Original Article
Outcome of Survivors of Accidental Deep Hypothermia and Circulatory Arrest Treated with Extracorporeal Blood Warming
N Engl J Med 1997; 337:1500-1505November 20, 1997
- 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°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 attempts. 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 patient 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.
Media in This Article
Table 1
Characteristics of the Patients at Rewarming and Follow-up.Article Activity
- Article
Deep accidental hypothermia (core temperature, <28°C) causes circulatory and neurologic disturbances.1-8 Even with immediate treatment, mortality rates are high.9-13 Successful management has been reported only in isolated cases.14,15 The long-term outcome of patients with accidental deep hypothermia and cardiac arrest has not been assessed in a larger series.
In a retrospective multicenter study, 234 patients with accidental hypothermia of various degrees were identified. Forty-six of these had deep hypothermia with circulatory arrest.11 Rewarming with cardiopulmonary bypass was attempted in 32 at three hospitals. The 15 long-term survivors, who were treated between 1977 and 1993, were healthy young people who had suffered deep hypothermia in most cases after mountaineering accidents or suicide attempts. The aim of this study was to assess the late outcome of these patients after rewarming with cardiopulmonary bypass.
Methods
Characteristics of the Patients
We studied 15 young patients without cardiovascular disease (7 female and 8 male; mean [±SD] age, 25.2±9.9 years; range, 9 to 43) who had suffered accidental deep hypothermia with circulatory arrest after mountaineering accidents, a boating accident, or murder or suicide attempts (Table 1Table 1
Characteristics of the Patients at Rewarming and Follow-up.). At rescue all patients were comatose. Nine initially had vital signs such as respiration, a pulse, or regular electric cardiac activity. The other six patients had neither respiration nor a pulse. In all nine patients who initially had vital signs, cardiopulmonary arrest occurred a mean of 14.8±18.6 minutes after the rescue operation was begun. All patients were intubated and ventilated and received ongoing cardiac massage during transportation to the hospital. At the time of admission, all 15 patients had documented circulatory arrest (ventricular fibrillation in 10 and asystole in 5) and fixed, dilated pupils. The mean interval from discovery of the patient to rewarming with cardiopulmonary bypass was 141±50 minutes (range, 30 to 240).Rewarming was performed by a cardiovascular surgeon using femoro-femoral cannulation and standard cardiopulmonary-bypass equipment (two patients were treated in Lausanne, four in Zurich, and nine in Bern). In two children sternotomy was necessary for cannulation. The mean rectal or esophageal temperature at referral was 21.8±2.5°C (range, 17.1 to 25.0) and rose to 35.6±1.8°C (range, 32.0 to 38.0) within 97.9±47.2 minutes (range, 60 to 240) after rewarming. After rewarming and arrival in the intensive care unit, 14 patients had a cardiac sinus rhythm and 1 had a transient nodal rhythm. Their pupils reacted normally to light. Seven patients were able to communicate within the first 12 hours after rewarming, five could communicate within 24 hours, and three required up to 30 days to regain consciousness. The mean duration of intubation and ventilation was 7.3±11.5 days (range, 8 hours to 44 days). The patients remained in the intensive care unit for an average of 10.5±13.1 days (range, 2 to 46).
The main problems at discharge were pulmonary in 11 patients, neurologic in 9, neuropsychological in 10, cardiac in 4, and renal in 5. Four patients had fractures, one had a burn caused by an inadequate rewarming attempt, one had pancreatitis, and one had deep venous thrombosis (cardiopulmonary-bypass cannulation site). Five patients were sent home directly from the hospital after 7.8±2.2 days (range, 5 to 10). Ten patients were transferred to other hospitals after 22.7±19.5 days (range, 2 to 55) for further treatment or rehabilitation, where they stayed for 40.2±58.9 days (range, 7 to 228).
Assessment
All patients or their parents were contacted and gave informed consent for the study. All agreed to a follow-up examination. This was performed at the hospital in Bern 6.7±4.0 years (range, 5 days to 179 months) after the accident.
At follow-up, physical and neurologic examinations and special tests described below were performed. The results were categorized as normal, borderline (abnormal without clinical relevance), or pathologic (abnormal with clinical relevance).
Neurovascular Ultrasound Studies
A duplex system for color coding (Acuson XP10, Mountain View, Calif.) was used to visualize the extracranial vessels (internal, external, and common carotid and vertebral arteries on both sides), and a 2-MHz pulsed Doppler system (TC2-64B or TC2-2000, Eden Medical Electronics, Ueberlingen, Germany) was used for flow-velocity measurements of the intracranial vessels (anterior, middle, and posterior cerebral arteries on both sides and basilar artery). These examinations were performed to rule out an extracranial or intracranial macroangiopathy, which could influence the results of other neuropsychological and neurophysiologic studies. Flow velocities were compared with those in a control group of healthy subjects matched for age and sex.
Electroencephalography and Neuropsychological Tests
Electroencephalography was performed on all patients. Standard electrode positions were used according to the 10–20 method. Adult patients underwent comprehensive neuropsychological testing with a standardized battery of clinical tests.16 Patient 6 underwent an equivalent test battery for children on the fifth day after the accident. Functioning in all patients was assessed on the basis of each patient's ability to provide personal information, orientation, mental control, attention span, memory, higher cognitive functions, spatial performance, and language abilities. A score of 0 was assigned if there was no impairment, a score of 1 in the case of slight impairment, a score of 2 in the case of moderate impairment, and a score of 3 in the case of severe impairment. The results were compared with existing values in age-matched controls.16 The patients' overall neuropsychological performance was scored with the same scale.
