• Michael Wanscher, Lisbeth Agersnap, Jesper Ravn, Stig Yndgaard, Jørgen Feldbæk Nielsen, Else R Danielsen, Christian Hassager, Bertil Romner, Carsten Thomsen, Steen Barnung, Anne Grethe Lorentzen, Hans Høgenhaven, Matthew Davis, and Jacob Eifer Møller.
• Department of Anesthesiology and Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark.
• Resuscitation. 2012 Sep 1; 83 (9): 107810841078-84.

BackgroundResuscitation guidelines for the treatment of accidental hypothermia are based primarily on isolated cases. Mortality rates are high despite aggressive treatment aimed at restoring spontaneous circulation and normothermia.MethodsThe present report is based on a boating accident where 15 healthy subjects (median age 16 (range 15-45) years) were immersed in 2 °C salt water. Seven victims were recovered in circulatory arrest with a median temperature of 18.4 °C (range 15.5-20.2 °C). They were all rewarmed with extracorporeal membrane oxygenation (ECMO) and were subsequently evaluated with advanced neuroradiological and functional testing. The remaining 7 had established spontaneous circulation without the use of ECMO. One victim drowned in the accident.ResultsThe victims that survived the accident without circulatory arrest were predominantly females with a higher body mass index. Victims with circulatory arrest pH on arrival was a median of 6.61 (range 6.43-6.94), with ECMO being established a median of 226 (178-241)min after the accident. Magnetic resonance spectroscopy showed neuronal dysfunction in five. In five victims initial normal white matter spectra progressed to show evidence of abnormal axonal membranes. Based on the seven-level Functional Independence Measure test functional outcome was good in six circulatory arrest victims and in all without circulatory arrest. Mild to moderate cognitive dysfunction was seen in six and severe dysfunction in one circulatory arrest victim.ConclusionSeven patients with profound accidental hypothermic circulatory arrest were successfully resuscitated using a management approach that included extracorporeal rewarming, followed by successive periods of therapeutic hypothermia and sedated normothermia and intensive neurorehabilitation. Seven other hypothermic victims (core temperature as low as 23 °C) that did not suffer circulatory arrest also survived the accident.Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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