English Coonhound with suspected myxedema coma complicated by severe hypothermia and metabolic abnormalities was treated with a combination of active external and core rewarming techniques, i.v. and oral administration of levothyroxine, supplemental oxygen, and administration of fluids (0.9% NaCl solution). Myxedema coma develops as a consequence of severe hypothyroidism and is characterized by a hypometabolic, stuporous state. Myxedema coma is associated with a high mortality rate, and most reported cases have involved Doberman Pinschers. Intravenous administration of levothyroxine can be used successfully in combination with oral administration to restore normal metabolic function and assist in warming and thermoregulation, although dosages should be conservative to avoid adverse cardiovascular effects.
Collapse
Affiliation(s)
- R A Henik
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison 53706, USA
| | | |
Collapse
|
21
|
Opdahl H. Survival Put to the Acid Test: Extreme Arterial Blood Acidosis (pH 6.33) after Near Drowning. Crit Care Med 1999. [DOI: 10.1097/00003246-199909000-00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
|