Magnetic Resonance Imaging of the Brain
Magnetic resonance imaging of the brain was carried out on a 1.5-T system with a circularly polarized head coil (Signa, General Electric, Milwaukee). T1-weighted sagittal and axial multislice scans (single spin–echo) and T2-weighted axial (double spin–echo) sequences covering the entire brain were obtained. Two neuroradiologists independently assessed the images with respect to global or focal atrophy and the presence of lesions. They were told the patients' age and sex but not clinical details.
Statistical Analysis
Descriptive statistics were generated when appropriate. Unless otherwise stated, values are expressed as means (±SD) and ranges. When the results were compared with those in age-matched control subjects, the differences were calculated by the nonparametric Wilcoxon signed-rank test.
Results
History and Physical Examination
Fourteen patients reported complete recovery and one patient (Patient 10) satisfactory recovery from the accident. Despite persistent deficits due to accident-related injuries but not to the hypothermia, none of the patients felt handicapped. They all resumed their former lifestyles. Only one patient (Patient 4) required medical treatment for preexisting psychiatric problems. The general physical examination showed normal findings in all patients.
Neurologic Findings
Three patients had borderline abnormalities that were probably related to circulatory arrest during hypothermia (Table 1). Other abnormalities were preexisting or caused by injuries incurred during the accident but were not related to hypoxia or hypothermia. Patient 6 had mildly impaired coordination of his left arm and hand, which interfered minimally with function. Patient 7 had an impaired ability to make rapid alternating movements of his left hand (dysdiadochokinesia) at follow-up that did not affect his overall performance. He had resumed his profession as an engineer and his sports activities such as mountaineering and climbing. This patient showed the most remarkable recovery, since it took six months for him to be able to walk unaided and about one year for him to be able to read and write normally. Patient 9 had dysesthesia of his left foot.
Neurovascular Ultrasound Studies
All patients had normal carotid and vertebral arteries in the neck on duplex scanning. Flow velocities of the extracranial and intracranial vessels were within the normal range.
Electroencephalography
On visual assessment five patients had borderline results and one had pathologic results (Table 1). The borderline alterations consisted of focal abnormalities (slow waves and epileptiform discharges) in three patients and slowed background activity in two. Patient 12, who had the lowest core temperature at rescue, had an electroencephalogram with slowed background activity and sharp and theta waves in the right temporoparietal region. However, he had no history of seizures and did not require antiepileptic medication. All documented electroencephalographic changes were probably related to hypothermia.
Neuropsychological Findings
Thirteen of the 15 patients completed neuropsychological testing. Patient 4 refused to complete testing, but interview data did not indicate partial or global cognitive impairment. Patient 13 was interviewed in her native language of Swedish and did not show any neuropsychological impairment; however, neither test material nor norms were available in her native language.
Patient 6, who could not be tested at follow-up, made a good recovery and resumed attending school. Patient 7, who had very severe neuropsychological deficits on discharge from the hospital, including aphasia, apraxia, and emotional problems, recovered completely. Patient 10 had slightly impaired orientation and memory and a moderately impaired attention span, corresponding to the traumatic brain damage seen on imaging. Despite severe brain injury, which required rehabilitation for seven months, he attended a regular school and did not require special tutoring. Overall, no patient had any hypothermia-related impairment.
Magnetic Resonance Imaging of the Brain
Findings on magnetic resonance imaging were normal in 13 patients and pathologic in 2 patients. Patient 7 had a global cerebellar atrophy, symmetrically involving both cerebellar hemispheres and the vermis. In addition, T2-weighted images showed a low signal intensity of the basal ganglia due to bilateral calcifications. The calcifications, but not the cerebellar atrophy, were already apparent on a computed tomographic scan obtained 10 days after the accident. Therefore, the cerebellar atrophy was most likely related to the hypothermia, and the calcifications were not. Magnetic resonance imaging of Patient 10 showed cortical and subcortical defects of the right frontal and temporal lobes as a result of a sustained head injury, which was not related to the hypothermia. Twelve of the 15 magnetic resonance scans showed subtle enlargements of basal perivascular spaces, which were considered within the limits of normal.
