Problems and Pitfalls of Qualification for Extracorporeal Rewarming in Severe Accidental Hypothermia

• Published in: Journal of cardiothoracic and vascular anesthesia 2016-12, Vol.30 (6), p.1693-1697
• Main Authors: Jarosz, Anna, MD, Kosiński, Sylweriusz, MD, PhD, Darocha, Tomasz, MD, PhD, Paal, Peter, MD, PhD, Gałązkowski, Robert, DrPH, Hymczak, Hubert, MD, Drwiła, Rafał, MD, PhD
• Format: Article
• Language: English
• Subjects: Accidents; Adolescent; Adult; advanced cardiac life support; Aged; Aged, 80 and over; Anesthesia & Perioperative Care; cardiac arrest; cardiopulmonary resuscitation; Child; Child, Preschool; Critical Care; extracorporeal life support; Female; Humans; hypothermia; Hypothermia - therapy; Male; Middle Aged; Pregnancy; Retrospective Studies; rewarming; Rewarming - methods; Treatment Outcome; Young Adult
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2016.05.015

Objectives When establishing the Severe Hypothermia Treatment Centre, certain problems and pitfalls regarding the qualification for extracorporeal rewarming were encountered. The authors shared their experience and opened a discussion with other centers that deal with severe, accidental hypothermia. Design Retrospective analysis of medical records of all patients examined by the hypothermia coordinator. Setting Patients consulted and treated by the Severe Hypothermia Treatment Centre. Participants Patients who underwent accidental hypothermia. Interventions From July 2013 until January 2016, hypothermia coordinators at the Severe Hypothermia Treatment Centre examined the cases of 152 hypothermic patients. Of those cases, 127 patients were subjected to noninvasive rewarming in referral hospitals and 25 were accepted to the center for extracorporeal rewarming. Measurements and Main Results Difficulties that deferred or delayed the implementation of extracorporeal membrane oxygen rewarming were identified and addressed, including low platelet/red blood count, intraperitoneal fluid of unknown origin, abnormal results of head computed tomography, extremes of age, bleeding from the external auditory meatus, inaccuracy of infrared-based thermometers, iatrogenic trauma to the femoral vessels, chronic/terminal comorbidities, poisonings, pregnancy, hypoglycemia, hemodynamic stability despite severe hypothermia, and decontamination protocol. Conclusions The problems discussed may delay the use of extracorporeal membrane oxygen rewarming in hypothermic patients but should not discourage medical teams from the implementation of extracorporeal rewarming. The prognosis for severe hypothermia is favorable, even with a long resuscitation time and low core temperatures.