Eur J Cardio-thorac
Surg (1990) 4:390-393
Accidental deep hypothermia with cardiopulmonary arrest: extracorporeal blood rewarming in 11 patients B. H. Walpoth, T. Lecher, E Leupi, P. Schiiphach, W. Miihlemann, and U. Althaus Department
of Thoracic and Cardiovascular
Surgery, University
of Berne. Inselspital,
Abstract. Sixteen patients (age 13-53 years) with accidental deep hypothermia have been rewarmed in our clinic during the last 10 years, 14 by femoro-femoral cardiopulmonary bypass (CPB) of whom 11 had a cardiopulmonary arrest (asystole in 5 and ventricular fibrillation in 6). On admission, the latter were clinically dead showing wide non-reactive pupils and being supported by ventilation and external heart massage. In the survivors, the mean length of cold exposure was 4.4 h (2-5.5 h) and mean arrest interval until initiation of CPB was 2.5 h (1.4-3.7 h). Rectal temperature on admission ranged from 17.5 “C to 26 “C (mean 22.5 “C). The causes for hypothermia were fall into a crevasse (5), avalanche (1) drowning (2) and cold exposure (3) including 2 suicide attempts. Results are summarized in the following table:
Recovery Death
Crevasse
Exposure
Avalanche & Total Drowning
4 1
3 0
0 3
7 4
Eight of the 11 patients with deep hypothermia and cardiac arrest were rewarmed and resuscitated successfully with CPB. Three patients, including 2 cases of asphyxia (avalanche and drowning), could not be weaned from CPB despite adequate rewarming. The other drowned patient (53 years) died on the 3rd postoperative day (POD) from ARDS. The main complication was pulmonary edema (57%) and transient neurological deficits. All survivors became conscious during the first POD and resumed, their professional activity. We conclude that patients with accidental deep hypothermia and even prolonged cardiopulmonary arrest should be rewarmed and resuscitated rapidly by cardiopulmonary bypass. These measures are very promising particularly if the cause of accident and the circumstances suggest that cardiopulmonary arrest was induced by hypothermia alone withRead at the 3rd Annual Meeting of the European Association Cardio-thoracic Surgery, Munich, October 9-11, 1989
for
Berne, Switzerland
out other asphyxiating mechanisms. thorac Surg (1990) 4: 390 ~ 3931
[Eur J Cardio-
Key words: Accidental hypothermia ~ Cardiac arrest ~ Extracorporeal rewarming - Cardiopulmonary bypass
Hypothermia is a frequently underestimated problem leading to death if not recognized and treated adequately. The etiology includes cold exposure of the elderly or suicidal patients, drowning in cold water or a mountain accident such as a fall into a crevasse or avalanche casualties [3, 5. 11, 121. The latter present special problems due to the additional interference of asphyxiating mechanisms [9, 181. In severe hypothermia (temperature below 28 “C) cardiopulmonary arrest may occur and require a special rewarming method such as extracorporeal blood rewarming by cardiopulmonary bypass (CPB). CPB has the advantage of being able to rewarm the core of the body first and to support the body’s circulation and oxygenation until normal body temperature, cardiopulmonary function and metabolic homeostasis are reached [l, 2, 13, 16, 19, 201. This retrospective study focusses only on our experience with extracorporeal blood rewarming in patients with deep hypothermia and cardiopulmonary arrest. The aim is to analyze our results and to examine the indications and predicting factors for outcome. Patieuts During the last 10 years, we have treated 16 patients with accidental hypothermia of which 14 had extracorporeal blood rewarming. Eleven were admitted with cardiopulmonary arrest and were rewarmed by femoro-femoral CPB with an additional sternotomy in 2 early cases. We analyzed the last 11 patients and assessed the factors which might play a role in survival. The patients were divided into survivors (n = 7) and non survivors (n = 4), and the mean value and range were calculated for each group.
