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Cohen IJ. Delayed Rewarming Thrombocytopenia: A Suggested Preventable and Treatable Cause of Rewarming Deaths. J Pediatr Hematol Oncol 2024; 46:138-142. [PMID: 38447120 PMCID: PMC10956667 DOI: 10.1097/mph.0000000000002838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024]
Abstract
The lack of a consensus of accepted prognostic factors in hypothermia suggests an additional factor has been overlooked. Delayed rewarming thrombocytopenia (DRT) is a novel candidate for such a role. At body temperature, platelets undergoing a first stage of aggregation are capable of progression to a second irreversible stage of aggregation. However, we have shown that the second stage of aggregation does not occur below 32°C and that this causes the first stage to become augmented (first-stage platelet hyperaggregation). In aggregometer studies performed below 32°C, the use of quantities of ADP that cause a marked first-stage hyperaggregation can cause an augmented second-stage activation of the platelets during rewarming (second-stage platelet hyperaggregation). In vivo, after 24 hours of hypothermia, platelets on rewarming seem to undergo second-stage hyperaggregation, from ADP released from erythrocytes, leading to life-threatening thrombocytopenia. This hyperaggregation is avoidable if heparin is given before the hypothermia or if aspirin, alcohol or platelet transfusion is given during the hypothermia before reaching 32°C on rewarming. Many of the open questions existing in this field are explained by DRT. Prevention and treatment of DRT could be of significant value in preventing rewarming deaths and some cases of rescue collapse. Performing platelet counts during rewarming will demonstrate potentially fatal thrombocytopenia and enable treatment with platelet infusions aspirin or alcohol.
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Affiliation(s)
- Ian J. Cohen
- Tel Aviv University Faculty of Medicine, Ramat Aviv
- Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
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Podsiadło P, Smoleń A, Brožek T, Kosiński S, Balik M, Hymczak H, Cools E, Walpoth B, Nowak E, Dąbrowski W, Miazgowski B, Witt-Majchrzak A, Jędrzejczak T, Reszka K, Segond N, Debaty G, Dudek M, Górski S, Darocha T. Extracorporeal Rewarming Is Associated With Increased Survival Rate in Severely Hypothermic Patients With Preserved Spontaneous Circulation. ASAIO J 2023; 69:749-755. [PMID: 37039862 DOI: 10.1097/mat.0000000000001935] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Treatment recommendations for rewarming patients in severe accidental hypothermia with preserved spontaneous circulation have a weak evidence due to the absence of randomized clinical trials. We aimed to compare the outcomes of extracorporeal versus less-invasive rewarming of severely hypothermic patients with preserved spontaneous circulation. We conducted a multicenter retrospective study. The patient population was compiled based on data from the HELP Registry, the International Hypothermia Registry, and a literature review. Adult patients with a core temperature <28°C and preserved spontaneous circulation were included. Patients who underwent extracorporeal rewarming were compared with patients rewarmed with less-invasive methods, using a matched-pair analysis. The study population consisted of 50 patients rewarmed extracorporeally and 85 patients rewarmed with other, less-invasive methods. Variables significantly associated with survival included: lower age; outdoor cooling circumstances; higher blood pressure; higher PaCO 2 ; higher BE; higher HCO 3 ; and the absence of comorbidities. The survival rate was higher in patients rewarmed extracorporeally ( p = 0.049). The relative risk of death was twice as high in patients rewarmed less invasively. Based on our data, we conclude that patients in severe accidental hypothermia with circulatory instability can benefit from extracorporeal rewarming without an increased risk of complications.
