Treatment of accidental hypothermia with cardiopulmonary bypass: a case report

Abstract

This case report describes the successful treatment of severe accidental hypothermia of a 40-year-old woman. At arrival in the operating theatre her rectal temperature was 23°C, her nasal temperature 21°C and her periferal temperature 14°C. The patient presented with a severe respiratory and metabolic acidosis which was corrected during cardiopulmonary bypass (CPB). She was rewarmed to obtain a rectal and nasal temperature of 34°C. After 272 minutes, the patient was weaned successfully from CPB. The patient remained at mild hypothermia (34°C) for 24 hours in the intensive care unit (ICU). The chest X-ray showed some signs of acute respiratory distress syndrome (ARDS) in spite of normal blood gas values. This improved within a few days and, after five days, she was transferred to the nursing department. On the seventh day, the patient was discharged from hospital without physical or neurological complaints.

Keywords

accidental hypothermia drowning cardiopulmonary bypass

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References

1 Bernard SA Gray TW . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346: 557–563.

2 The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346: 549–556.

3 Vretenar DF Urschel JD Parrot JCW Unruh HW . Cardiopulmonary bypass resuscitation for accidental hypothermia. Ann Thorac Surg 1994; 58: 895–898.

4 Silfvast T Pettilä V . Outcome from severe accidental hypothermia in Southern Finland – a 10-year review. Resuscitation 2003; 59: 285–290.

5 Miranda DR Gommers D Struijs A . Ventilation according to the open lung concept attenuates pulmonary inflammatory response in cardiac surgery. Eur J Cardio-thoracic Surg 2005; 28: 889–895.

6 Walpoth BH Walpoth-Aslan BN Mattle HP . Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 1997; 20: 1500–1505.

7 Kornberger E Mair P . Important aspects in the treatment of severe accidental hypothermia: the Innsbruck-experience. J Neurosurg Anesth 1996; 8: 83–87.

8 Grigore AM Grocott HP Mathew JP . The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery. Anesth Analg 2002; 94: 4–10.

9 De Lange F Jones WL Mackensen GB Grocott HP . The effect of limited rewarming and postoperative hypothermia on cognitive function in a rat cardiopulmonary bypass model. Anesth Analg 2008; 106: 739–745.

10.

10 Dietrich WD Aonso O Busto R . Moderate hyperglycemia worsens acute blood-brain barrier injury after forebrain ischemia in rats. Stroke 1993; 24: 111–116.