391 Results The 7 survivors (4 females, 3 males) were 11 years younger than the non survivors (I female, 3 males). the difference not being of statistical significance (Table 1). The causes of accidental hypothermia include fall into a crevasse (5 patients), cold exposure (3), avalanche (1). drowning (1) and 1 case of suicidal cold-water exposure without intoxication. Mortality was attributed to asphyxia (2 patients), head injury (1) and aspiration (1). The time course is summarized in Table 2. There is no difference in the duration of cold exposure between the two groups (survivors vs. non survivors, 4.4 h and 4.7 h. respectively). The transport time was 30 min shorter in the non survivors (1.5 h vs. 2.0 h, P = ns). Five of the 7 survivors and 1 of the non survivors were first transferred to another hospital for primary care. In 3 cases, cardiac arrest occurred during rescue and transportation (sheltering death). All cases were either intubated, ventilated and received cardiac massage at rescue, during transportation
Table 1. Patients
Sur-\Iv
Surg (1990) 4:390-393
Accidental deep hypothermia with cardiopulmonary arrest: extracorporeal blood rewarming in 11 patients B. H. Walpoth, T. Lecher, E Leupi, P. Schiiphach, W. Miihlemann, and U. Althaus Department
of Thoracic and Cardiovascular
Surgery, University
of Berne. Inselspital,
Abstract. Sixteen patients (age 13-53 years) with accidental deep hypothermia have been rewarmed in our clinic during the last 10 years, 14 by femoro-femoral cardiopulmonary bypass (CPB) of whom 11 had a cardiopulmonary arrest (asystole in 5 and ventricular fibrillation in 6). On admission, the latter were clinically dead showing wide non-reactive pupils and being supported by ventilation and external heart massage. In the survivors, the mean length of cold exposure was 4.4 h (2-5.5 h) and mean arrest interval until initiation of CPB was 2.5 h (1.4-3.7 h). Rectal temperature on admission ranged from 17.5 “C to 26 “C (mean 22.5 “C). The causes for hypothermia were fall into a crevasse (5), avalanche (1) drowning (2) and cold exposure (3) including 2 suicide attempts. Results are summarized in the following table:
Recovery Death
Crevasse
Exposure
Avalanche & Total Drowning
4 1
3 0
0 3
7 4
Eight of the 11 patients with deep hypothermia and cardiac arrest were rewarmed and resuscitated successfully with CPB. Three patients, including 2 cases of asphyxia (avalanche and drowning), could not be weaned from CPB despite adequate rewarming. The other drowned patient (53 years) died on the 3rd postoperative day (POD) from ARDS. The main complication was pulmonary edema (57%) and transient neurological deficits. All survivors became conscious during the first POD and resumed, their professional activity. We conclude that patients with accidental deep hypothermia and even prolonged cardiopulmonary arrest should be rewarmed and resuscitated rapidly by cardiopulmonary bypass. These measures are very promising particularly if the cause of accident and the circumstances suggest that cardiopulmonary arrest was induced by hypothermia alone withRead at the 3rd Annual Meeting of the European Association Cardio-thoracic Surgery, Munich, October 9-11, 1989
for
Berne, Switzerland
out other asphyxiating mechanisms. thorac Surg (1990) 4: 390 ~ 3931
[Eur J Cardio-
Key words: Accidental hypothermia ~ Cardiac arrest ~ Extracorporeal rewarming - Cardiopulmonary bypass
Hypothermia is a frequently underestimated problem leading to death if not recognized and treated adequately. The etiology includes cold exposure of the elderly or suicidal patients, drowning in cold water or a mountain accident such as a fall into a crevasse or avalanche casualties [3, 5. 11, 121. The latter present special problems due to the additional interference of asphyxiating mechanisms [9, 181. In severe hypothermia (temperature below 28 “C) cardiopulmonary arrest may occur and require a special rewarming method such as extracorporeal blood rewarming by cardiopulmonary bypass (CPB). CPB has the advantage of being able to rewarm the core of the body first and to support the body’s circulation and oxygenation until normal body temperature, cardiopulmonary function and metabolic homeostasis are reached [l, 2, 13, 16, 19, 201. This retrospective study focusses only on our experience with extracorporeal blood rewarming in patients with deep hypothermia and cardiopulmonary arrest. The aim is to analyze our results and to examine the indications and predicting factors for outcome. Patieuts During the last 10 years, we have treated 16 patients with accidental hypothermia of which 14 had extracorporeal blood rewarming. Eleven were admitted with cardiopulmonary arrest and were rewarmed by femoro-femoral CPB with an additional sternotomy in 2 early cases. We analyzed the last 11 patients and assessed the factors which might play a role in survival. The patients were divided into survivors (n = 7) and non survivors (n = 4), and the mean value and range were calculated for each group.
391 Results The 7 survivors (4 females, 3 males) were 11 years younger than the non survivors (I female, 3 males). the difference not being of statistical significance (Table 1). The causes of accidental hypothermia include fall into a crevasse (5 patients), cold exposure (3), avalanche (1). drowning (1) and 1 case of suicidal cold-water exposure without intoxication. Mortality was attributed to asphyxia (2 patients), head injury (1) and aspiration (1). The time course is summarized in Table 2. There is no difference in the duration of cold exposure between the two groups (survivors vs. non survivors, 4.4 h and 4.7 h. respectively). The transport time was 30 min shorter in the non survivors (1.5 h vs. 2.0 h, P = ns). Five of the 7 survivors and 1 of the non survivors were first transferred to another hospital for primary care. In 3 cases, cardiac arrest occurred during rescue and transportation (sheltering death). All cases were either intubated, ventilated and received cardiac massage at rescue, during transportation
Table 1. Patients
Sur-\Iv