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Affiliation(s)
- Paweł Podsiadło
- From the Department of Emergency Medicine, Jan Kochanowski University, Kielce, Poland
| | - Agata Smoleń
- Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Poland
| | - Tomáš Brožek
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Hubert Hymczak
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Evelien Cools
- Department of Acute Medicine, Division of Anaesthesiology, University Hospitals, Geneva, Switzerland
| | - Beat Walpoth
- Emeritus. Department of Cardiovascular Surgery, University Hospitals of Geneva, Switzerland
| | - Ewelina Nowak
- Institute of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Dąbrowski
- Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Bartosz Miazgowski
- Emergency Department, University Hospital, Pomeranian Medical University, Szczecin, Poland
| | - Anna Witt-Majchrzak
- Department of Cardiac Surgery Provincial Specialist Hospital, Olsztyn, Poland
| | - Tomasz Jędrzejczak
- Department of Cardiosurgery, Pomeranian Medical University in Szczecin, Poland
| | - Kacper Reszka
- Department of Anaesthesiology and Intensive Care, University Hospital, Łódź, Poland
| | - Nicolas Segond
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
| | - Guillaume Debaty
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
| | - Michał Dudek
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biała, Poland
| | - Stanisław Górski
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
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Cohen IJ. Unrecognized platelet physiology is the cause of rewarming deaths in accidental hypothermia and neonatal cold injury. Med Hypotheses 2021; 148:110503. [PMID: 33540142 DOI: 10.1016/j.mehy.2021.110503] [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: 11/01/2020] [Revised: 12/24/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The lack of improvement in prognosis of accidental hypothermia and neonatal cold injury suggests that a major cause of mortality has not been appreciated. AIM OF THE ARTICLE To show that thrombocytopenia that deepens on rewarming under certain conditions is that missing factor. SCIENTIFIC BASIS Below 34 °C the first stage of aggregation is accentuated, the platelets are more sensitive to ADP and aggregation studies show an increased response "first stage hyper aggregation". We have confirmed that the irreversible second stage of platelet aggregation does not occur below 34 °C. On rewarming, the first stage of aggregation is followed by disaggregation. When platelets are warmed to 34 °C the potential exists for the platelets to undergo an irreversible second stage of aggregation "second stage platelet hyper aggregation" that can cause a further drop in platelet count and a bleeding diathesis. This only occurs if the platelets have been sufficiently primed when cold and may not be appreciated if platelet counts are not followed. SIGNIFICANCE OF THIS DATA AND CORRELATION WITH THE LITERATURE This thesis explains many other open questions. Why has the overall prognosis remained without improvement over the last half century? Why hypothermic cardiac surgery is free of this problem? Why the depth of hypothermia is alone not prognostic? Has following platelet counts been associated with improved prognosis? Why cardiac arrest does not affect prognosis? Why some patients die suddenly after recovering from hypothermia? Why are so many different rewarming techniques used? Why is the prognosis better in hypothermic suicide attempts? What is the pathophysiological explanation for reversible sequestration of platelets to the liver and spleen in hypothermia? Is DIC (diffuse intravascular coagulation) a problem in hypothermia? And how this new approach could improve prognosis? CONCLUSION Prognosis can be improved by following platelet counts during rewarming. In patients with prolonged hypothermia, this will show a life-threatening drop in such counts easily treated by platelet infusion.
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Affiliation(s)
- Ian J Cohen
- The Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv Israel, The Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
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Petrone P, Marini CP, Miller I, Brathwaite CEM, Howell RS, Cochrane D, Rodríguez-Velandia W, Rahn C, Allegra JR. Factors associated with severity of accidental hypothermia: A cohort retrospective multi-institutional study. Ann Med Surg (Lond) 2020; 55:81-83. [PMID: 32477500 PMCID: PMC7251493 DOI: 10.1016/j.amsu.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background Frequently it is difficult to determine illness severity in hypothermic patients. Our goal was to determine if there are factors associated with illness severity of hypothermic emergency department (ED) patients. Methods Multi-hospital retrospective cohort. Consecutive patients in 24 EDs (1-1-2012 to 4-30–2015). Hypothermic patients (≤35 °C) were identified using ICD codes. We used hospital admission as marker of illness severity. Student's t-test was used for differences between mean age and temperature for admitted and discharged patients. We calculated the percent of patients admitted by factor, the difference from overall admission rate and 95% confidence interval (CI) of difference. Results There were 2094 visits with hypothermia ICD code. Of these, 132 patients had initial rectal temperatures ≤35 °C. Females comprised 42%; the mean age was 55 ± 23 years, and overall admission rate was 62%. The percent of patients with alcohol, trauma and found indoors were 39%, 27% and 27%, respectively. For admitted and discharged patients the mean ages were 60 and 48 years, respectively (p = 0.01), and initial mean temperature 32.3 °C vs. 33 °C, respectively (p = 0.07). Found indoors was associated with an 86% admission rate, a 22% increase (95% CI, 3%–34%) compared to overall admission rate. There was no statistically significant difference in admission rates from overall admission rate based on gender, alcohol or trauma. Conclusions For hypothermic ED patients increased severity of illness was associated with older age and found indoors but not associated with initial temperature, gender, alcohol or trauma. These findings may assist physicians in treatment and disposition decisions. Accidental hypothermia is defined as a decrease in core body temperature to less than 35°C (95°F). Secondary hypothermia can occur in healthy and ill persons, even in warm environments, as a result of predisposing factors. Maintenance of a normal core temperature is achieved from a balance between heat production and heat loss. Factors associated with increased severity of illness for hypothermic ED patients were older age and found indoors.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine; Mineola, New York, USA
