Successful Pre-Rewarming Resuscitation after Cardiac Arrest in Severe Hypothermia: A Retrospective Cohort Study from the International Hypothermia Registry

Evelien Cools, Marie Meyer, Delphine Courvoisier and Beat Walpoth
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Evelien Cools: Department of Acute Medicine, Division of Anaesthesiology, University Hospitals Geneva, 1205 Geneva, Switzerland
Marie Meyer: Department of Anaesthesiology, Centre Hospitalier University Vaudois, 1011 Lausanne, Switzerland
Delphine Courvoisier: Quality of Care Unit, University Hospitals of Geneva, 1205 Geneva, Switzerland
Beat Walpoth: Emeritus, Department of Cardiovascular Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland

IJERPH, 2022, vol. 19, issue 7, 1-9

Abstract: The aim of our study is to investigate successful pre-rewarming resuscitation after hypothermic cardiac arrest (HCA). The hypothermic heart may be insensitive to defibrillation when core temperature is below 30 °C and after successful defibrillation, sinus rhythm often returns into ventricular fibrillation. Recurrent defibrillation attempts may induce myocardial injury. Discrepancy exists concerning pre-rewarming defibrillation between the guidelines of the European Resuscitation Council and American Heart Association. The International Hypothermia Registry (IHR) gathers hypothermia cases. The primary outcome was survival. Secondary outcomes were the characteristics of defibrillation, the effect of Adrenaline administration under 30 °C, and the duration of CPR. Of the 239 patients, eighty-eight were in cardiac arrest at arrival of the rescue team. Successful pre-rewarming resuscitation was obtained in 14 patients. The outcome showed: seven deaths, one vegetative state, two patients with reversible damage, and four patients with full recovery. A total of five patients had a shockable rhythm, and defibrillation was successful in four patients. The response rate to Adrenaline was reported as normal in six patients. There were no statistically significant differences in the presence of a shockable rhythm, the success of defibrillation, and the effect on Adrenaline administration between the survivors and non-survivors. Successful resuscitation in severe hypothermia is possible before active rewarming and arrival in the hospital, thus improving the chance of survival.

Keywords: accidental hypothermia; resuscitation; rewarming; mountain medicine (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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