Discussion
Survival after accidental deep hypothermia (core temperature, <28°C) and prolonged cardiac arrest is rare.7,9,12 Although there have been isolated case reports, the long-term outcome of such patients has not been described. The results of our study are encouraging. At follow-up all 15 patients who survived rewarming with cardiopulmonary bypass had resumed their former activities and lifestyles. There were either no hypothermia-related neurologic or neuropsychological deficits or only mild ones. Abnormal findings on examination were due to injuries sustained during the accident or rescue. Both the high survival rate (47 percent; 15 of 32 patients) and the long-term outcome of our patients are remarkable considering the severe neurologic problems in the early period after rewarming (prolonged coma, amnesia, aphasia, ataxia, or spasticity). Some patients needed long-term rehabilitation. Severe deficits soon after rewarming have also been documented in other studies.6,12,17 The favorable outcome in our study is in contrast to resuscitation results in patients with normothermia and cardiac arrest, who have a poor outcome. Only 8 to 14 percent of patients with out-of-hospital or in-hospital cardiac arrest survive resuscitation and leave the hospital.18,19 In other reports, 33 to 48 percent of survivors had persistent moderate-to-severe neurologic and neuropsychological impairment.20,21
Five main reasons may account for the relatively good survival rate and favorable long-term outcome in our patients with hypothermia. First, hypothermia was deep. Hypothermia increases the tolerance of the brain to ischemia. It slows metabolic processes and reduces oxygen consumption.22,23 The protective effect of moderate hypothermia has been applied successfully in the treatment of traumatic brain injury.24 In cardiac surgery deep hypothermia is routinely used for cerebral protection when circulatory arrest is required.25-28 At a core temperature of 20°C cardiac arrest is tolerated for up to 30 minutes without clinically significant neurologic or neuropsychological deficits.27,28 Second, none of our patients had asphyxia or hypoxic brain damage before hypothermia developed, problems that often occur in avalanche or drowning victims.3,12,29-31 Asphyxia that precedes cooling of the body increases the risk of death.11 Third, our surviving patients were young, were in good general health, and had no vascular risk factors. Unlike patients in other referral centers our patients were not homeless people, who are often malnourished and have other medical problems.32 Fourth, the infrastructure and experience of rescue organizations in Switzerland may have influenced the outcome favorably.33,34 Thirteen patients were rescued by helicopter with a professional team that included a physician. During transportation and at the hospital, hypothermia was maintained and the patients were rewarmed only after cardiopulmonary bypass was initiated.6,11,35
The fifth and potentially crucial factor responsible for the good outcome in this series may have been the rewarming technique.6,35,36 Early rewarming with cardiopulmonary bypass has theoretical advantages as compared with other rewarming methods: it is the fastest method of rewarming; it provides adequate and immediate circulatory support; it may improve tissue perfusion by hemodilution; metabolic and toxic derangements can be corrected rapidly; and the heart is rewarmed before the rest of the body, thus preventing shock due to peripheral vasodilatation.35 In the absence of such contraindications as asphyxia, severe traumatic injury, and extremely elevated serum potassium levels (exceeding 10 mmol per liter), cardiopulmonary bypass appears to be the rewarming method of choice for accidental deep hypothermia with circulatory arrest.6,10,11,35 However, the value of this technique is doubtful for a patient with circulatory arrest but only moderate hypothermia.13,29 The upper and lower limits of the core temperature at which rewarming attempts justify the use of extracorporeal circulation remain unclear.12,13,17,29,34
In patients with preserved circulation and a less severe hypothermia, other rewarming techniques can be used and may be preferable.12,13,32,37,38 For instance, rewarming with warm air is noninvasive and technically easy to perform.39 In addition, the availability of rewarming with cardiopulmonary bypass is limited to large medical centers. Another important goal is to establish predictors of poor outcome in deep accidental hypothermia.8,11,13,17,29,40
In conclusion, our study demonstrates that the long-term outcome of survivors of accidental deep hypothermia with prolonged circulatory arrest and rewarming with cardiopulmonary bypass is favorable. Severe hypothermia-related neurologic deficits observed in the early post-rewarming period had disappeared at follow-up. Permanent neurologic deficits of clinical relevance were either preexisting or due to injuries sustained during the accident or rescue. The long-term survival rate of 47 percent is higher than previously reported9,12,29 and may be explained by the severity of hypothermia, the rewarming technique used, the rescue teams used, the patients' characteristics, and the absence of asphyxia before exposure to the cold.
We are indebted to the emergency physicians at the primary care centers involved in the rescue and referral of patients to the university hospitals; to the Swiss rescue teams (REGA, Air Zermatt, and Air Glacier); and to the personnel of Inselspital for carrying out specialized tests: the personnel of the electroencephalography section, especially Mr. M. Kollar, for performing electroencephalography; Dr. C. Bassetti for helpful comments (the Department of Neurology); Mrs. C. Herrmann of the cerebrovascular laboratory for performing the ultrasound examinations (Departments of Neurology and Neurosurgery); Mr. G. di Stefano, M.A., and Mrs. A. Schnidrig, M.A., for their help in performing neuropsychological tests on some of the patients (the Department of Psychiatry); and the staff of the magnetic resonance imaging unit, especially Dr. E. Tuncdogan and Mr. T. Gbedegbegnon, chief technician, for expert assistance (the Department of Neuroradiology).
Source Information
From the Departments of Thoracic and Cardiovascular Surgery (B.H.W., B.N.W.-A., U.A.), Neurology (H.P.M., L.S.), Psychiatry (B.P.R.), and Neuroradiology (G.S.), University of Bern, Inselspital, Bern; the Department of Cardiovascular Surgery, University Hospital of Lausanne, Lausanne (A.P.F., L.v.S.); and the Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich (L.v.S.) — all in Switzerland.
Address reprint requests to Dr. Walpoth at the Department of Thoracic and Cardiovascular Surgery, University of Bern, Inselspital, 3010 Bern, Switzerland.
- References
References
1
Paton BC . Accidental hypothermia. Pharmacol Ther 1983;22:331-337
CrossRef | Web of Science | Medline2
Mills WJ Jr . Summary of the treatment of the cold injured patient: hypothermia. Alaska Med 1983;25:29-32
Medline3
Harnett RM ,Pruitt JR ,Sias FR . A review of the literature concerning resuscitation from hypothermia. I. The problem and general approaches. Aviat Space Environ Med 1983;54:425-434
Web of Science | Medline4
Lloyd EL. Resuscitation. In: Lloyd EL, ed. Hypothermia and cold stress. London: Routledge, Chapman, Hall, 1986:237-43.
