Management of Profound Accidental Hypothermia with Cardiorespiratory Arrest

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Abstract
Complete recovery following rapid rewarming is described in 3 tourists who were admitted in a state of profound hypothermia with total cardiorespiratory arrest (rectal temperature ranging from 19-24 .degree.C). In all 3 patients, respiration and circulation had ceased during the rescue operation. Rapid core rewarming was achieved by thoracotomy and continuous irrigation of the pericardial cavity with warm fluids in one patient, whereas in the other 2 patients rewarming was accomplished with extracorporeal circulation using femoro-femoral bypass. In the 1st patient, the heart could not be defibrillated earlier than 90 min following thoracotomy; in the other, patients rewarming was attained very rapidly, and within 1/2 h after institution of bypass, resuscitation of the heart was successful. The patients fully recovered their intellectual and physical abilities, despite the prolonged periods of circulatory arrest lasting from 21/2-4 h. Rapid core rewarming is the adequate therapy for profound accidental hypothermia with circulatory arrest or low cardiac output. If feasible, extracorporeal circulation represent the method of choice because it combines the advantage of immediate central rewarming with the benefit of efficient circulatory support, the heart is rewarmed before the shell, thus preventing the rewarming shock due to peripheral vasodilatation. Resuscitative efforts should be promptty initiated and vigorously pursued, even in the state of clinical death; in profound hypothermia neurologic examination is inconclusive regarding prognosis.