| | - Corrado P Marini
- Department of Surgery, Jacobi Medical Center; Albert Einstein College of Medicine; Bronx, New York, USA
| | - Ivan Miller
- Department of Emergency Medicine, Westchester Medical Center; Valhalla, New York, USA
| | - Collin E M Brathwaite
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine; Mineola, New York, USA
| | - Raelina S Howell
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine; Mineola, New York, USA
| | - Dennis Cochrane
- Department of Emergency Medicine, Morristown Medical Center; Morristown, New Jersey, USA
| | - Wilson Rodríguez-Velandia
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine; Mineola, New York, USA
| | - Candela Rahn
- Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine; Mineola, New York, USA
| | - John R Allegra
- Department of Emergency Medicine, Morristown Medical Center; Morristown, New Jersey, USA
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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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Dietrichs ES, Tveita T, Smith G. Hypothermia and cardiac electrophysiology: a systematic review of clinical and experimental data. Cardiovasc Res 2020; 115:501-509. [PMID: 30544147 DOI: 10.1093/cvr/cvy305] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 12/17/2022] Open
Abstract
Moderate therapeutic hypothermia procedures are used in post-cardiac arrest care, while in surgical procedures, lower core temperatures are often utilized to provide cerebral protection. Involuntary reduction of core body temperature takes place in accidental hypothermia and ventricular arrhythmias are recognized as a principal cause for a high mortality rate in these patients. We assessed both clinical and experimental literature through a systematic literature search in the PubMed database, to review the effect of hypothermia on cardiac electrophysiology. From included studies, there is common experimental and clinical evidence that progressive cooling will induce changes in cardiac electrophysiology. The QT interval is prolonged and appears more sensitive to decreases in temperature than the QRS interval. Severe hypothermia is associated with more pronounced changes, some of which are proarrhythmic. This is supported clinically where severe accidental hypothermia is commonly associated with ventricular fibrillation or asystole. J-waves in human electrocardiogram recordings are regularly but not always observed in hypothermia. Its relation to ventricular repolarization and arrhythmias is not obvious. Little clinical data exist on efficacy of anti-arrhythmic drugs in hypothermia, while experimental data show the potential of some agents, such as the class III antiarrhythmic bretylium. It is apparent that QT-prolonging drugs should be avoided.
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Affiliation(s)
- Erik Sveberg Dietrichs
- Department of Medical Biology, Experimental and Clinical Pharmacology Research Group, UiT, The Arctic University of Norway, Tromsø, Norway.,Division of Diagnostic Services, Department of Clinical Pharmacology, University Hospital of North Norway, Tromsø, Norway
| | - Torkjel Tveita
- Department of Clinical Medicine, Anesthesia and Critical Care Research Group, UiT, The Arctic University of Norway, Tromsø, Norway.,Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Godfrey Smith
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
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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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8
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Byard RW, Bright FM. Lethal hypothermia - a sometimes elusive diagnosis. Forensic Sci Med Pathol 2017; 14:421-423. [PMID: 28871387 DOI: 10.1007/s12024-017-9916-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 01/26/2023]
Affiliation(s)
- Roger W Byard
- School of Medicine, The University of Adelaide, Frome Road, Level 3 Medical School North Building, Adelaide, 5005, Australia.
| | - Fiona M Bright
- School of Medicine, The University of Adelaide, Frome Road, Level 3 Medical School North Building, Adelaide, 5005, Australia
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9
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Håheim B, Kondratiev T, Dietrichs ES, Tveita T. The beneficial hemodynamic effects of afterload reduction by sodium nitroprusside during rewarming from experimental hypothermia. Cryobiology 2017; 77:75-81. [PMID: 28479295 DOI: 10.1016/j.cryobiol.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Rewarming from hypothermia is associated with depressed cardiac function, known as hypothermia-induced cardiac dysfunction (HCD), and increased systemic vascular resistance (SVR). Previous studies on pharmacological treatment of HCD have demonstrated beneficial effects when using drugs with the combined effects; cardiac inotropic support and peripheral vasodilation. The presented study aims to investigate the isolated effects of arterial dilatation on cardiac functional variables during rewarming from hypothermia using sodium nitroprusside (SNP). METHODS We utilized a rat model designed to induce HCD following 4 h at 15 °C and rewarming. To study effects on left ventricular (LV) functional variables in response to afterload reduction by SNP during rewarming a conductance catheter was used. Index of LV contractility, preload recruitable stroke work (PRSW), was obtained with inferior vena cava occlusions at 37 °C before and after hypothermia. Pressure signals from a catheter in the left femoral artery was used to pharmacologically adjust SVR. RESULTS After rewarming both animal groups showed significant reduction in both SV and CO as a manifestation of HCD. However, compared to saline controls, SV and CO in SNP-treated animals increased significantly during rewarming in response to afterload reduction displayed as reduced SVR, mean arterial- and end-systolic pressures. The cardiac contractility variable PRSW was equally reduced after rewarming in both groups. CONCLUSION When rewarming the present model of HCD a significant increase in SVR takes place. In this context, pharmacologic intervention aimed at reducing SVR show clear positive results on CO and SV. However, a reduction in SVR alone is not sufficient to fully alleviate CO during HCD, and indicate the need of additional inotropic support.