5
Danzl DF ,Pozos RS . Multicenter hypothermia survey. Ann Emerg Med 1987;16:1042-1055
CrossRef | Web of Science | Medline6
Walpoth BH ,Locher T ,Leupi F ,Schupbach P ,Muhlemann W ,Althaus U . Accidental deep hypothermia with cardiopulmonary arrest: extracorporeal blood rewarming in 11 patients. Eur J Cardiothorac Surg 1990;4:390-393
CrossRef | Web of Science | Medline7
Herity B ,Daly L ,Bourke GJ ,Horgan JM . Hypothermia and mortality and morbidity: an epidemiological analysis. J Epidemiol Community Health 1991;45:19-23
CrossRef | Web of Science | Medline8
Danzl DF ,Pozos RS . Accidental hypothermia. N Engl J Med 1994;331:1756-1760
Full Text | Web of Science | Medline9
Hauty MG ,Esrig BC ,Hill JG ,Long WB . Prognostic factors in severe accidental hypothermia: experience from the Mt. Hood tragedy. J Trauma 1987;27:1107-1112
CrossRef | Web of Science | Medline10
Auerbach PS . Some people are dead when they're cold and dead. JAMA 1990;264:1856-1857
CrossRef | Web of Science | Medline11
Locher T ,Walpoth BH ,Pfluger D ,Althaus U . Akzidentelle Hypothermie in der Schweiz (1980-1987) -- Kasuistik und prognostische Faktoren. Schweiz Med Wochenchr 1991;121:1020-1028
Medline12
Kornberger E ,Mair P . Important aspects in the treatment of severe accidental hypothermia: the Innsbruck experience. J Neurosurg Anesthesiol 1996;8:83-87
CrossRef | Web of Science | Medline13
Larach MG . Accidental hypothermia. Lancet 1995;345:493-498
CrossRef | Web of Science | Medline14
von Segesser LK ,Garcia E ,Turina M . Perfusion without systemic heparinization for rewarming in accidental hypothermia. Ann Thorac Surg 1991;52:560-561
CrossRef | Web of Science | Medline15
Bolte RG ,Black PG ,Bowers RS ,Thorne JK ,Corneli HM . The use of extracorporeal rewarming in a child submerged for 66 minutes. JAMA 1988;260:377-379
CrossRef | Web of Science | Medline16
Perret E. Gehirn und Verhalten — Neuropsychologie des Menschen. Bern, Switzerland: Hans Huber, 1973.
17
Danzl DF ,Hedges JR ,Pozos RS . Hypothermia outcome score: development and implications. Crit Care Med 1989;17:227-231
CrossRef | Web of Science | Medline18
Roewer N ,Kloss T ,Puschel K . Langzeiterfolg und Lebensqualität nach präklinischer kardiopulmonaler Reanimation. Anaesth Intensivther Notfallmed 1985;20:244-250
CrossRef | Medline19
Bedell SE ,Delbanco TL ,Cook EF ,Epstein FH . Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med 1983;309:569-576
Full Text | Web of Science | Medline20
Longstreth WT Jr ,Inui TS ,Cobb LA ,Copass MK . Neurologic recovery after out-of-hospital cardiac arrest. Ann Intern Med 1983;98:588-592
Web of Science | Medline21
Roine RO ,Kajaste S ,Kaste M . Neuropsychological sequelae of cardiac arrest. JAMA 1993;269:237-242
CrossRef | Web of Science | Medline22
Bigelow WG ,Lindsay WK ,Harrison RC ,Gordon RA ,Greenwood WF . Oxygen transport and utilization in dogs at low body temperatures. Am J Physiol 1950;160:125-137
Web of Science | Medline23
Rosomoff HL . Pathophysiology of the central nervous system during hypothermia. Acta Neurochir Suppl (Wien) 1964;13:11-2224
Marion DW ,Penrod LE ,Kelsey SF , et al. Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 1997;336:540-546
Full Text | Web of Science | Medline25
Hypothermia, circulatory arrest, and cardiopulmonary bypass. In: Kirklin JW, Barratt-Boyes BG. Cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results, and indications. 2nd ed. Vol. 1. New York: Churchill Livingstone, 1993:61-127.
26
Griepp EB ,Griepp RB . Cerebral consequences of hypothermic circulatory arrest in adults. J Card Surg 1992;7:134-155
CrossRef | Web of Science | Medline27
Barratt-Boyes BG ,Neutze JM ,Clarkson PM ,Shardey GC ,Brandt PWT . Repair of ventricular septal defect in the first two years of life using profound hypothermia-circulatory arrest techniques. Ann Surg 1976;184:376-390
CrossRef | Web of Science | Medline28
Messmer BJ ,Schallberger U ,Gattiker R ,Senning A . Psychomotor and intellectual development after deep hypothermia and circulatory arrest in early infancy. J Thorac Cardiovasc Surg 1976;72:495-502
Web of Science | Medline29
Schaller MD ,Fischer AP ,Perret CH . Hyperkalemia: a prognostic factor during acute severe hypothermia. JAMA 1990;264:1842-1845
CrossRef | Web of Science | Medline30
Falk M ,Brugger H ,Adler-Kastner L . Avalanche survival chances. Nature 1994;368:21-21
CrossRef | Web of Science | Medline31
Biggart MJ ,Bohn DJ . Effect of hypothermia and cardiac arrest on outcome of near-drowning accidents in children. J Pediatr 1990;117:179-183
CrossRef | Web of Science | Medline32
Miller JW ,Danzl DF ,Thomas DM . Urban accidental hypothermia: 135 cases. Ann Emerg Med 1980;9:456-461
CrossRef | Web of Science | Medline33
Dubas F, Henzelin R, Michelet J. Avalanches: prevention and rescue. In: Dubas F, Vallotton J, eds. A color atlas of mountain medicine. St. Louis: Mosby–Year Book, 1991:104-12.
