Prolonged and profound therapeutic hypothermia for the treatment of "brain death" after a suicidal intoxication. Challenging conventional wisdoms.
Therapeutic hypothermia has been reported to improve the neurologic outcome of comatose survivors of out-of-hospital cardiac arrest. The use of therapeutic hypothermia in patients who have had an acute ischemic-hypoxic brain injury after a suicidal intoxication has not been previously reported. We present the case of a young woman who presented comatose to our emergency department after attempting suicide by ingesting diazepam and a bottle of antifreeze (ethylene-glycol). Despite aggressive supportive care, the patient progressed to what appeared to be clinical brain death. At this point, the patient was managed with therapeutic hypothermia for 36 hours. The patient awoke within 48 hours of rewarming and made a complete and full neurologic recovery. In conclusion, this case has important implications in the management of patients who have had an acute ischemichypoxic brain injury. Inappropriately labeling such patients as "brain dead" will result in the failure to institute therapeutic hypothermia and other advanced neuroprotective interventions in patients who could be salvaged with a good neurologic outcome.
Marik
Paul E
PE
EVMS Internal Medicine, Norfolk, VA 2350, USA. paul@marikonline.org
Varon
Joseph
J
D000328:Adult; D001926:Brain Death; D003128:Coma / Q000139:chemically induced / Q000628:therapy; D003975:Diazepam / Q000506:poisoning*; D019855:Ethylene Glycol / Q000506:poisoning*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D006993:Hypnotics and Sedatives / Q000506:poisoning*; D013406:Suicide, Attempted
D006993:Hypnotics and Sedatives; D019855:Ethylene Glycol; D003975:Diazepam