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Affiliation(s)
- Brage Håheim
- Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037 Tromsø, Norway.
| | - Timofey Kondratiev
- Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037 Tromsø, Norway.
| | - Erik Sveberg Dietrichs
- Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037 Tromsø, Norway; Department of Research and Education, Norwegian Air Ambulance Foundation, 1441 Drøbak, Norway.
| | - Torkjel Tveita
- Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037 Tromsø, Norway; Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, 9038 Tromsø, Norway.
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Darocha T, Kosiński S, Jarosz A, Drwila R. Extracorporeal Rewarming From Accidental Hypothermia of Patient With Suspected Trauma. Medicine (Baltimore) 2015; 94:e1086. [PMID: 26166091 PMCID: PMC4504651 DOI: 10.1097/md.0000000000001086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The use of extracorporeal membrane oxygenation is a new approach to rewarming patients with severe hypothermia and hemodynamic instability. There are, however, many questions regarding qualification for this technique in case of suspected or confirmed trauma.A male with confirmed accidental hypothermia (25°C) and after successful cardiopulmonary resuscitation from in-hospital cardiac arrest was subjected to a protocol of extracorporeal rewarming from profound hypothermia. Because of unclear history, a full trauma computed tomography was performed that showed pericerebral hematoma and signs of previously undergone right craniotomy, multiple right-sided rib fractures and the presence of intraperitoneal fluid. Based on repeated imaging and specialist consultation, no life-threatening injuries were identified and rewarming with extracorporeal membrane oxygenation was safely performed. In a year follow-up, the patient was found to be alive, with no neurologic deficits.Although this case highlights the first successful utilization of extracorporeal rewarming in a trauma patient at our center there are several limitations to its widespread use.
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Affiliation(s)
- Tomasz Darocha
- From the Department of Anesthesiology and Intensive Care, John Paul II Hospital, Collegium Medicum, Jagiellonian University, Cracow, Poland (TD, AJ, RD) and Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland (SK)
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Spencer JM, Sheridan SC. Web-based hypothermia information: a critical assessment of Internet resources and a comparison to peer-reviewed literature. Perspect Public Health 2014; 135:85-91. [PMID: 24532173 DOI: 10.1177/1757913913517977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Hypothermia is a medical condition characterized by a drop in core body temperature, and it is a considerable source of winter weather-related vulnerability in mid-/high-latitude areas. Heat vulnerability research, including assessments of internet-based resources, is more thoroughly represented in the peer-reviewed literature than cold-related vulnerability research. This study was undertaken to summarize available web-based hypothermia information, and then determine its scientific validity compared to the peer-reviewed literature. METHODS This research takes a similar approach used by Hajat et al. for web-based heat vulnerability research, and utilizes this framework to assess hypothermia information found on the internet. Hypothermia-related search terms were used to obtain websites containing hypothermia information, and PubMed (medical literature search engine) and Google Scholar were used to identify peer-reviewed hypothermia literature. The internet information was aggregated into categories (vulnerable populations, symptoms, prevention), which were then compared to the hypothermia literature to determine the scientific validity of the web-based guidance. The internet information was assigned a Strength of Recommendation Taxonomy (SORT) grade (developed by the American Academy of Family Practitioners) of A, B, or C based on the peer-reviewed evidence. RESULTS Overall, 25 different pieces of guidance within the three categories were identified on 49 websites. Guidance concerning hypothermia symptoms most frequently appeared on websites, with six symptoms appearing on 50% or greater of websites. No piece of guidance within the vulnerable population categories appeared on greater than 60% of the websites, and prevention-related guidance was characterized by varied SORT grades. CONCLUSIONS Hypothermia information on the internet was not entirely congruent with the information within the peer-reviewed medical literature. Several suggestions for improving web-based hypothermia resources include clearly listing sources for users to see and eliminating guidance with lower SORT grades and replacing with evidence-based information.
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Affiliation(s)
- Jeremy M Spencer
- Department of Geography, Kent State University, Department of Geosciences, The University of Akron Akron, OH
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Baumgartner EA, Belson M, Rubin C, Patel M. Hypothermia and Other Cold-Related Morbidity Emergency Department Visits: United States, 1995–2004. Wilderness Environ Med 2008; 19:233-7. [DOI: 10.1580/07-weme-or-104.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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