34
Brugger H ,Durrer B ,Adler-Kastner L . On-site triage of avalanche victims with asystole by the emergency doctor. Resuscitation 1996;31:11-16
CrossRef | Web of Science | Medline35
Althaus U ,Aeberhard P ,Schupbach P ,Nachbur BH ,Muhlemann W . Management of profound accidental hypothermia with cardiorespiratory arrest. Ann Surg 1982;195:492-495
CrossRef | Web of Science | Medline36
Davies DM ,Millar EJ ,Miller IA . Accidental hypothermia treated by extracorporeal blood warming. Lancet 1967;1:1036-1037
CrossRef | Web of Science | Medline37
Gentilello LM ,Cobean RA ,Offner PJ ,Soderberg RW ,Jurkovich GJ . Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill patients. J Trauma 1992;32:316-325
CrossRef | Web of Science | Medline38
Gregory JS ,Bergstein JM ,Aprahamian C ,Wittmann DH ,Quebbeman EJ . Comparison of three methods of rewarming from hypothermia: advantages of extracorporeal blood warming. J Trauma 1991;31:1247-1251
CrossRef | Web of Science | Medline39
Steele MT ,Nelson MJ ,Sessler DI , et al. Forced air speeds rewarming in accidental hypothermia. Ann Emerg Med 1996;27:479-484
CrossRef | Web of Science | Medline40
Mair P ,Kornberger E ,Furtwaengler W ,Balogh D ,Antretter H . Prognostic markers in patients with severe accidental hypothermia and cardiocirculatory arrest. Resuscitation 1994;27:47-54
CrossRef | Web of Science | Medline
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Kasim Oguz Coskun, Aron Frederik Popov, Jan Dieter Schmitto, José Hinz, Thomas Kriebel, Friedrich Albert Schoendube, Wolfgang Ruschewski, Theodor Tirilomis. (2010) Extracorporeal Circulation for Rewarming in Drowning and Near-Drowning Pediatric Patients. Artificial Organs 34:11, 1026-1030
CrossRef23
P. K. SUOMINEN, N. H. VALLILA, L. M. HARTIKAINEN, H. I. SAIRANEN, R. E. KORPELA. (2010) Outcome of drowned hypothermic children with cardiac arrest treated with cardiopulmonary bypass. Acta Anaesthesiologica Scandinavica 54:10, 1276-1281
CrossRef24
Jerry P. Nolan, Jasmeet Soar, David A. Zideman, Dominique Biarent, Leo L. Bossaert, Charles Deakin, Rudolph W. Koster, Jonathan Wyllie, Bernd Böttiger. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 81:10, 1219-1276
CrossRef25
Allan R. de Caen, Monica E. Kleinman, Leon Chameides, Dianne L. Atkins, Robert A. Berg, Marc D. Berg, Farhan Bhanji, Dominique Biarent, Robert Bingham, Ashraf H. Coovadia, Mary Fran Hazinski, Robert W. Hickey, Vinay M. Nadkarni, Amelia G. Reis, Antonio Rodriguez-Nunez, James Tibballs, Arno L. Zaritsky, David Zideman. (2010) Part 10: Paediatric basic and advanced life support. Resuscitation 81:1, e213-e259
CrossRef26
Jasmeet Soar, Gavin D. Perkins, Gamal Abbas, Annette Alfonzo, Alessandro Barelli, Joost J.L.M. Bierens, Hermann Brugger, Charles D. Deakin, Joel Dunning, Marios Georgiou, Anthony J. Handley, David J. Lockey, Peter Paal, Claudio Sandroni, Karl-Christian Thies, David A. Zideman, Jerry P. Nolan. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 81:10, 1400-1433
CrossRef27
Charles D. Deakin, Laurie J. Morrison, Peter T. Morley, Clifton W. Callaway, Richard E. Kerber, Steven L. Kronick, Eric J. Lavonas, Mark S. Link, Robert W. Neumar, Charles W. Otto, Michael Parr, Michael Shuster, Kjetil Sunde, Mary Ann Peberdy, Wanchun Tang, Terry L. Vanden Hoek, Bernd W. Böttiger, Saul Drajer, Swee Han Lim, Jerry P. Nolan. (2010) Part 8: Advanced life support. Resuscitation 81:1, e93-e174
CrossRef28
Benedict Kjaergaard, Louise K. Jakobsen, Conny Nielsen, Peter J. Knudsen, Søren R. Kristensen, Anders Larsson. (2010) Low plasma potassium in deep hypothermic cardiac arrest indicates that cardiac arrest is secondary to hypothermia: a porcine study. European Journal of Emergency Medicine 17:3, 131-135
CrossRef29
Jeff Boyd, Hermann Brugger, Michael Shuster. (2010) Prognostic factors in avalanche resuscitation: A systematic review. Resuscitation 81:6, 645-652
CrossRef30
Rehana Qadir, Khalil Kanjwal. (2010) Severe Bradycardia With a Prominent J Wave Refractory to Atropine: Was It a Cause or a Result of a Fall? A Case Report and a Brief Review on the Treatment of Hypothermia. American Journal of Therapeutics 17:2, 223-225
CrossRef31
Rogier Caluwé, Raymond Vanholder, Annemieke Dhondt. (2010) Hemodialysis as a Treatment of Severe Accidental Hypothermia. Artificial Organs 34:3, 237-239
CrossRef32
