Endovascular rewarming in the emergency department for moderate to severe accidental hypothermia

Klein, Lauren R.; Huelster, Joshua; Adil, U.; Rischall, Megan; Brunette, Douglas D.; Kempainen, Robert R.; Prekker, Matthew E.

doi:10.1016/j.ajem.2017.05.001

Cited by 18 publications

(16 citation statements)

References 26 publications

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“…At this stage warmed (38-42°C) non-dextrose IV fluid may be carefully administered as well [1,2,3]. In HT III (described in case 1) the patient is in imminent danger of slipping into cardiac arrest and thus invasive active approaches are indicated: warmed IV fluids, and pleural or peritoneal lavage [1,2,3,6]. Despite mere modest results in recent studies, at HT II or III consideration may also be given to the placement of a centrally-located endovascular warming Zoll® catheter [6,7].…”

Section: Resultsmentioning

confidence: 99%

“…In HT III (described in case 1) the patient is in imminent danger of slipping into cardiac arrest and thus invasive active approaches are indicated: warmed IV fluids, and pleural or peritoneal lavage [1,2,3,6]. Despite mere modest results in recent studies, at HT II or III consideration may also be given to the placement of a centrally-located endovascular warming Zoll® catheter [6,7]. During treatment of HT I, II and III, it is important to continuously assess the patient's hemodynamic stability as well as their response to the therapy with appropriate core temperature elevation.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Complete Neurological Recovery after Severe Accidental Hypothermia: Two Cases and a Novel Algorithm Proposal

Delvecchio¹,

Marinica²,

Williams³

et al. 2019

AJMCR

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Primary accidental hypothermia results from endogenous thermoregulatory mechanisms being overwhelmed by environmental stressors. Vulnerable populations include the elderly, mentally ill, homeless, and chemically dependent. When core temperatures fall below 35°C, the resulting metabolic derangements provoke cardiopulmonary compromise and dysrhythmia. Due to the human body's innate protective mechanisms there are reports of patients making complete neurologic recovery after exposure to extreme temperatures and prolonged cardiopulmonary arrest. We describe two cases from our institution demonstrating appropriate treatment methods for the two most severe stages of hypothermia. A 57-year-old male with a core temperature of 27°C who was successfully resuscitated with warm bladder and thoracic lavage and a 34-year-old female with a core temperature of 22°C that fully recovered after 5 hours of external cardiopulmonary bypass. From our experience and a review of the literature, we have developed a modified version of the Swiss staging model and incorporated it into a novel treatment algorithm for in-hospital adult accidental hypothermia patients presenting to urban community hospitals. The two example cases described highlight how appropriate utilization of this novel algorithm can lead to positive outcomes in otherwise critical clinical scenarios.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Complete Neurological Recovery after Severe Accidental Hypothermia: Two Cases and a Novel Algorithm Proposal

Delvecchio¹,

Marinica²,

Williams³

et al. 2019

AJMCR

View full text Add to dashboard Cite

show abstract

“…Unlike other studies that reported the predominant conditions associated with secondary hypothermia were cold and alcohol or drug intoxication, 4,12 more than half of the patients in this study had internal diseases, which should be treated alongside rewarming. Considering that the cause of death of patients with secondary hypothermia is often an underlying disease, rather than the hypothermia itself, 14,15 there might be little difference in the quality of care for patients with internal diseases between the specialized centers and non-specialized centers in this study. In contrast, among patients with systolic blood pressure of <90 mmHg, care at the specialized centers had a positive association with improved outcome.…”

Section: Discussionmentioning

confidence: 96%

Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry

Fujimoto

Matsuyama

Morita

et al. 2020

Acute Medicine & Surgery

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“…Several techniques are described in the literature that can be considered if CPB or ECMO are unavailable. These include esophageal warming devices, endovascular catheters, hemodialysis, and endocavitary lavage (1,2,(4)(5)(6)(13)(14)(15). While no randomized controlled trials exist, several case reports and reviews have tried to compare various techniques.…”

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confidence: 99%

“…While no randomized controlled trials exist, several case reports and reviews have tried to compare various techniques. These sources to do not seem to favor any particular technique over another but rather reports the rates of temperature rise (1)(2)(3)(5)(6)(7)(13)(14)(15). Classically, lavage techniques are attempted in the thoracic cavity, the peritoneum, the bladder, the stomach, the esophagus, or the colon.…”

mentioning

confidence: 99%

Severe accidental hypothermia in Phoenix? Active rewarming using thoracic lavage

Mozer¹,

Raz²,

Wyatt³

et al. 2019

Southwest J Pulm Crit Care

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Hypothermia can progress quickly and become life threatening if left untreated. Rewarming in the severely hypothermic patient is of critical importance and is achieved with active and passive techniques. Here we present a case of a hypothermic patient with cardiac instability for whom thoracic lavage was ultimately used. We will review the treatment of hypothermia and discuss the technical aspects our approach. Case Presentation A 53 year-old male with a past medical history of substance abuse, chronic hepatitis C, and poorly controlled type 2 diabetes mellitus complicated by a recent hospitalization for osteomyelitis was brought to the emergency department after being found lying on a road in a shallow pool of water in the early morning hours of a rainy day in Phoenix, Arizona. The ambient temperature that night was 39 F (3.9 C). Emergency Medical Services (EMS) noted a decreased level of consciousness and obtained a finger stick glucose of 15 mg/dl. EMS reported a tympanic membrane temperature of 23.9 C. En route, the patient was administered 2mg naloxone and 25g dextrose intravenously with no improvement in his mental status. On Emergency Department (ED) arrival, the patient had a GCS of 8 (Eyes 4, Verbal 1, Motor 3) and exhibited intermittent posturing. His foot wound appeared clean and without signs of infection. The initial core temperature recorded was 25.9C via bladder thermometer, systolic blood pressure was 92/50, and heart rate fluctuated between 50 and 90 beats per minute. After removing wet clothing, initiation of warmed saline, and placing a forced warm air blanket on the patient, he was intubated for airway protection and vasopressors were initiated. Osborn waves were evident on the initial EKG (Figure 1).

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Endovascular rewarming in the emergency department for moderate to severe accidental hypothermia

Cited by 18 publications

References 26 publications

Complete Neurological Recovery after Severe Accidental Hypothermia: Two Cases and a Novel Algorithm Proposal

Complete Neurological Recovery after Severe Accidental Hypothermia: Two Cases and a Novel Algorithm Proposal

Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry

Severe accidental hypothermia in Phoenix? Active rewarming using thoracic lavage

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