Prolonged mechanical CPR of a 48-year old male patient in severe hypothermia conducted in the emergency department – case report
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Clinical Emergency Department, Regional Specialist Hospital in Olsztyn, Poland
School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
Clinical Department of Endocrinology, Diabetology and Internal Diseases, Regional Specialist Hospital in Olsztyn, Poland
Cardiology Department, Regional Specialist Hospital in Olsztyn, Poland
Clinical Unit of Anesthesiology and Intensive Care, University Hospital, Olsztyn, Poland
Clinical Department of Cardiology and Internal Medicine, University Hospital, Olsztyn, Poland
Clinical Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Poland
Submission date: 2017-06-01
Acceptance date: 2017-06-22
Online publication date: 2018-02-02
Publication date: 2019-11-17
Corresponding author
Rakesh Jalali   

Clinical Emergency Department of Regional Specialist Hospital in Olsztyn, Żołnierska 18, 10-561 Olsztyn, Poland. Phone: +4889 538 62 99.
Pol. Ann. Med. 2018;25(1):144-147
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.

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.

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.

None declared.
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