Pankaj Saxena, Jaffar Shehatha, Adam Boyt, Mark Newman, Igor E Konstantinov. (2009) Role of Extracorporeal Circulation in the Management of Accidental Deep Hypothermia. Heart, Lung and Circulation 18:6, 416-418
CrossRef33
Fujioka Masaki, Tasaki Isao, Houbara Seiji, Hayashida Youich, Fujiwara Shinsuke, Takayama Hayato. (2009) Revival From Deep Hypothermia After 4 Hours of Cardiac Arrest Without the Use of Extracorporeal Circulation. The Journal of Trauma: Injury, Infection, and Critical Care 67:5, E173-E176
CrossRef34
Ulf Guenther, Dirk Varelmann, Christian Putensen, Hermann Wrigge. (2009) Extended therapeutic hypothermia for several days during extracorporeal membrane-oxygenation after drowning and cardiac arrest. Resuscitation 80:3, 379-381
CrossRef35
Morita Seiji, Inokuchi Sadaki, Inoue Shigeaki, Akieda Kazuki, Umezawa Kazuo, Nakagawa Yoshihide, Yamamoto Isotoshi. (2008) The Efficacy of Rewarming With a Portable and Percutaneous Cardiopulmonary Bypass System in Accidental Deep Hypothermia Patients With Hemodynamic Instability. The Journal of Trauma: Injury, Infection, and Critical Care 65:6, 1391-1395
CrossRef36
Thomas A. Cappaert, Jennifer A. Stone, John W. Castellani, Bentley Andrew Krause, Daniel Smith, Bradford A. Stephens. (2008) National Athletic Trainers' Association Position Statement: Environmental Cold Injuries. Journal of Athletic Training 43:6, 640-658
CrossRef37
H. Brugger, P. Paal, M. Hohlrieder, G. Sumann. (2008) Medizinische Aspekte zum Lawinenunfall. Notfall + Rettungsmedizin 11:7, 505-513
CrossRef38
A. Alfonzo, A. Lomas, I. Drummond, E. McGugan. (2008) Survival after 5-h resuscitation attempt for hypothermic cardiac arrest using CVVH for extracorporeal rewarming. Nephrology Dialysis Transplantation 24:3, 1054-1056
CrossRef39
M. Skorning, S. Bergrath, S.K. Beckers, D. Rörtgen, J.C. Brokmann. (2008) Erweiterte kardiopulmonale Reanimation in besonderen Situationen: Teil 2. Der Anaesthesist 57:6, 621-640
CrossRef40
Shi-Min Yuan, Amihay Shinfeld, Ehud Raanani. (2008) Cardiopulmonary bypass as an adjunct for the noncardiac surgeon. Journal of Cardiovascular Medicine 9:4, 338-355
CrossRef41
Sarah C. Vince, Neil J. Flint, Andrew P. Hall. (2008) A novel non-invasive warming technique in severe accidental hypothermia. Resuscitation 77:1, 144-145
CrossRef42
Rosmarie Oberhammer, Werner Beikircher, Christoph Hörmann, Ingo Lorenz, Roger Pycha, Liselotte Adler-Kastner, Hermann Brugger. (2008) Full recovery of an avalanche victim with profound hypothermia and prolonged cardiac arrest treated by extracorporeal re-warming. Resuscitation 76:3, 474-480
CrossRef43
Megan Laniewicz, Kenneth Lyn-Kew, Robert Silbergleit. (2008) Rapid Endovascular Warming for Profound Hypothermia. Annals of Emergency Medicine 51:2, 160-163
CrossRef44
Eric R. Scaife, R.C. Connors, S.E. Morris, P.F. Nichol, R.E. Black, M.E. Matlak, K. Hansen, R.G. Bolte. (2007) An established extracorporeal membrane oxygenation protocol promotes survival in extreme hypothermia. Journal of Pediatric Surgery 42:12, 2012-2016
CrossRef45
Christoph Eich, Anselm Bräuer, Arnd Timmermann, Stephan K.W. Schwarz, Sebastian G. Russo, Karin Neubert, Bernhard M. Graf, Ivan Aleksic. (2007) Outcome of 12 drowned children with attempted resuscitation on cardiopulmonary bypass: An analysis of variables based on the “Utstein Style for Drowning”. Resuscitation 75:1, 42-52
CrossRef46
Anand Iyer, Vincent Rajkumar, Dinesh Sadasivan, Jaye Bruce, Ian Gilfillan. (2007) No one is dead until warm and dead. The Journal of Thoracic and Cardiovascular Surgery 134:4, 1042-1043
CrossRef47
Elfriede Ruttmann, Annemarie Weissenbacher, Hanno Ulmer, Ludwig Müller, Daniel Höfer, Juliane Kilo, Walter Rabl, Birgit Schwarz, Günther Laufer, Herwig Antretter, Peter Mair. (2007) Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. The Journal of Thoracic and Cardiovascular Surgery 134:3, 594-600
CrossRef48
M. Hohlrieder, M. Kaufmann, M. Moritz, V. Wenzel. (2007) Management der akzidentellen Hypothermie. Der Anaesthesist 56:8, 805-811
CrossRef49
Peter Paal, John Ellerton, Günther Sumann, Florian Demetz, Peter Mair, Hermann Brugger. (2007) Basic Life Support Ventilation in Mountain Rescue. High Altitude Medicine & Biology 8:2, 147-154
CrossRef50
