Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Præstø Fjord boating accident.
BACKGROUND
Resuscitation guidelines for the treatment of accidental hypothermia are based primarily on isolated cases. Mortality rates are high despite aggressive treatment aimed at restoring spontaneous circulation and normothermia.


METHODS
The present report is based on a boating accident where 15 healthy subjects (median age 16 (range 15-45) years) were immersed in 2 °C salt water. Seven victims were recovered in circulatory arrest with a median temperature of 18.4 °C (range 15.5-20.2 °C). They were all rewarmed with extracorporeal membrane oxygenation (ECMO) and were subsequently evaluated with advanced neuroradiological and functional testing. The remaining 7 had established spontaneous circulation without the use of ECMO. One victim drowned in the accident.


RESULTS
The victims that survived the accident without circulatory arrest were predominantly females with a higher body mass index. Victims with circulatory arrest pH on arrival was a median of 6.61 (range 6.43-6.94), with ECMO being established a median of 226 (178-241)min after the accident. Magnetic resonance spectroscopy showed neuronal dysfunction in five. In five victims initial normal white matter spectra progressed to show evidence of abnormal axonal membranes. Based on the seven-level Functional Independence Measure test functional outcome was good in six circulatory arrest victims and in all without circulatory arrest. Mild to moderate cognitive dysfunction was seen in six and severe dysfunction in one circulatory arrest victim.


CONCLUSIONS
Seven patients with profound accidental hypothermic circulatory arrest were successfully resuscitated using a management approach that included extracorporeal rewarming, followed by successive periods of therapeutic hypothermia and sedated normothermia and intensive neurorehabilitation. Seven other hypothermic victims (core temperature as low as 23 °C) that did not suffer circulatory arrest also survived the accident.
Department of Anesthesiology and Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark.
Michael
M
Wanscher
Lisbeth
L
Agersnap
Jesper
J
Ravn
Stig
S
Yndgaard
Jørgen Feldbæk
JF
Nielsen
Else R
ER
Danielsen
Christian
C
Hassager
Bertil
B
Romner
Carsten
C
Thomsen
Steen
S
Barnung
Anne Grethe
AG
Lorentzen
Hans
H
Høgenhaven
Matthew
M
Davis
Jacob Eifer
JE
Møller
D000293:Adolescent; D000328:Adult; D003943:Diagnostic Techniques, Neurological; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012151:Resuscitation; D055815:Young Adult