Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming

Details

Serval ID
serval:BIB_34A05C6CE1C2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming
Journal
New England Journal of Medicine
Author(s)
Walpoth  B. H., Walpoth-Aslan  B. N., Mattle  H. P., Radanov  B. P., Schroth  G., Schaeffler  L., Fischer  A. P., von Segesser  L., Althaus  U.
ISSN
0028-4793
Publication state
Published
Issued date
11/1997
Peer-reviewed
Oui
Volume
337
Number
21
Pages
1500-5
Notes
Journal Article
Multicenter Study --- Old month value: Nov 20
Abstract
BACKGROUND: Cardiopulmonary bypass has been used to rewarm victims of accidental deep hypothermia. Unlike other rewarming techniques, it restores organ perfusion immediately in patients with inadequate circulation. This study evaluated the long-term outcome of survivors of accidental deep hypothermia with circulatory arrest who had been rewarmed with cardiopulmonary bypass. METHODS: Deep hypothermia (core temperature, <28 degrees C) with circulatory arrest was found in 46 of 234 patients with accidental hypothermia. In 32 of the 46 patients, rewarming with cardiopulmonary bypass was attempted, resulting in 15 long-term survivors. In most of these patients, deep hypothermia developed after mountaineering accidents or suicide at tempts. After an average (+/-SD) of 6.7+/-4.0 years of follow-up, we obtained the patients' medical histories and performed neurologic and neuropsychological examinations, neurovascular ultrasound studies, electroencephalography, and magnetic resonance imaging of the brain. RESULTS: The average age of the patients was 25.2+/-9.9 years; seven were female and eight were male. The mean interval from discovery of the patient to rewarming with cardiopulmonary bypass was 141+/-50 minutes (range, 30 to 240). At follow-up there were no hypothermia-related sequelae that impaired quality of life. Neurologic and neuropsychological deficits observed in the early period after rewarming had fully or almost completely disappeared. One patent had cerebellar atrophy on magnetic resonance imaging with mild clinical signs, a condition that may have been caused by hypothermia. Other clinical abnormalities were either preexisting or due to injuries not related to hypothermia CONCLUSIONS: This clinical experience demonstrates that young, otherwise healthy people can survive accidental deep hypothermia with no or minimal cerebral impairment, even with prolonged circulatory arrest. Cardiopulmonary bypass appears to be an efficacious rewarming technique.
Keywords
Accidents Adolescent Adult Brain/pathology *Cardiopulmonary Bypass Central Nervous System Diseases/etiology Child Electroencephalography Female Follow-Up Studies Heart Arrest/etiology/*therapy Humans Hypothermia/complications/*therapy Magnetic Resonance Imaging Male Mountaineering Neuropsychological Tests Retrospective Studies *Rewarming/methods Suicide, Attempted Survivors Treatment Outcome
Pubmed
Web of science
Create date
14/02/2008 15:17
Last modification date
20/08/2019 14:21
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