Effects of ethanol on systemic hemodynamics in a porcine model of accidental hypothermia

Loppnow, Gregory; Wilson, Lance D.

doi:10.1016/j.ajem.2015.07.012

Cited by 5 publications

(2 citation statements)

References 22 publications

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“…This post-rewarming heart failure was found in various studies with different results. In experimental studies on canine or pig models, residual left systolic ventricular dysfunction was demonstrated [14,15]. However, in a more recent prospective work conducted on a small sample of 9 patients in which VA-ECMO was implemented for HT III or IV, the researchers discovered moderate biventricular diastolic dysfunction but no systolic impairment after the rewarming process [16].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Therapeutic management of severe hypothermia with veno-arterial ECMO: where do we stand? Case report and review of the current literature

Ledoux

Leger

2020

Scand J Trauma Resusc Emerg Med

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Background: Severe accidental hypothermia is associated with high morbidity and mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides an efficient rewarming method with complete cardiopulmonary support. The use of VA-ECMO for this indication has greatly improved the vital and functional prognosis of patients. Case presentation: We report a case of a 46-year-old patient who was treated for severe hypothermia with a temperature of 22.4°C along with initial cardiac arrest, whose progression was favorable after the implementation of VA-ECMO support. Two months after initial cardiac arrest, the patient was reassessed and showed signs of complete recovery with regard to his mental and physical capacities. Conclusions: The recent international publications and groups of experts recommend the use of VA ECMO as the gold standard therapy to treat severe hypothermia. Therefore, it seems suitable to update the current knowledge on the topic by analysing the latest international publications. The performance of this technique calls into question ethical and economic factors. Two distinct medical teams tried to identify and regroup prognosis factors in predictive survival scores. They raise the question of the utility of these scores in clinical practice. Indeed, according to which survival rate should we proceed to prolonged resuscitation and implement VA-ECMO? Additional studies will be needed for external approval of these survival scores, and additional reflection by experts will be required.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Therapeutic management of severe hypothermia with veno-arterial ECMO: where do we stand? Case report and review of the current literature

Ledoux

Leger

2020

Scand J Trauma Resusc Emerg Med

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“… • Hypotension is the norm. • After rewarming, mean arterial pressure, contractility, and cardiac output are decreased, especially if alcohol ingested before cooling [ 273 ]. • More prolonged depression of cardiac function after rewarming CENTRAL NERVOUS SYSTEM • Reflexes become increasingly sluggish as body temperature falls and become absent ≈ 28–30 °C [ 230 , 274 ].…”

Section: Accidental Hypothermia: An Update- Part 2 In-hospital Managementioning

confidence: 99%

Accidental hypothermia–an update

Paal

Gordon

Strapazzon

et al. 2016

Scand J Trauma Resusc Emerg Med

232

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BackgroundThis paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest.MethodsThe authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review.ResultsThe hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature <28 °C, ventricular arrhythmia, systolic blood pressure <90 mmHg), and those who have already arrested, should be transferred directly to an ECLS-centre. Cardiac arrest patients should receive continuous cardiopulmonary resuscitation (CPR) during transfer. If prolonged transport is required or terrain is difficult, mechanical CPR can be helpful. Delayed or intermittent CPR may be appropriate in hypothermic arrest when continuous CPR is impossible. Modern post-resuscitation care should be implemented following hypothermic arrest. Structured protocols should be in place to optimise pre-hospital triage, transport and treatment as well as in-hospital management, including detailed criteria and protocols for the use of ECLS and post-resuscitation care.ConclusionsBased on new evidence, additional clinical experience and clearer management guidelines and documentation, the treatment of accidental hypothermia has been refined. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.

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