Advanced cardiac life support and defibrillation in severe hypothermic cardiac arrest.
The application of Advanced Cardiac Life Support (ACLS) in severe hypothermic cardiac arrest remains controversial. While the induction of mild hypothermia has been shown to improve outcomes in patients already resuscitated from cardiac arrest, it is unknown whether ACLS protocols are effective during the resuscitation of the severely hypothermic cardiac arrest patient. We describe a case of a 47-year-old man who was successfully resuscitated from a ventricular fibrillation (VF) arrest with a core body temperature of 26.4 degrees C. The patient had been found unresponsive in a bathtub of cold water following an apparent suicide attempt. An incorrect pronouncement of death by the fire department delayed his transport to the hospital by more than four hours. Once in the emergency department (ED), the patient sustained a VF cardiac arrest and was successfully defibrillated using ACLS protocols. He ultimately survived his hospitalization with near-complete neurologic recovery. In this case report, we discuss the application of ACLS to the resuscitation of the hypothermic cardiac arrest patient as well as the issues involved in the prehospital determination of death.
Lee
Christopher H
CH
Yale-New Haven Medical Center, Emergency Medicine Residency Program, New Haven, Connecticut 06519, USA. c.lee@yale.edu
Van Gelder
Carin
C
Burns
Kevin
K
Cone
David C
DC
D022561:Advanced Cardiac Life Support / Q000379:methods*; D004554:Electric Countershock; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D017694:Rewarming; D013406:Suicide, Attempted; D014693:Ventricular Fibrillation / Q000628:therapy*