Shuhei Komatsu, Takumi Shimomatsuya, Taketsune Kobuchi, Masayuki Nakajima, Hirokazu Amaya, Sayuri Konishi, Susumu Shiraishi, Susumu Ono, Kazuhiro Maruhashi. (2007) Severe Accidental Hypothermia Successfully Treated by Rewarming Strategy Using Continuous Venovenous Hemodiafiltration System. The Journal of Trauma: Injury, Infection, and Critical Care 62:3, 775-776
CrossRef51
M. Platzer, E. Trampitsch, R. Likar, C. Breschan, H.-V. Schalk. (2007) Kardiopulmonale Reanimation nach Heroinintoxikation und Hypothermie. Der Anaesthesist 56:2, 141-144
CrossRef52
Gregory J. Jurkovich. (2007) Environmental Cold-Induced Injury. Surgical Clinics of North America 87:1, 247-267
CrossRef53
S. Maisch, K. Ntalakoura, H. Boettcher, K. Helmke, P. Friederich, A. E. Goetz. (2007) Schwere akzidentelle Hypothermie mit Kreislaufstillstand und extrakorporaler Erwärmung. Der Anaesthesist 56:1, 25-29
CrossRef54
Manfred Oechmichen, Christoph Meissner. (2006) Cerebral Hypoxia and Ischemia: The Forensic Point of View: A Review. Journal of Forensic Sciences 51:4, 880-887
CrossRef55
Marcus J. Schultz, Peter E. Spronk. (2006) Hypothermia and Lung Rest for Acute Lung Injury: Truly Exploiting Reduced Ventilatory Need or Just the Treatment Benefit of Hypothermia Alone?. Critical Care Medicine 34:3, 936
CrossRef56
P. Paal, W. Beikircher, H. Brugger. (2006) Der Lawinennotfall. Der Anaesthesist 55:3, 314-324
CrossRef57
J. Soar, C. D. Deakin, J. P. Nolan, G. Abbas, A. Alfonzo, A. J. Handley, D. Lockey, G. D. Perkins, K. Thies, B. W. Böttiger, B. Dirks, V. Dörges, H. Domanovits, H. Gervais. (2006) Kreislaufstillstand unter besonderen Umständen. Notfall + Rettungsmedizin 9:1, 123-154
CrossRef58
Benedict Kjærgaard, Peter Bach. (2006) Warming of patients with accidental hypothermia using warm water pleural lavage. Resuscitation 68:2, 203-207
CrossRef59
Jasmeet Soar, Charles D. Deakin, Jerry P. Nolan, Gamal Abbas, Annette Alfonzo, Anthony J. Handley, David Lockey, Gavin D. Perkins, Karl Thies. (2005) European Resuscitation Council Guidelines for Resuscitation 2005. Resuscitation 67, S135-S170
CrossRef60
J.-C. Schewe, U. Heister, M. Fischer, A. Hoeft. (2005) Akzidentelle urbane Unterkühlung. Der Anaesthesist 54:10, 1005-1011
CrossRef61
Christoph Eich, Anselm Bräuer, Dietrich Kettler. (2005) Recovery of a hypothermic drowned child after resuscitation with cardiopulmonary bypass followed by prolonged extracorporeal membrane oxygenation. Resuscitation 67:1, 145-148
CrossRef62
Lars Wik, Steinar Kiil. (2005) Use of an automatic mechanical chest compression device (LUCAS) as a bridge to establishing cardiopulmonary bypass for a patient with hypothermic cardiac arrest. Resuscitation 66:3, 391-394
CrossRef63
Ravindranath Tiruvoipati, Senthil K. Balasubramanian, Espeed Khoshbin, Leonidas Hadjinikolaou, Andrzej W. Sosnowski, Richard K. Firmin. (2005) Successful Use of Venovenous Extracorporeal Membrane Oxygenation in Accidental Hypothermic Cardiac Arrest. ASAIO Journal 51:4, 474-476
CrossRef64
Brian R. Plaisier. (2005) Thoracic lavage in accidental hypothermia with cardiac arrest — report of a case and review of the literature. Resuscitation 66:1, 99-104
CrossRef65
C. Marquis, D. Journois, A. Teboul, F. Bellenfant, D. Safran. (2005) High frequency oscillatory ventilation associated with cardiopulmonary bypass in the management of drowning and deep hypothermia. Journal Européen des Urgences 18:2, 100-101
CrossRef66
Sapana P. Adhikari, Robert A. Lowenstein. (2005) Severe Hypothermia Complicated by Home Heating Fuel Oil Contamination. Prehospital Emergency Care 9:4, 454-456
CrossRef67
J. Slotboom, C. Kiefer, C. Brekenfeld, C. Ozdoba, L. Remonda, K. Nedeltchev, M. Arnold, H. Mattle, G. Schroth. (2004) Locally induced hypothermia for treatment of acute ischaemic stroke: a physical feasibility study. Neuroradiology 46:11, 923-934
CrossRef68
Davida A Robinson, Patrick K.H O’Brien, Raeeda M Gheewala, Ella M Nikulina, Douglas D Payne, Ronald P Hammer, Kenneth G Warner. (2004) Differential expression of neuronal fos protein after cold water drowning and controlled rewarming1 1No competing interests declared.. Journal of the American College of Surgeons 198:3, 404-409
CrossRef69
Betty J Tsuei, Paul A Kearney. (2004) Hypothermia in the trauma patient. Injury 35:1, 7-15
CrossRef70
Tom Silfvast, Ville Pettilä. (2003) Outcome from severe accidental hypothermia in Southern Finland—a 10-year review. Resuscitation 59:3, 285-290
CrossRef71
