Intractable Ventricular Fibrillation Associated with Profound Accidental Hypothermia — Successful Treatment with Partial Cardiopulmonary Bypass

Towne, William D.; Geiss, W. Peter; Yanes, H.O.; Rahimtoola, Shahbudin H.

doi:10.1056/nejm197211302872210

Cited by 72 publications

(11 citation statements)

References 6 publications

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“…Hypothermia is associated with an increased susceptibility for ventricular arrhythmias and ventricular fibrillation (VF) (2,19,20,30,31), and this effect has been related to slowing of conduction, a heterogeneous increase in ventricular repolarization, and the dispersion of refractoriness (25,29). On the other hand, myocardial cooling has also been used to modify different cardiac rhythm disturbances.…”

mentioning

confidence: 99%

Effects of acute reduction of temperature on ventricular fibrillation activation patterns

Chorro

Guerrero²,

Ferrero

et al. 2002

American Journal of Physiology-Heart and Circulatory Physiology

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Because of its electrophysiological effects, hypothermia can influence the mechanisms that intervene in the sustaining of ventricular fibrillation. We hypothesized that a rapid and profound reduction of myocardial temperature impedes the maintenance of ventricular fibrillation, leading to termination of the arrhythmia. High-resolution epicardial mapping ( series 1; n = 11) and transmural recordings of ventricular activation ( series 2; n = 10) were used to analyze ventricular fibrillation modification during rapid myocardial cooling in Langendorff-perfused rabbit hearts. Myocardial cooling was produced by the injection of cold Tyrode into the left ventricle after induction of ventricular fibrillation. Temperature and ventricular fibrillation dominant frequency decay fit an exponential model to arrhythmia termination in all experiments, and both parameters were significantly correlated ( r = 0.70, P < 0.0001). Termination of the arrhythmia occurred preferentially in the left ventricle and was associated with a reduction in conduction velocity (−60% in left ventricle and −54% in right ventricle; P < 0.0001) and with activation maps predominantly exhibiting a single wave front, with evidence of wave front extinction. We conclude that a rapid reduction of temperature to <20°C terminates ventricular fibrillation after producing an important depression in myocardial conduction.

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mentioning

confidence: 99%

Effects of acute reduction of temperature on ventricular fibrillation activation patterns

Chorro

Guerrero²,

Ferrero

et al. 2002

American Journal of Physiology-Heart and Circulatory Physiology

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“…This is usually performed with a hemodialysis machine or a pump oxygenator such as that used during cardiopulmonary bypass. In patients with severe cardiopulmonary collapse, a pump oxygenator offers the advantage of hemodynamic support, rapid elevation of temperature, and nearly complete regulation of acid-base and oxygen disorders [56,65,106,114,134].…”

Section: Treatmentmentioning

confidence: 99%

Disorders of Temperature Control: Hypothermia, Part III

Curley

Irwin

1986

J Intensive Care Med

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Hypothermia, defined as a body core temperature below 35°C, results from exposure to cold, drugs, metabolic dysfunction, or nervous system or skin disorders. The diagnosis and clinical assessment of patients with hypothermia should be based on a thorough knowledge of the characteristic physiologic changes that accompany hypothermia and affect all organ systems. Morbidity and mortality resulting from hypothermia may be reduced when physicians anticipate the well-known complications of hypothermia and carefully rewarm the patient.The rate and method of rewarming must be individualized, taking into account available resources and the patient's cardiopulmonary status and underlying disease.In Parts I and II of this review, the normal physiology of temperature regulation and three hvperthermic syndromes-heat stroke, malignant hyperthermia, and neuroleptic malignant syndrome-were reviewed. This section focuses on unintentional hypothermia and reviews in detail its pathogenesis, pathophysiologic factors, diagnosis, and management. Iatrogenic and intentional hypothermia in the perioperative setting is briefly discussed.Hypothermia, defined as a core temperature below 35°C, is not uncommon; it occurs at all ambient temperatures and in patients of all ages, although more commonly in the elderly. During the winter in Great Britain, 0.7% of all hospital admissions [1], 3% of elderly patients admitted [2], and at least 10% of otherwise healthy elderly individuals examined at home [3] had core temperatures in the hypothermic range. Review of death certificates in the United States reveals an average mortality rate for hypothermia of 0.22 per 100,000 individuals; white women have the lowest rates, and nonwhite men, the highest [4]. When all data are reviewed, the overall mortality from hypothermia in the United States has been conservatively estimated at 17 deaths per million of the general population peryear {5]. The mortality rate for treated hypothermia ranges from 12% [6] to 73% [7]. Cause and PathogenesisAlthough hypothermia can occur in all climates, at nearly all ambient temperatures, and at every age, the most frequent causes (vide infra) appear to be exposure, use of depressant drugs, and hypoglycemia. The elderly, because of a &dquo;normal&dquo; impairment of regulatory function, constitute a large portion of the patients who become hypothermic. A brief review of the causes of hypothermia (Table 1) at UNIVERSITE LAVAL on July 1, 2015 jic.sagepub.com Downloaded from 271 Table 1. Causes of Hypothermia and their pathogenesis will help develop a rational approach to treatment.Exposure to Cold Fatal hypothermia occurs frequently, even in the healthy young adult who simply has been overexposed to the elements. Wet, wind, and exhaustion contribute to increased loss of body heat. Wet clothing loses 90% of its insulating value [8], rendering soaked individuals effectively nude. Exposure to rain or snow was believed to contribute greatly to the development of hypothermia in 15 of 23 incidents in hikers discussed in one rev...

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“…Even minor manipulations can induce ventricular fibrillation in a hypothermic patient. Therefore rough handling of the patient must be avoided, and transport has to be accomplished as gently as possible with the patient in a supine position [1,2,10]. In practice there are two ways of rescue: by helicopter or by boat, using single-sling rescue equipments like the ªLifeslingº system in yachting.…”

Section: Introductionmentioning

confidence: 99%

Rescue Lifting System (RLS) Might Help to Prevent Death After Rescue from Immersion in Cold Water

Witt²,

Hänert³

et al. 2001

Int J Sports Med

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Intractable Ventricular Fibrillation Associated with Profound Accidental Hypothermia — Successful Treatment with Partial Cardiopulmonary Bypass

Cited by 72 publications

References 6 publications

Effects of acute reduction of temperature on ventricular fibrillation activation patterns

Effects of acute reduction of temperature on ventricular fibrillation activation patterns

Disorders of Temperature Control: Hypothermia, Part III

Rescue Lifting System (RLS) Might Help to Prevent Death After Rescue from Immersion in Cold Water

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