CASE REPORT
Prolonged mechanical CPR of a 48-year old male patient in severe hypothermia conducted in the emergency department – case report
 
More details
Hide details
1
Clinical Emergency Department, Regional Specialist Hospital in Olsztyn, Poland
2
School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
3
Clinical Department of Endocrinology, Diabetology and Internal Diseases, Regional Specialist Hospital in Olsztyn, Poland
4
Cardiology Department, Regional Specialist Hospital in Olsztyn, Poland
5
Clinical Unit of Anesthesiology and Intensive Care, University Hospital, Olsztyn, Poland
6
Clinical Department of Cardiology and Internal Medicine, University Hospital, Olsztyn, Poland
7
Clinical Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Poland
CORRESPONDING AUTHOR
Rakesh Jalali   

Clinical Emergency Department of Regional Specialist Hospital in Olsztyn, Żołnierska 18, 10-561 Olsztyn, Poland. Phone: +4889 538 62 99.
Online publication date: 2018-02-02
Publication date: 2019-11-17
Submission date: 2017-06-01
Acceptance date: 2017-06-22
 
Pol. Ann. Med. 2018;25(1):144–147
KEYWORDS
ABSTRACT
Introduction:
Hypothermia is still one of the major problems of modern emergency medicine. It causes reduction in oxygen consumption by brain tissue, which has neuro- and cardio protective effect. Most of the time, severe hypothermia leads to prolonged resuscitation resulting in decreased quality of cardiopulmonary resuscitation (CPR) due to the rescuers fatigue.

Aim:
The aim of this paper is to introduce the case of prolonged resuscitation with the use of mechanical device, conducted in hypothermic patient.

Case study:
We report a case study of 48-year-old male in severe hypothermia (19°C) and active gastrointestinal bleeding. We have conducted prolonged CPR for 142 minutes together with noninvasive core warming techniques that resulted in conversion of pulseless electrical activity to ventricular fibrillation and achievement of return of spontaneous circulation. Despite proper treatment, patient died next day in Intensive Care Unit due to the multi-organ failure.

Results and discussion:
Cardiac arrest in case of severe hypothermia can lead to survival with good neurologic outcome, however prolonged cardiac arrest results in hypoxic brain injury and severe neurological dysfunction. It is crucial to initiate effective chest compressions to maintain minimal cerebral blood flow. Mechanical devices can be implemented in such situations in order to provide efficient CPR.

Conclusions:
Cardiac arrest due to hypothermia can lead to extension of resuscitation. To improve survival of patients in situations requiring prolonged resuscitation, mechanical devices performing chest compressions should be implemented. It is possible to successfully warm up hypothermic cardiac arrest patients through noninvasive methods.

CONFLICT OF INTEREST
None declared.
 
REFERENCES (15)
1.
Truhlář A, Deakin CD, Soar J, Khalifa GE, Alfonzo A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015;95:148–201. https://doi.org/10.1016/j.resu....
 
2.
Brown DJ, Brugger H, Boyd J, Paal P. Accidental hypothermia. N Engl J Med. 2012;367(20):1930–1938. https://doi.org/10.1056/NEJMra....
 
3.
Zafren K. Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia. Emerg Med Clin North Am. 2017;35(2):261–279. https://doi.org/10.1016/j.emc.....
 
4.
Gilbert M, Busund R, Skagseth A, Nilsen PÅ, Solbø JP. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet. 2000;355(9201):375–376. https://doi.org/10.1016/S0140-....
 
5.
Nosaka N, Okada A, Tsukahara H. Effects of Therapeutic Hypothermia for Neuroprotection from the Viewpoint of Redox Regulation. Acta Med Okayama. 2017;71(1):1–9.
 
6.
Mochizuki K, Sekiguchi Y, Iwashita T, Okamoto K. Favorable neurologic outcome in a patient with accidental hypothermia following cardiopulmonary resuscitation for over 165 minutes and intensive care for post-cardiac arrest syndrome. Nihon Shuchu Chiryo Igakukai zasshi. 2014;21(4):333–336.
 
7.
Boue Y, Lavolaine J, Bouzat P, Payen JF. Neurologic recovery from profound accidental hypothermia after 5 hours of cardiopulmonary resuscitation. Crit Care Med. 2013; 42(2):167–170. https://doi.org/10.1097/CCM.0b....
 
8.
Kot P, Botella J. [Cardiac arrest due to accidental hypothermia and prolonged cardiopulmonary resuscitation]. Med Intensiva. 2010;34(8):567–570 [in Spanish]. https://doi.org/10.1016/j.medi....
 
9.
Meytes V, Schilberg SP, Amaturo M, Kilaru M. An uncommon case of severe accidental hypothermia in an urban setting. Oxf Med Case Reports. 2015;2015(12):371–373. https://doi.org/10.1093/omcr/o....
 
10.
Rawal G, Yadav S, Garg N. Therapeutic Hypotermia after Prolonged Cardiac Arrest: Case Report with Review of Literature. J Clin Diagn Res. 2015;9(9):1–2.
 
11.
Drozdowska A, Drozdowski P, Szczepanowski Z, Zachara M, Rams P, Ślusarczyk K. Physician facing ethical issues of biomedical experiments. Pol Ann Med. 2012;19(2):148–152. https://doi.org/10.1016/j.poam....
 
12.
Mair P, Kornberger E, Furtwaengler W, Balogh D, Antretter H. Prognostic markers in patients with severe accidental hypothermia and cardiocirculatory arrest. Resuscitation. 1994;27(1):47–54. https://doi.org/10.1016/0300-9....
 
13.
Farstad M, Andersen KS, Koller ME, Grong K, Segadal L, Husby P. Rewarming from accidental hypothermia by extracorporeal circulation. A retrospective study. Eur J Cardiothorac Surg. 2001;20(1):58–64. https://doi.org/10.1016/S1010-....
 
14.
Hauty MG, Esrig BC, Hill JG, Long WB. Prognostic factors in severe accidental hypothermia: experience from the Mt. Hood tragedy. J Trauma. 1987;27(10):1107–1112. https://doi.org/10.1097/000053....
 
15.
Silfvast T, Pettilä V. Outcome from severe accidental hypothermia in Southern Finland. A 10-year review. Resuscitation. 2003;59(3):285–290. https://doi.org/10.1016/S0300-....