Hypothermic Cardiac Arrest With Full Neurologic Recovery After Approximately Nine Hours of Cardiopulmonary Resuscitation: Management and Possible Complications

Forti, Alessandro; Brugnaro, Pamela; Rauch, Simon; Crucitti, Manuela; Brugger, Hermann; Cipollotti, Giovanni; Strapazzon, Giacomo

doi:10.1016/j.annemergmed.2018.09.018

Cited by 29 publications

(20 citation statements)

References 14 publications

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“…Favourable patient outcomes have been reported after endovascular thrombectomy performed up to 16 h after ischaemic stroke (Albers et al, 2018). Furthermore, therapeutic hypothermia during elective surgery is considered to be neuroprotective, buying surgeons and patients precious time, and accidental hypothermic cardiocirculatory arrest induced by cold exposure/drowning has been shown to extend the 'survival' time of the brain by up to as much as 9 h in the most extreme cases without any evidence of neurological damage (Figure 4b;Forti et al, 2019;Gilbert, Busund, Skagseth, Nilsen, & Solbø, 2000).…”

Section: Beyond Limits; the Brain's Unexpected Resiliencementioning

confidence: 99%

Oxygen and brain death; back from the brink

Bailey

2019

Experimental Physiology

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New Findings What is the topic of this review?To explore the unique evolutionary origins of the human brain and critically appraise its energy budget, including limits of oxygen and glucose deprivation during anoxia and ischaemia. What advances does it highlight?The brain appears to be more resilient to substrate depletion than traditionally thought, highlighting greater resilience and an underappreciated capacity for functional recovery. Abstract The human brain has evolved into an unusually large, complex and metabolically expensive organ that relies entirely on a continuous supply of O2 and glucose. It has traditionally been assumed that its exorbitant energy budget, combined with little to no energy reserves, renders it especially vulnerable to anoxia and ischaemia, with substrate depletion and progression towards cell death largely irreversible and rapid. However, new and exciting evidence suggests that neurons can survive for longer than previously thought, highlighting an unexpected resilience and underappreciated capacity for functional recovery that has changed the way we think about brain cell death. Nature has the potential to unlock some of the mysteries underlying ischaemic survival, with select vertebrates having solved the problem of anoxia–hypoxia tolerance over millions of years of evolution. Better understanding of their survival strategies, including remarkable adaptations in brain physiology and redox homeostasis, might help to identify new therapeutic targets for human diseases characterized by O2 deprivation, ischaemia–reperfusion injury and ageing.

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Section: Beyond Limits; the Brain's Unexpected Resiliencementioning

confidence: 99%

Oxygen and brain death; back from the brink

Bailey

2019

Experimental Physiology

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“…We read with great interest the recent case report by Forti et al 1 We appreciate the professionalism and dedication of the rescue and medical teams and applaud their success. They pushed the limit of human potential for survival, proving once again that "no one is dead until warm and dead.…”

Section: Hypothermic Cardiac Arrest Patients' Selection Criteria For mentioning

confidence: 91%

Hypothermic Cardiac Arrest Patients’ Selection Criteria for Extracorporeal Life Support Rewarming in Extreme Cases

