• Eric R Scaife, R C Connors, S E Morris, P F Nichol, R E Black, M E Matlak, K Hansen, and R G Bolte.
• IRB 0020292, University of Utah Institutional Review Board, Salt Lake City, UT 84113-1103, USA. eric.scaife@hsc.utah.edu
• J. Pediatr. Surg. 2007 Dec 1;42(12):2012-6.

BackgroundHistorical reports indicate that active rewarming with extracorporeal membrane oxygenation (ECMO) can salvage a patient after hypothermic cardiac arrest. We created a protocol that includes ECMO for extreme hypothermia to guide rewarming of the hypothermic patient.MethodsA retrospective review of the ECMO rewarming protocol (2004-2006) was conducted.ResultsThe active rewarming protocol is a flowchart that is available on our hospital intranet and can be accessed in the trauma bay. A severely hypothermic patient triggers the activation of a TRAUMA ONE-OP ECMO response. During the 2-year period, there were 5 activations of the system and 4 children were placed on ECMO. Two of the 4 were dramatically salvaged and eventually discharged neurologically intact. All 5 children were found pulseless at the scene before transport. The average time from the injury occurrence to arrival was 94 minutes (range, 41-181 minutes). Mean cardiopulmonary resuscitation time was 78.2 minutes (range, 37-152 minutes). The mean core temperature on arrival was 25.4 degrees C (range, 20.4 degrees C-28.6 degrees C). The average time from arrival to ECMO cannulation was 25.5 minutes (range, 16-37 minutes).ConclusionA preemptive strategy for the severely hypothermic patient provides an organized approach and prompt response. Expeditious rewarming can make the difference in an opportunity for survival.

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