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Eur J Cardiothorac Surg 2001;20:58-64
© 2001 Elsevier Science NL

Rewarming from accidental hypothermia by extracorporeal circulation.

A retrospective study

^a Department of Anesthesia and Intensive Care, Haukeland University Hospital, University of Bergen, N-5021 Bergen, Norway
^b Department of Heart Disease, Haukeland University Hospital, University of Bergen, N-5021 Bergen, Norway
^c Surgical Research Laboratory, Haukeland University Hospital, University of Bergen, N-5021 Bergen, Norway

Received 12 January 2001; received in revised form 23 March 2001; accepted 23 March 2001.

Corresponding author. Tel.: +47-5597-6865; fax: +47-5597-6898
e-mail: phus{at}haukeland.no

Objective: Twenty-six patients with accidental hypothermia combined with circulatory arrest or severe circulatory failure were rewarmed to normothermia by use of extracorporeal circulation (ECC). The aim of the present study was to evaluate our results. Patients and methods: The treatment of six female and 20 male patients (median age: 26.7 years; range 1.9–76.3 years) rewarmed in the period 1987–2000 was evaluated retrospectively. Hypothermia was related to immersion/submersion in cold water (n=17), avalanche (n=1) or prolonged exposure to cold surroundings (n=8). Prior to admission, the trachea was intubated and cardiopulmonary resuscitation (CPR) initiated in all patients with cardiorespiratory arrest (n=22), whereas in those with respiration/circulation (n=4) only oxygen therapy via a facemask was given. Results: Nineteen of the 26 patients were weaned off ECC whereas seven died because of refractory respiratory and/or cardiac failure. Eight of the 19 successfully weaned patients were discharged from hospital after a median of 10 days. One patient died 3 days after circulatory arrest (complete atrioventricular block) resulting in severe cerebral injury. The remaining ten patients died following 1–2 days due to severe hypoxic brain injury (n=5), cerebral bleeding (n=1) or irreversible cardiopulmonary insufficiency (n=4). Based on the reports from the site of accident, two groups of patients were identified: the asphyxia group (n=15) (submersions (n=14); avalanche accident (n=1)) and the non-asphyxia group (n=11) (patients immersed or exposed to cold environment). Seven intact survivors discharged from hospital belonged to the non-asphyxia group whereas one with a severe neurological deficit was identified within the asphyxia group. Conclusion: Patients with non-asphyxiated deep accidental hypothermia have a reasonable prognosis and should be rewarmed before further therapeutic decisions are made. In contrast, drowned patients with secondary hypothermia have a very poor prognosis. The treatment protocol under such conditions should be the subject for further discussion.

Key Words: Accidental hypothermia • Near-drowning • Drowning • Extracorporeal circulation • Extracorporeal blood rewarming

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