Parada cardíaca por hipotermia accidental y resucitación cardiopulmonar prolongada

Abstract

In cardiac arrest produced by accidental hypothermia, cardiopulmonary resuscitation must be prolonged until normal body temperature is achieved. There are different rewarming methods. In theory, the more invasive ones are elective in patients with cardiac arrest because of their higher rewarming speed. However, it has not been proven that these methods are better than the non-invasive ones. We present a case report of a patient with cardiac arrest due to accidental hypothermia who was treated without interruption for three hours with heart massage. This is the longest successful cardiopulmonary resuscitation known up-to-date in Spain. In order to rewarm the body, a combination of non-invasive methods was used: active external rewarming with convective warm air, gastric and bladder lavage with warm saline solution and intravenous warm saline infusion. This case shows that it is possible to treat hypothermic cardiac arrest successfully through these rewarming methods, which are both easy to apply and feasible in any hospital.

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“…4 Low core temperature causes decrease in basic metabolism and neurologic function, 5 which in terms of cardiac arrest can have neuroprotective effect. Although SCA in case of severe hypothermia can lead to survival with good neurologic outcome, [6][7][8][9] prolonged cardiac arrest results in hypoxic brain injury and severe neurological dysfunction. 10 It is crucial to initiate effective chest compressions to maintain minimal cerebral blood flow.…”

“…However, literature and presented case study, show that it is possible to warm up hypothermic cardiac arrest patients successfully through noninvasive methods, which are both easy to apply and feasible in any hospital. 8 There are some studies on prognostic factors likely to identify patients in hypothermic cardiac arrest who would probably survive. According to Mair et al on plasma potassium levels (serum potassium more than 9 mmol/L), central venous pH (pH less than 6.50) and ACT (activated clotting time more than 400 s) on admission can be used to identify hypothermic arrest victims with predicted poor outcome.…”

Manejo de la hipotermia accidental severa

“…Como hay víctimas con hipotermias severas que se han reanimado con éxito después de varias horas en asistolia 10 , como la TCC más baja reanimada sin lesiones neurológicas ha sido de 13,7…”

“…En víctimas en parada cardiaca el recalentamiento debería hacerse con circulación extracorpórea, método más agresivo e invasivo que los anteriores que se comentará más adelante. Consigue elevar la TCC entre [8][9][10][11][12] • C/hora.…”

“…Para muchos autores, estas técnicas son las más adecuadas para el recalentamiento de víctimas en paro cardiaco 57---60 . Con ellas, es posible conseguir reanimar a las víctimas hipotérmicas con una recuperación neurológica completa y sin secuelas posteriores, incluso después de 2 horas en asistolia, aunque esta total recuperación también ha sido posible en paradas cardiacas más prolongadas y sin técnicas tan cruentas 10 . Para estos autores, la puesta en marcha de estos métodos tan invasivos suponen un retraso importante en el inicio del tratamiento.…”