Extracorporeal Life Support for Refractory Cardiac Arrest from Accidental Hypothermia: A 10-Year Experience in Edinburgh

• Published in: The Journal of emergency medicine 2017-02, Vol.52 (2), p.160-168
• Main Authors: Khorsandi, Maziar, MRCS, Dougherty, Scott, MRCP, Young, Neil, FRCA, Kerslake, Dean, FRCEM, Giordano, Vincenzo, MD, Lendrum, Robert, FRCA, Walker, William, FRCS, Zamvar, Vipin, FRCS, Yim, Ivan, MRCS, Pessotto, Renzo, FRCS
• Format: Article
• Language: English
• Subjects: Adult; Aged; Emergency; extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - standards; Extracorporeal Membrane Oxygenation - statistics & numerical data; Female; heart arrest; Heart Arrest - epidemiology; Heart Arrest - etiology; Heart Arrest - therapy; Humans; hypothermia; Hypothermia - complications; Hypothermia - epidemiology; Hypothermia - etiology; Male; Middle Aged; Retrospective Studies; Rewarming - methods; Rewarming - statistics & numerical data; Scotland - epidemiology; Survival Rate; Treatment Outcome
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2016.10.043

Abstract Background Cardiac arrest caused by accidental hypothermia is a rare phenomenon with a significant mortality rate if untreated. The consensus is that these patients should be rewarmed with extracorporeal life support (ECLS) with the potential for excellent survival and neurologic outcomes. However, given the lack of robust data and clinical trials, the optimal management of such patients remains elusive. Objective In this single-center study, we looked at the outcomes of all adult patients undergoing salvage ECLS for cardiac arrest caused by accidental hypothermia over a 10-year period from June 2006 to June 2016. Methods These data were obtained from the Royal Infirmary of Edinburgh cardiothoracic surgery database. The patients' hard copy case notes, TrakCare (InterSystems Corp, Cambridge, MA), picture archiving and communications system (PACS), and WardWatcher databases were used to cross-check the accuracy of the acquired data. Results Eleven patients met the inclusion criteria. The etiology of hypothermia was exposure to cold air (64%) and cold water immersion (36%). Two (18%) were treated with extracorporeal membrane oxygenation and the rest with cardiopulmonary bypass. The mean age was 51 years (range 32–73), and the mean core body temperature on admission was 20.6°C (range