Guillaume Debaty1, Ibrahim Moustapha2, Pierre Bouzat3, Maxime Maignan4, Marc Blancher2, Amandine Rallo2, Julien Brun5, Olivier Chavanon6, Vincent Danel2, Françoise Carpentier2, Jean-François Payen3, Raphaël Briot4. 1. UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525/Equipe PRETA, Grenoble F-38041, France; Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France. Electronic address: gdebaty@chu-grenoble.fr. 2. Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France. 3. Department of Anesthesiology and Critical Care, Grenoble University Hospital, Grenoble, France; INSERM U836, Grenoble F-38042, France; Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble F-38042, France. 4. UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525/Equipe PRETA, Grenoble F-38041, France; Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France. 5. Department of Anesthesiology and Critical Care, Grenoble University Hospital, Grenoble, France. 6. Department of Cardiac Surgery, Grenoble University Hospital, Grenoble, France; HP2 Laboratory, INSERM U 1042, Grenoble, France.
Abstract
OBJECTIVE: To describe the factors associated with outcome after accidental deep hypothermia. METHODS: We conducted a retrospective cohort study on patients with accidental hypothermia (core temperature <28 °C) admitted to a Level I emergency room over a 10-year period. RESULTS: Forty-eight patients were included with a median temperature of 26 °C (range, 16.3-28 °C) on admission. The etiology of hypothermia was exposure to a cold environment (n = 27), avalanche (n = 13) or immersion in cold water (n = 8). Mean age was 47 ± 22 years, and 58% were males. Thirty-two patients had a cardiac arrest (CA): 15 patients presented unwitnessed cardiac arrest (UCA) and 17 patients presented rescue collapse (RC). Extracorporeal life support (ECLS) was implemented in 21 patients with refractory cardiac arrest and in two patients with hemodynamic instability. Overall mortality was 50%. For cardiac arrest patients, only three out of 15 patients with UCA survived at day 28, whereas eight out of 17 patients with RC survived. The cerebral performance category score was 4 for all the survivors of UCA and 1 [range, 1-2] for survivors of RC. Patients with poor outcome presented more UCA, a lower pH, a higher serum potassium, creatinine, serum sodium or lactate level as well as more severe coagulation disorders. CONCLUSION: Cardiac arrest related to rescue collapse was associated with favorable outcome. On-scene rescue collapse should prompt prolonged resuscitation and ECLS rewarming in all CA patients with deep hypothermia. Conversely, unwitnessed cardiac arrest was associated with unfavorable outcome and will likely not benefit from ECLS.
OBJECTIVE: To describe the factors associated with outcome after accidental deep hypothermia. METHODS: We conducted a retrospective cohort study on patients with accidental hypothermia (core temperature <28 °C) admitted to a Level I emergency room over a 10-year period. RESULTS: Forty-eight patients were included with a median temperature of 26 °C (range, 16.3-28 °C) on admission. The etiology of hypothermia was exposure to a cold environment (n = 27), avalanche (n = 13) or immersion in cold water (n = 8). Mean age was 47 ± 22 years, and 58% were males. Thirty-two patients had a cardiac arrest (CA): 15 patients presented unwitnessed cardiac arrest (UCA) and 17 patients presented rescue collapse (RC). Extracorporeal life support (ECLS) was implemented in 21 patients with refractory cardiac arrest and in two patients with hemodynamic instability. Overall mortality was 50%. For cardiac arrestpatients, only three out of 15 patients with UCA survived at day 28, whereas eight out of 17 patients with RC survived. The cerebral performance category score was 4 for all the survivors of UCA and 1 [range, 1-2] for survivors of RC. Patients with poor outcome presented more UCA, a lower pH, a higher serum potassium, creatinine, serum sodium or lactate level as well as more severe coagulation disorders. CONCLUSION:Cardiac arrest related to rescue collapse was associated with favorable outcome. On-scene rescue collapse should prompt prolonged resuscitation and ECLS rewarming in all CA patients with deep hypothermia. Conversely, unwitnessed cardiac arrest was associated with unfavorable outcome and will likely not benefit from ECLS.
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