title: 17 degrees Celsius body temperature--resuscitation successful?
abstract: The resuscitation of patients with accidental profound hypothermia is challenging. A 17-year-old man got lost on the first of January, after a New Year's Eve party in the foothills of the Alps. After a search of four hours, he was found unconscious with fixed pupils, a Glasgow Coma Scale of three points, and a body temperature below 20° Celsius. There were no signs for traumatic injuries. Initial electrocardiogram (ECG) showed no heart activity. Basic life support was begun by the mountain rescue service and continued by the medical helicopter team. The patient was transferred under continuous cardiac massage, airway management with intubation and intravenous line via external jugular vein by helicopter to the nearest hospital for analysis of serum potassium. Body temperature was 17°C measured by urinary bladder electronic thermometer. The serum potassium was 7.55 mmol/L, therefore the patient was transferred by helicopter to the next cardiovascular center for rewarming with extracorporal circulation (ECC). Under the rewarming process with ECC, the heart activity restarted at 25°C with external defibrillation. The patient was rewarmed to 37.2°C after four hours of ECC. Cerebral CT scans after 24 h and 48 h revealed no significant hypoxia and after extubation the early rehabilitation process started. After six weeks, the patient regained the ability to walk and started to communicate on a basic level. After 54 days the patient presented signs of septic shock. After initial stabilization and CT diagnostic, a laparotomy was performed. The intraoperative finding was a total necrosis of the small bowel and colon. The patient died on the same day. Post mortem examination showed a necrotizing enterocolitis with transmural necrosis of the bowel. Survivors of uncontrolled profound hypothermia below 20°C core temperature are rare. The epicrisis is often prolonged by complications of different causes. The present case reports a necrotizing enterocolitis with a non-occlusive mesenteric ischemia (NOMI) as a medium-term complication of profound hypothermia.
authors.affiliation: Trauma Center Murnau, Prof. Küntscherstrasse 8, Murnau, Germany. shungerer@bgu–murnau.de
authors.forename: Sven
authors.initials: S
authors.lastname: Hungerer
authors.forename: Michael
authors.initials: M
authors.lastname: Ebenhoch
authors.forename: Volker
authors.initials: V
authors.lastname: Bühren
mesh_terms: D000293:Adolescent; D017732:Air Ambulances; D004562:Electrocardiography; D020345:Enterocolitis, Necrotizing / Q000209:etiology*; D017809:Fatal Outcome; D015600:Glasgow Coma Scale; D006336:Heart Massage; D006801:Humans; D007035:Hypothermia / Q000150:complications* / Q000628:therapy; D007511:Ischemia / Q000209:etiology; D008020:Life Support Care; D008297:Male; D011188:Potassium / Q000097:blood; D017694:Rewarming; D012772:Shock, Septic / Q000209:etiology; D013152:Splanchnic Circulation
chemical_list: D011188:Potassium