Successful resuscitation for cardiac arrest due to severe accidental hypothermia accompanied by mandibular rigidity: a case of cold stiffening mimicking rigor mortis

Bunya, Naofumi; Sawamoto, Keigo; Kakizaki, Ryuichiro; Wada, Kenshiro; Katayama, Yoichi; Mizuno, Hirotoshi; Inoue, Hiroyuki; Uemura, Shuji; Harada, Keisuke; Narimatsu, Eichi

doi:10.1186/s12245-018-0205-8

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…Air pockets indicated that they had been breathing before HCA ( 66 , 94 , 95 , 100 ). Fifteen men and eight women suffered HCA secondary to drug or alcohol abuse ( 2 , 45 , 46 , 53 , 54 , 56 , 57 , 62 , 63 , 70 , 76 , 81 , 86 , 90 , 91 , 98 , 101 , 104 , 105 , 109 , 121 ). All underwent successful resuscitation with ECLS.…”

Section: Resultsmentioning

confidence: 99%

Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

et al. 2021

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Introduction: This systematic review and meta-analysis aims at comparing outcomes of rewarming after accidental hypothermic cardiac arrest (HCA) with cardiopulmonary bypass (CPB) or/and extracorporeal membrane oxygenation (ECMO).Material and Methods: Literature searches were limited to references with an abstract in English, French or German. Additionally, we searched reference lists of included papers. Primary outcome was survival to hospital discharge. We assessed neurological outcome, differences in relative risks (RR) of surviving, as related to the applied rewarming technique, sex, asphyxia, and witnessed or unwitnessed HCA. We calculated hypothermia outcome prediction probability score after extracorporeal life support (HOPE) in patients in whom we found individual data. P < 0.05 considered significant.Results: Twenty-three case observation studies comprising 464 patients were included in a meta-analysis comparing outcomes of rewarming with CPB or/and ECMO. One-hundred-and-seventy-two patients (37%) survived to hospital discharge, 76 of 245 (31%) after CPB and 96 of 219 (44 %) after ECMO; 87 and 75%, respectively, had good neurological outcomes. Overall chance of surviving was 41% higher (P = 0.005) with ECMO as compared with CPB. A man and a woman had 46% (P = 0.043) and 31% (P = 0.115) higher chance, respectively, of surviving with ECMO as compared with CPB. Avalanche victims had the lowest chance of surviving, followed by drowning and people losing consciousness in cold environments. Assessed by logistic regression, asphyxia, unwitnessed HCA, male sex, high initial body temperature, low pH and high serum potassium (s-K+) levels were associated with reduced chance of surviving. In patients displaying individual data, overall mean predictive surviving probability (HOPE score; n = 134) was 33.9 ± 33.6% with no significant difference between ECMO and CPB-treated patients. We also surveyed 80 case reports with 96 victims of HCA, who underwent resuscitation with CPB or ECMO, without including them in the meta-analysis.Conclusions: The chance of surviving was significantly higher after rewarming with ECMO, as compared to CPB, and in patients with witnessed compared to unwitnessed HCA. Avalanche victims had the lowest probability of surviving. Male sex, high initial body temperature, low pH, and high s-K+ were factors associated with low surviving chances.

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Section: Resultsmentioning

confidence: 99%

Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

et al. 2021

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“…Several findings can be confused with definitive signs of death, so that a living person could be declared dead or attempts could be made to resuscitate a deceased person. Mimics of dependent lividity include hematomas (a solid swelling of clotted blood within the tissues), reddish skin discoloration of parts of the body that are not generally the lowest parts in hypothermia and frostbite, and some skin conditions. Dependent lividity can be overlooked in poor lighting conditions, in people with dark skin, when there are superficial injuries, and when skin is covered with blood, dirt, or other substances (Figure 12). Mimics of postmortem rigidity include stiff joints in cold conditions, 5,69 severe hypothermia, sequelae of surgical procedures, or consequences of injuries. Conditions that can be confused with different stages of putrefaction include dark skin, hematomas, blistering, sepsis, and bleeding from the mouth and nose. Full thickness frostbite with black, mummified skin, especially affecting cold-exposed areas such as ears, nose, fingers, or toes can cause local mummification (dry gangrene), similar to beginning mummification after death (Figures 13A and B, Figures 14A and B). …”

