An established extracorporeal membrane oxygenation protocol promotes survival in extreme hypothermia.
BACKGROUND
Historical 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.


METHODS
A retrospective review of the ECMO rewarming protocol (2004-2006) was conducted.


RESULTS
The 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).


CONCLUSIONS
A 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.
Scaife
Eric R
ER
IRB 0020292, University of Utah Institutional Review Board, Salt Lake City, UT 84113-1103, USA. eric.scaife@hsc.utah.edu
Connors
R C
RC
Morris
S E
SE
Nichol
P F
PF
Black
R E
RE
Matlak
M E
ME
Hansen
K
K
Bolte
R G
RG
D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome