Successful resuscitation from prolonged hypothermic cardiac arrest without extracorporeal life support: a case report

Melanie Kuhnke,Roland Albrecht,Joerg C Schefold,Peter Paal

doi:10.1186/s13256-019-2282-6

Abstract

BackgroundWe report a case of successful prolonged cardiopulmonary resuscitation (5 hours and 44 minutes) following severe accidental hypothermia with cardiac arrest treated without rewarming on extracorporeal life support.Case presentationA 52-year-old Italian mountaineer, was trapped in a crevasse and rescued approximately 7 hours later by a professional rescue team. After extrication, he suffered a witnessed cardiac arrest with ventricular fibrillation. Immediate defibrillation and cardiopulmonary resuscitation were started. His core temperature was 26.0 °C. Due to weather conditions, air transport to an extracorporeal life support center was not possible. Thus, he was rewarmed with conventional rewarming methods in a rural hospital. Auto-defibrillation occurred at a core temperature of 29.8 °C after 5 hours and 44 minutes of continued cardiopulmonary resuscitation. With a core temperature of 33.4 °C, he was finally admitted to a level 1 trauma center and extracorporeal life support was no longer required. Seven weeks following the accident, he was discharged home with complete neurological recovery.ConclusionsSuccessful rewarming from severe hypothermia without extracorporeal life support use as performed in this case suggests that patients with primary hypothermic cardiac arrest have a chance of a favorable neurological outcome even after several hours of cardiac arrest when cardiopulmonary resuscitation and conventional rewarming are performed continuously. This may be especially relevant in remote areas, where extracorporeal life support rewarming is not available.

Highlights

We report a case of successful prolonged cardiopulmonary resuscitation (5 hours and 44 minutes) following severe accidental hypothermia with cardiac arrest treated without rewarming on extracorporeal life support.Case presentation: A 52-year-old Italian mountaineer, was trapped in a crevasse and rescued approximately 7 hours later by a professional rescue team
During the past two decades, extracorporeal life support (ECLS) rewarming has become a cornerstone in the treatment of patients with hypothermia-induced cardiac arrest [2, 3]
An arterial blood gas analysis showed a pH of 7.2, lactate 11.2 mmol/ L, partial pressure of oxygen in arterial blood 18.1 kPa, and potassium 2.7 mmol/L. This encouraged the team to continue Cardiopulmonary resuscitation (CPR) and conventional rewarming, and to push for either transport of the patient to an ECLS center or for a portable ECLS device to be transferred to the patient

Summary

Conclusions

We report a case of successful non-ECLSbased rewarming of a patient with witnessed primary hypothermic cardiac arrest with complete neurological recovery. Extensive CPR was provided making this case one of the longest cases of CPR in the literature that resulted in a favorable neurological outcome. In patients with primary hypothermic cardiac arrest, successful rewarming can be achieved with continuous CPR being provided in the absence of ECLS systems.

Background

Discussion