Considering veno-venous extracorporeal membrane oxygenation as a first-line strategy for rewarming in accidental hypothermia complicated by cardiac arrest

Abstract

Severe accidental hypothermia can lead to cardiac arrest. The most efficient method of resuscitating and warming is by ECMO (Extracorporeal Membrane Oxygenation). While the convention is to use VA ECMO (Veno Arterial ECMO), using VV ECMO (Veno Venous ECMO) in which the blood is returned directly into the right ventricle could be an alternative and lead to conversion to life sustaining cardiac rhythm. In this article we present our case series of ECMO for resuscitation of accidental hypothermia complicated by cardiac arrest. We used VV ECMO for 4 patients; in 3 of them ROSC (Return of Spontaneous Circulation) was successfully achieved. We also discuss the potential advantages of VV ECMO and VA ECMO in this setting and present our algorithm for management.

Keywords

cardiac arrest ECMO ECPR hypothermia

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References

Brown

Brugger

Boyd

, et al. Accidental hypothermia. N Engl J Med 2012; 367: 1930–1938.

Wanscher

Agersnap

Ravn

, et al. Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Præstø Fjord boating accident. Resuscitation 2012; 83: 1078–1084.

Southwick

Dalglish

. Recovery after prolonged asystolic cardiac arrest in profound hypothermia. A case report and literature review. JAMA 1980; 243: 1250–1253.

Pasquier

Hugli

Paal

, et al. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: the HOPE score. Resuscitation 2018; 126: 58–64.

Pasquier

Rousson

Darocha

, et al. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: an external validation of the HOPE score. Resuscitation 2019; 139: 321–328.

Swol

Darocha

Paal

, et al. Extracorporeal life support in accidental hypothermia with cardiac arrest—a narrative review. Am Soc Artif Intern Organs J 2022; 68: 153–162.

Lott

Truhlář

Alfonzo

ERC Special Circumstances Writing Group Collaborators , et al. European resuscitation council guidelines 2021: cardiac arrest in special circumstances. Resuscitation 2021; 161: 152–219.

Davies

Millar

Miller

. Accidental hypothermia treated by extracorporeal blood warming. Lancet 1967; 1: 1036–1037.

Prekker

Rischall

Carlson

, et al. Extracorporeal membrane oxygenation versus conventional rewarming for severe hypothermia in an urban emergency department. Acad Emerg Med 2023; 30: 6–15.

10.

Tiruvoipati

Balasubramanian

Khoshbin

, et al. Successful use of venovenous extracorporeal membrane oxygenation in accidental hypothermic cardiac arrest. Am Soc Artif Intern Organs J 2005; 51: 474–476.

11.

Truhlář

Deakin

Soar

, et al. European resuscitation council guidelines for resuscitation 2015. Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95: 148–201.

12.

Vanden Hoek

Morrison

Shuster

, et al. Part 12: cardiac arrest in special situations: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010; 122(18 Suppl 3): S829–S861.

13.

Kosiński

Drzewiecka

Pasquier

, et al. Successful defibrillation at a core temperature of 18.2 degrees Celsius. Wilderness Environ Med 2020; 31: 230–234.

14.

Mouritzen

Andersen

. Mechanisms of ventricular fibrillation during hypothermia. Relative changes in myocardial refractory period and conduction velocity. J Thorac Cardiovasc Surg 1966; 51: 585–589.

Considering veno-venous extracorporeal membrane oxygenation as a first-line strategy for rewarming in accidental hypothermia complicated by cardiac arrest - a case series

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