Treatment of Profound Hypothermia

Welton, David E.

doi:10.1001/jama.1978.03290210073038

Cited by 24 publications

(5 citation statements)

References 14 publications

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“…Body cooling poses several well-documented risks, although few are clinically significant with mild hypothermia (32-35°C). Cardiac arrhythmias are unlikely at core temperature >30°C (Welton et al, 1978;Piktel et al, 2011). Coagulopathy appears mild above 33°C (Rohrer & Natale, 1992;Eicher et al, 2005;Hall et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Hypothermia for pediatric refractory status epilepticus

et al. 2013

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SUMMARY Purpose Refractory status epilepticus (RSE) is a life-threatening emergency, demonstrating, by definition, significant pharmacoresistance. We describe five cases of pediatric RSE treated with mild hypothermia. Methods Retrospective chart review was performed of records of children who received hypothermia for RSE at two tertiary-care pediatric hospitals between 2009 and 2012. Key Findings Five children with RSE received mild hypothermia (32–35°C). Hypothermia reduced seizure burden during and after treatment in all cases. Prior to initiation of hypothermia, four children (80%) received pentobarbital infusions to treat RSE, but relapsed after pentobarbital discontinuation. No child relapsed after treatment with hypothermia. One child died after redirection of care. Remaining four children were discharged. Significance This is the largest pediatric case series reporting treatment of RSE with mild hypothermia. Hypothermia decreased seizure burden during and after pediatric RSE and may prevent RSE relapse.

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Section: Discussionmentioning

confidence: 99%

Hypothermia for pediatric refractory status epilepticus

et al. 2013

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“…If the heart is cooler than the periphery, it may not be able to increase the cardiac output sufficiently. In addition, the heart is in a hyperexcitable condition (145). Furthermore, the increased peripheral circulation may increase the concentration of acid metabolites in the blood, leading to aggravated acidosis and a risk of arrhythmias.…”

Section: General Problems During Rewarmingmentioning

confidence: 99%

“…Rewarming by extra-corporeal circulation techniques is effective, producing rewarming rates between 3" and 10°C/h (90, 145,150,165). On the other hand, this method can only be used in special departments, and this, at least in our country, limits its application.…”

Section: Extra-corporeal Circulationmentioning

confidence: 99%

Accidental hypothermia Review of the literature

Lønning

Skulberg

Åbyholm

1986

Acta Anaesthesiol Scand

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“…[5][6][7][8] Severe hypothermia from outdoor exposure is encountered in urban emergency departments (EDs) throughout the United States, 9 but published experience with this rare condition has primarily come from Europe. [10][11][12][13] Although conventional methods for active internal rewarming have not changed substantially for decades, 14 U.S. emergency physicians may be less familiar with use of an intravascular rewarming catheter or ECMO for this indication. Delayed or ineffective active internal rewarming attempts may lead to early complications such as the paradoxical decrease in core body temperature known as "core afterdrop" which can contribute to clinical deterioration.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation versus conventional rewarming for severe hypothermia in an urban emergency department

Prekker

Rischall

Touroutoutoudis

et al. 2022

Academic Emergency Medicine

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Background Severe hypothermia (core body temperature < 28°C) is life‐threatening and predisposes to cardiac arrest. The comparative effectiveness of different active internal rewarming methods in an urban U.S. population is unknown. We aim to compare outcomes between hypothermic emergency department (ED) patients rewarmed conventionally using an intravascular rewarming catheter or warm fluid lavage versus those rewarmed using extracorporeal membrane oxygenation (ECMO). Methods We performed a retrospective cohort analysis of adults with severe hypothermia due to outdoor exposure presenting to an urban ED in Minnesota, 2007–2021. The primary outcome was hospital survival. We also calculated the rewarming rate in the 4 h after ED arrival and compared these data between patients rewarmed with ECMO (the extracorporeal rewarming group) versus without ECMO (the conventional rewarming group). We repeated these analyses in the subgroup of patients with cardiac arrest. Results We analyzed 44 hypothermic ED patients: 25 patients in the extracorporeal rewarming group (median temperature 24.1°C, 84% with cardiac arrest) and 19 patients in the conventional rewarming group (median temperature 26.3°C, 37% with cardiac arrest; 89% received an intravascular rewarming catheter). The median rewarming rate was greater in the extracorporeal versus conventional group (2.3°C/h vs. 1.5°C/h, absolute difference 0.8°C/h, 95% confidence interval [CI] 0.3–1.2°C/h) yet hospital survival was similar (68% vs. 74%). Among patients with cardiac arrest, hospital survival was greater in the extracorporeal versus conventional group (71% vs. 29%, absolute difference 42%, 95% CI 4%–82%). Conclusions Among ED patients with severe hypothermia and cardiac arrest, survival was significantly higher with ECMO versus conventional rewarming. Among all hypothermic patients, ECMO use was associated with faster rewarming than conventional methods.

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Treatment of Profound Hypothermia

Cited by 24 publications

References 14 publications

Hypothermia for pediatric refractory status epilepticus

Hypothermia for pediatric refractory status epilepticus

Accidental hypothermia Review of the literature

Extracorporeal membrane oxygenation versus conventional rewarming for severe hypothermia in an urban emergency department

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