Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-23T19:12:42.162Z Has data issue: false hasContentIssue false
  • English
  • Français

Successful Resuscitation of a Child with Severe Hypothermia after Cardiac Arrest of 88 Minutes

Published online by Cambridge University Press:  28 June 2012

Ulf Schmidt ,
Karl-Wilhelm Fritz ,
Wolfgang Kasperczyk  and
Harald Tscherne
Ulf Schmidt*
Affiliation:
Medizinische Hochschule Hannover, Unfallchirurgische Klinik, Hannover, Germany
Karl-Wilhelm Fritz
Affiliation:
Nordwest-Krankenhaus Sanderbusch, Anaesthesie-Abteilung und Anaesthesiologische Intensivstation, Sande, Germany
Wolfgang Kasperczyk
Affiliation:
Medizinische Hochschule Hannover, Unfallchirurgische Klinik, Hannover, Germany
Harald Tscherne
Affiliation:
Medizinische Hochschule Hannover, Unfallchirurgische Klinik, Hannover, Germany
*
Medizinische Hoehschule, Unfallchirurgishe Klinik, 30625 Hannover, Germany
Get access Rights & Permissions [Opens in a new window]

Abstract

A 4-year-old boy broke through the ice of a frozen lake and drowned. The boy was extricated from the icy water by a rescue helicopter that was dispatched shortly after the incident. Although the boy was severely hypothermic, no cardiac response could be induced with field resuscitation measures, including intubation, ventilation, suction, and cardiopulmonary resuscitation.

On admission, the primary findings included fixed, nonreacting pupils and asystole. The first core temperature measured was 19.8° C (67.6° F). During active, external warming, the first ventricular beats were observed 20 minutes after admission, and changed 10 minutes later to a sinus rhythm. Continuous monitoring included repeated arterial blood gas and electrolyte tests; prophylaxis for cerebral edema was performed with hyperventilation and administration of sodium Brevimytal and dexamethasone. Seventy minutes after admission, hemodynamics stabilized and the boy was transferred to the pediatric intensive care unit (PICU), where active external warming was continued to raise the core temperature at a rate of 1° C/hour.

Adult respiratory distress syndrome developed, and the boy had to be ventilated in the PICU for 10 days. He was discharged home after another two weeks. He recovered fully. The rapid heat loss with the induction of severe hypothermia (<20° C; 68° F) was the main reason for survival in this rare event of a patient with cardiac arrest lasting 88 minutes after accidental hypotherma.

Keywords

accidental hypothermiaair rescuecardiac arrestdrowninghypothermiapost-resuscitation managementresuscitationrewarming
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 1 , March 1995 , pp. 60 - 62
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hossli, G: Storungen im warmehaushalt: Akzidentelle allgemeine hypothermie. In: Ahnefeld, FW, Dick, W, Kilian, J, Schuster, HP (Hrsg), Nofallmedizin, Berlin, Heidelberg, New York, Springer, 1986.Google Scholar
2. Lehmann, H (1982): 12 Stunden in Seenot in einem Tiedegewasser. In: 1982 in Cuxhaven der Deutschen Gesellschaft zur Rettung Schiffbruchiger, Symposiumsband. Unterkuhlung im Seenotfall: 2, Symposium 22.-24.4, 1982 in Cuxhaven der Deutschen Gesellschaft zur Rettung Schiflbruchiger, Symposiumsband.Google Scholar
3. Low, A (1982): das “ELMA TRES“ Ungluck: Drama im Orkan 1982 in Cuxhaven der Deutschen Gesellschaft zur Rettung Schiffbruchiger, Symposiumsband.Google Scholar
4. Lonning, PE, Skulberg, A, Abyholm, F: Accidental hypothermia—Review of the literature. Acta Anaesthesiol Scand 1986;30:601.CrossRefGoogle ScholarPubMed
5. Miller, JV, Danzl, DF, Thomas, DM: Urban accidental hypothermia: 135 cases. Ann Emerg Med 1980;9:456.CrossRefGoogle ScholarPubMed
6. Muhlemann, W: Dreimal akzidentelle hypothermie: Voraussetzungen und Besonderheiten einer adaquaten Therapie. In: Skifahren und Sicherheit. III. International Symposium, in Davos, Buchdruckerei Davos, 1982;202.Google Scholar
7. Bloch, M: Cerebral effects of rewarming following prolonged hypothermia. Significance for the management of severe cardiocerebral injury and acute pyrexia. Brain 1967;90:769.CrossRefGoogle Scholar
8. Conn, AW: Brain-protection in near-drowned children. Sixth Myron B. Laver International Postgraduate Course in Anaesthesia and Intensive Care for Infants and Children. Basel, 1986; pp 14 and 15.3.Google Scholar
9. Hemperl, V, Kloss, T: Der thermische Notfall-Praklinische Versorgung. Krankenhausarzt 1986;59:660.Google Scholar
10. Michenfelder, J: A valid demonstration of barbiturate-induced brain protection in man—At last. Anaesthesiology 1986;4:140.CrossRefGoogle Scholar
11. Bretschneider, HL: Stoffwechselstorungen bei Hypothermie. In: Unterkuhlung im Seenotfall: 2. Symposium 22.0-24.4, 1982 in Cuxhaven der Deutschen Gesellschaft zur Rettung Schiflbruchiger, Symposiumsband.Google Scholar
12. DePay, AW: Klinische Behandlung von Unterkuhlten. In: Unterkuhlung im Seenottall 2; Symposium 22.-24.4, 1982 in Cuxhaven der Deutschen Gesellschaft zur Rettung Schiflbruchiger, Symposiumsband.Google Scholar
13. Bigelow, WG, Hopps, JA, Callaghan, JC: Radio-frequency rewarming in resuscitation from severe hypothermia. Can J Med Sci 1952;30:1985.Google ScholarPubMed
14. Loyd, ELL: Accidental hypothermia treated by central rewarming through the airway. Br J Anaesth 1973;54:41.CrossRefGoogle Scholar
15. Pickering, BG, Bristow, GK, Craig, BB: Core rewarming by peritoneal irrigation in accidental hypothermia with cardiac arrest Anaesth Analg 1977;56:574.Google ScholarPubMed
16. Sefrin, P: Unterkuhlung und Verletzung in Cuxhaven der Deutschen Gesellschaft zur Rettung Schiffbruchiger, Symposiumsband, 1982.Google Scholar
17. Joyner, RW: Temperature effects on neuronal elements. Fed Proc 1981;40:2814.Google ScholarPubMed