In a case of profound hypothermia, peritoneal dialysis was utilized with a dual purpose, removing barbiturate and rewarming the "core" in advance of the "shell." Recovery without any sequela occurred from a body temperature of 69.8 F (21 C). ACCIDENTAL hypothermia, in spite of recent ac¬ complishments from the use of induced hypother¬ mia, still carries an extremely high mortality rate and poses a multiplicity of therapeutic challenges. Among these are cardiac arrhythmias and arrest, electrolyte and fluid abnormalities, prevention of permanent damage to the brain and extremities, and perhaps the most challenging of all, how to rewarm the victim.1'8 Experimental data appear to support the thesis that the internal organs (core) must be rewarmed in advance of the external parts (shell) in order to cope with the normal or above normal metabolic needs, which the rewarmed shell will demand of the cardiac and respiratory systems.3 Methods previous¬ ly used include hot baths, gastric lavage, diathermy, blankets, exposure to room temperature, and warm liquids introduced into the pleural cavity, although some of these obviously do not satisfy the "core first" principle.The following is, to our knowledge, the first de¬ scription of the use of a method of rapid rewarming, with complete recovery from a body temperature of 69.8 F (21 C).
Report of a CaseA 24-year-old white woman, clad in dress and under¬ clothes, was discovered at 7 pm Feb 21, 1966, in an unheated tool shed. Her family physician reported that he "found her in a sitting position slumped forward, with right leg crossed over the left, no heart beat audible, no pulse, pupils widely dilated and did not react to light; skin quite cold and pale. Only sign of life was an occasional weak respiratory attempt." Although the patient appeared moribund, external cardiac massage and mouth to mouth resuscitation were instituted and continued until she was transferred to the emergency room at approximately 7:55 PM.When the patient arrived in the emergency room, it was the impression of those present that she was dead. Her skin was extremely cold, her pupils were widely dilated and fixed, and there were no heart sounds, blood pressure, or pulse present. However, a weak respiratory movement was observed. Because of this it was decided to institute vigorous resuscitative measures in spite of opinions that prognosis for survival was nil, and that even if she sur¬ vived cerebral damage would probably be extreme.External cardiac massage was reinstituted, an endotracheal tube was inserted, and respirations were manually per¬ formed. During this time a laboratory thermometer was inserted high into the rectum for periods of five minutes; this consistently gave readings of 69.8 F (21 C).Because of the severe hypothermia and the suspicion by her physician of drug ingestion, peritoneal dialysis was thought to offer dual therapeutic possibilities for rapidly rewarming the core and removing any dialyzable drugs. A catheter was inserted through a suprapubic trocar into the left peritoneal gu...