Section: Discussionmentioning

confidence: 99%

Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom)

Schön

Gordon

Hölzl³

et al. 2020

Wilderness & Environmental Medicine

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Determination of death requires specific knowledge, training, and experience in most cases. It can be particularly difficult when external conditions, such as objective hazards in mountains, prevent close physical examination of an apparently lifeless person, or when examination cannot be accomplished by an authorized person. Guidelines exist, but proper use can be difficult. In addition to the absence of vital signs, definitive signs of death must be present. Recognition of definitive signs of death can be problematic due to the variability in time course and the possibility of mimics. Only clear criteria such as decapitation or detruncation should be used to determine death from a distance or by laypersons who are not medically trained. To present criteria that allow for accurate determination of death in mountain rescue situations, the International Commission for Mountain Emergency Medicine convened a panel of mountain rescue doctors and a forensic pathologist. These recommendations are based on a nonsystematic review of the literature including articles on determination of death and related topics.

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“…As for the organ function damage,the myocardial damage was more serious after 1 hour immersion in low temperature seawater,but liver and kidney damage is less.These means that myocardial has poor tolerance to low temperature. When the core temperature drops, ventricular brillation is likely to occur, or even cardiac arrest [22] . What's more, due to the heart is an active blood supplier, low-temperature seawater immersion caused cardiac acceleration to ensure blood supply to vital organs throughout the body, thus increasing myocardial metabolism.But liver and kidney are a passive organ that receives blood,lowtemperature seawater would reduce the metabolic rate of liver and kidney function [23] .…”

Section: Discussionmentioning

confidence: 99%

Effect of seawater immersion on pathophysiological changes in rats combined burns with open abdominal injury

ying

Liu

jifu

2020

Preprint

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Objective: To observe the effects of seawater immersion on the pathophysiological changes in rats combined burns with open abdominal injury.Method: Eighty-eight male Sprague-Dawley(SD) rats combined burns with open abdominal injuries were randomly divided into the seawater immersion group (SI) and the control group (Ctl).Rats in SI group were immersed in seawater at 15℃ for 1 hour. The changes of respiration, blood pressure, rectal temperature, blood gases, blood electrolyte, liver and kidney function, coagulation function, heart damage and animal survival at different time points in the early stage (within 9 hours after injury) were observed.Result: After immersed in seawater, the body temperature of rats in SI group were significantly decreased, the respiration were remarkably inhibited and the blood pressure were obviously declined as compared to those in Ctl group. The blood pH of rats in SI group were significantly lower than those in Ctl group, showing severe acidosis(P<0.05). The changes of HCO3-, PCO2 and BE also presented the similiar trends(P<0.05). PO2 and PCO2 in SI group were significantly higher than those in Ctl group (P<0.05). However, the SaO2 in SI group were lower than those in Ctl group (P<0.05). Blood sodium and chlorine in SI group were higher than those in Ctl group, showing severe hypernatremia and hyperchloremia(P<0.05). The concentration of potassium and calcium were not obviously changed. The liver and kidney function parameters(AST,ALT,Urea,Crea) in SI group were lower than those in Ctl group 4 hours after injury(P<0.05), while myocardial damage markers (TNT) in SI group were higher than those in Ctl group. There were no significant differences in coagulation function between the two groups. The survival time of the SI group rats were shorter than those in Ctl group and the mortality was higher than those in Ctl group (66.7% vs 41.7%).Conclusion: Low-temperature seawater immersion might aggravate injury, accelerate animal death, induce hypothermia, respiratory depression, acidosis, hypernatremia and hyperchloremia. Immersing in low temperature seawater for 1 hour can cause myocardial damage, but it has protective effects on the liver and kidney. Therefore, more attentions should be paid to the secondary injury caused by seawater immersion in the emergency treatment of the wounded, such as rapidly rewarming, rectifying the acidosis and maintaining the stability of homeostasis of the wounded, so as to lay the foundation for the further definitive treatments.

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Successful resuscitation for cardiac arrest due to severe accidental hypothermia accompanied by mandibular rigidity: a case of cold stiffening mimicking rigor mortis

Cited by 10 publications

References 12 publications

Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom)

Effect of seawater immersion on pathophysiological changes in rats combined burns with open abdominal injury

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