Outcome of drowned hypothermic children with cardiac arrest treated with cardiopulmonary bypass.
BACKGROUND
There is a lack of data on the outcome of cardiopulmonary bypass (CPB) rewarming of hypothermic children with cardiac arrest following drowning.


OBJECTIVE
To retrospectively analyze single-center outcome of drowning victims treated with CPB.


METHODS
This retrospective study included all hypothermic drowning victims admitted to the Hospital for Children and Adolescents with attempted resuscitation on CPB between 1994 and 2008 inclusive. Median sternotomy and cannulation of the ascending aorta and the right atrium for CPB were performed on all victims.


RESULTS
Nine hypothermic drowning victims, comprising five boys and four girls, with a median age of 3.8 years (range, 1.5-10 years). The median submersion time was 38 min (range, 5-75 min) and the median water temperature was 6.5 °C (range, 0.2-16.5 °C). The median core temperature was 21.9 °C (range 17.7-32.8 °C) at arrival to the hospital. All nine children were able to be weaned from CPB. Only one child, with mild to moderate neurological deficit, became a long-term survivor. She was slowly rewarmed up to 33 °C with CPB and kept in mild hypothermia for 48 h.


CONCLUSIONS
Large numbers of submerged children can be primarily resuscitated with CPB. Unfortunately, many of them will decease from severe hypoxic brain injury. Slow rewarming with CPB may improve the likelihood of a better neurological outcome.
Suominen
P K
PK
Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland.
Vallila
N H
NH
Hartikainen
L M
LM
Sairanen
H I
HI
Korpela
R E
RE
D022561:Advanced Cardiac Life Support; D001831:Body Temperature; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000150:complications / Q000628:therapy*; D007036:Hypothermia, Induced; D002534:Hypoxia, Brain / Q000209:etiology; D007223:Infant; D008297:Male; D015701:Near Drowning / Q000628:therapy*; D009422:Nervous System Diseases / Q000209:etiology; D012151:Resuscitation; D016414:Resuscitation Orders; D012189:Retrospective Studies; D017694:Rewarming / Q000379:methods*; D013696:Temperature