Podsiadło

Kosiński

Darocha

et al. 2019

Annals of Emergency Medicine

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with infection may be more stoic or familiar with the examination process, and pain will be less obvious on examination. There are other studies that also suggest that findings such as cervical, uterine, and adnexal tenderness are insensitive and nonspecific, and vary when different clinicians perform the examination. 2-5 In the "Limitations" section of the study, we acknowledged that pelvic inflammatory disease can be attributed to other organisms such as Mycoplasma genitalium, herpes, and normal flora overgrowth. However, the antibiotic regimens that the Centers for Disease Control and Prevention suggests are targeted toward chlamydia, gonorrhea, and trichomonas. Visualization or palpation provided by the pelvic examination does not clarify which organism is involved or which antibiotic is needed. We agree with the concern for patients with negative test results for sexually transmitted infections and positive results for pelvic examinations, and the related risk of chronic complications because of untreated cases. In the article, we discuss a stepwise approach that begins with urine point-of-care testing for chlamydia, gonorrhea, 6 trichomonas, candida, and clue cells. For patients with negative urine testing results, we suggested the pelvic examination can be considered to aid diagnosis. Surveillance data show that rates of sexually transmitted infections and their subsequent complications are increasing every year, as is antibiotic resistance to gonorrhea. The current approach, which relies heavily on the pelvic examination, is proving unsuccessful at combating this epidemic. Empiric treatment of all patients with positive pelvic examination results, as Dr. Swartz points out, means that almost 60% of women are being treated with antibiotics that do not truly target the cause of their infection. This approach does not necessarily resolve the patient's problem and creates resistance. The use of point-of-care sexually transmitted infection results and development of additional sensitive tests for other causes of cervicitis and pelvic inflammatory disease will aid in making a correct diagnosis. New treatment guidelines are imperative, and we encourage physicians who work in high-risk areas to repeat our study for external validity and assess whether it pertains primarily to cervicitis and not pelvic inflammatory disease.

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“…本症例では，確実に心停止が確認されてからV–A ECMOが駆動されるまでに69分間，安定した心拍再開が得られるまでに206分間かかったが，良好な神経学的予後を得ることができた。偶発性低体温症による心停止で，CPRを222分間行った後にV–A ECMOを駆動して，心停止から522分後に心拍再開，3か月後に後遺症なく退院した症例も報告されている。また，偶発性低体温症による心停止では，下顎硬直があっても社会復帰する症例や，心停止が認知されてからCPRが開始されるまで70分かかったものの社会復帰できた症例，V–A ECMOを使わずに344分間のCPRを経て社会復帰した症例も報告されていることから，諦めずに蘇生を試みることが重要だと思われる。…”

Section: 考　　察unclassified

経皮的心肺補助装置が有用だった偶発性低体温症による心肺停止の1例(A case of cardiopulmonary arrest due to accidental hypothermia that was treated effectively with extracorporeal membrane oxygenation)

聖大

周

崇行

et al. 2021

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨　偶発性低体温症による心肺停止の蘇生と体温管理に，veno–arterial extracorporeal membrane oxygenation （V–A ECMO）が有用だった症例を経験したので報告する。症例は73歳の女性。3月某日の昼前，側溝にはまっているところを発見され，救急要請となった。初期波形は心静止で，搬送中に心室細動となった。電気的除細動に抵抗性で，病院到着後も一貫して心室細動が持続した。膀胱温は23.3℃で，偶発性低体温症による難治性心室細動と考え，V–A ECMOを用いて心肺蘇生と復温を行う方針とした。救急隊接触から69分後にV–A ECMOを駆動開始し，救急隊接触から206分後に膀胱温が32℃に達したため，電気的除細動を行ったところ，心拍再開した。引き続き体温管理療法を行い，膀胱温34℃を24時間維持した。入院2日目にV–A ECMOは離脱できた。頭部CTでは散在性の脳梗塞を合併したものの，入院8日目には簡単な意思疎通が可能になり，入院9日目には意識レベルは清明まで改善した。心停止時間は最低206分間と長時間であったが，高度の低体温では神経学的予後が期待できる可能性があるので，心停止時間が長くとも，V–A ECMOを用いた管理を検討するべきである。

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Hypothermic Cardiac Arrest With Full Neurologic Recovery After Approximately Nine Hours of Cardiopulmonary Resuscitation: Management and Possible Complications

Cited by 29 publications

References 14 publications

Oxygen and brain death; back from the brink

Oxygen and brain death; back from the brink

Hypothermic Cardiac Arrest Patients’ Selection Criteria for Extracorporeal Life Support Rewarming in Extreme Cases

経皮的心肺補助装置が有用だった偶発性低体温症による心肺停止の1例(A case of cardiopulmonary arrest due to accidental hypothermia that was treated effectively with extracorporeal membrane oxygenation)

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