Schwere akzidentelle Hypothermie mit Kreislaufstillstand und extrakorporaler Erwärmung

Abstract

In patients with severe hypothermia and cardiac arrest, active rewarming is recommended by extracorporeal circulation with cardiopulmonary bypass. The current guidelines for resuscitation of the European Resuscitation Council now include the recommendation regarding patients with hypothermia remaining comatose after initial resuscitation to accomplish an active rewarming only up to a temperature of 32-34 degrees C and to maintain a mild hypothermia for 12-24 h. We report the case of a 2-year-old boy who suffered from severe hypothermia after falling into ice-cold water. On discovery cardiac arrest with asystole was present and the first measured temperature was 23.8 degrees C. Resuscitation led to restoration of spontaneous circulation. The patient was rewarmed by extracorporeal circulation with cardiopulmonary bypass to 33 degrees C then mild hypothermia was maintained for a further 12 h. On the third day after the accident the patient was extubated and after a further 9 days was discharged without any sequelae.

Accidental hypothermia–an update

“…Unlike adults, small children may still have signs of life with a core temperature in the mid-teens [ 192 ] and a normal cardiac rhythm may resume when the temperature is 20 °C or less [ 192 , 225 ]. Rewarming may be faster in children compared to adults given the larger surface-to-mass ratio and should follow the same principles as for adults [ 131 , 133 , 192 , 212 , 226 ].…”