Hermann Brugger, Günther Sumann, Roland Meister, Liselotte Adler-Kastner, Peter Mair, Hanns Christian Gunga, Wolfgang Schobersberger, Markus Falk. (2003) Hypoxia and hypercapnia during respiration into an artificial air pocket in snow: implications for avalanche survival. Resuscitation 58:1, 81-88
CrossRef72
Tom Skyhøj Olsen, Uno Jakob Weber, Lars Peter Kammersgaard. (2003) Therapeutic hypothermia for acute stroke. The Lancet Neurology 2:7, 410-416
CrossRef73
Bruno Durrer, Hermann Brugger, David Syme. (2003) The Medical On-site Treatment of Hypothermia: ICAR-MEDCOM Recommendation. High Altitude Medicine & Biology 4:1, 99-103
CrossRef74
Birgit Schwarz, Peter Mair, Josef Margreiter, Andreas Pomaroli, Christoph Hoermann, Johannes Bonatti, Karl H. Lindner. (2003) Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support*. Critical Care Medicine 31:3, 758-764
CrossRef75
Steven W. Werns. (2003) Percutaneous extracorporeal life support: Reserve for patients with reversible causes of shock and cardiac arrest *. Critical Care Medicine 31:3, 978-980
CrossRef76
Hermann Brugger, Bruno Durrer. (2002) On-Site Treatment of Avalanche Victims ICAR-MEDCOM-Recommendation. High Altitude Medicine & Biology 3:4, 421-425
CrossRef77
Xiao-Feng Yang, Jong Hee Chang, Steven M Rothman. (2002) Intracerebral temperature alterations associated with focal seizures. Epilepsy Research 52:2, 97-105
CrossRef78
Richard E Moon, Robert J Long. (2002) Drowning and near-drowning. Emergency Medicine Australasia 14:4, 377-386
CrossRef79
Hermann Brugger, Bruno Durrer, Liselotte Adler-Kastner, Markus Falk, Frank Tschirky. (2001) Field management of avalanche victims. Resuscitation 51:1, 7-15
CrossRef80
Elisabeth Kornberger, Karl H. Lindner, Viktoria D. Mayr, Birgit Schwarz, Kirsten S. Rackwitz, Volker Wenzel, Anette C. Krismer, Peter Mair. (2001) Effects of epinephrine in a pig model of hypothermic cardiac arrest and closed-chest cardiopulmonary resuscitation combined with active rewarming. Resuscitation 50:3, 301-308
CrossRef81
M. Roeggla, M. Holzer, G. Roeggla, M. Frossard, A. Wagner, A. N. Laggner. (2001) Prognosis of Accidental Hypothermia in the Urban Setting. Journal of Intensive Care Medicine 16:3, 142-149
CrossRef82
Gordon G Giesbrecht. (2001) Emergency treatment of hypothermia. Emergency Medicine Australasia 13:1, 9-16
CrossRef83
K.P. Ivanov. (2000) Physiological blocking of the mechanisms of cold death: theoretical and experimental considerations. Journal of Thermal Biology 25:6, 467-479
CrossRef84
D.Shaun Gray, Robert S. Burnham. (2000) Preliminary outcome analysis of a long-term rehabilitation program for severe acquired brain injury. Archives of Physical Medicine and Rehabilitation 81:11, 1447-1456
CrossRef85
Charles E. Smith, Roderick A. Yamat. (2000) Avoiding hypothermia in the trauma patient. Current Opinion in Anaesthesiology 13:2, 167-174
CrossRef86
Mads Gilbert, Rolf Busund, Arne Skagseth, Paul Åge Nilsen, Jan P Solbø. (2000) Resuscitation from accidental hypothermia of 13·7°C with circulatory arrest. The Lancet 355:9201, 375-376
CrossRef87
Julie I. Sanchez, Charles N. Paidas. (1999) CHILDHOOD TRAUMA. Surgical Clinics of North America 79:6, 1503-1535
CrossRef88
Helge Opdahl. (1999) Survival Put to the Acid Test: Extreme Arterial Blood Acidosis (pH 6.33) after Near Drowning. Critical Care Medicine 27:9, 2072-2073
CrossRef89
Ludwig K von Segesser. (1999) Cardiopulmonary support and extracorporeal membrane oxygenation for cardiac assist. The Annals of Thoracic Surgery 68:2, 672-677
CrossRef90
Mayuki Aibiki, Souichi Maekawa, Takashi Nishiyama, Keisuke Seki, Satoshi Yokono. (1999) Activated cytokine production in patients with accidental hypothermia. Resuscitation 41:3, 263-268
CrossRef91
Elisabeth Kornberger, Birgit Schwarz, Karl H. Lindner, Peter Mair. (1999) Forced air surface rewarming in patients with severe accidental hypothermia. Resuscitation 41:2, 105-111
CrossRef92
Peter Mair, Elisabeth Kornberger. (1999) Cardiopulmonary resuscitation in accidental hypothermia. Current Opinion in Critical Care 5:3, 216
CrossRef93
N HANANIA. (1999) ACCIDENTAL HYPOTHERMIA. Critical Care Clinics 15:2, 235-249
CrossRef94
(1998) Accidental Deep Hypothermia. New England Journal of Medicine 338:16, 1160-1162
Full Text95
Lazar, Harold L., . (1997) The Treatment of Hypothermia. New England Journal of Medicine 337:21, 1545-1547
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