title: Extracorporeal-assisted rewarming in the management of accidental deep hypothermic cardiac arrest: a systematic review of the literature.
abstract: A systematic review of the literature surrounding the use of Extra-Corporeal Assisted Rewarming (ECAR) in patients presenting with deep hypothermia or hypothermic cardiac arrest was undertaken using a structured protocol. Thirty-one papers were deemed suitable for review, 13 of these were of sufficient quality to permit systematic data analysis. The primary outcome measure was survival to hospital discharge. The secondary outcome measure was functional neurological status at last follow-up. Analysis revealed a 67.7% survival to discharge and a 61.5% rate of good neurological recovery for patients presenting with pure hypothermic cardiac arrest. This was in marked contrast to a 23.4% survival and a 9.4% rate of good neurological outcome in those presenting with a mixed hypoxic/hypothermic arrest. Other data revealed a survival benefit for patients presenting with deep hypothermia without cardiac arrest treated with ECAR compared to those treated with conventional rewarming techniques. Hypoxic arrest, serum potassium > 10 mmol/L and presenting rhythm of asystole were found likely be significant predictors of poor outcome. Innovative reperfusion and rewarming strategies are also reviewed.
authors.affiliation: Dept of Cardiothoracic Surgery, Royal Perth Hospital, Wellington St, Perth WA 6011, Australia. Electronic address: Bdunne14784@gmail.com.
authors.forename: Ben
authors.initials: B
authors.lastname: Dunne
authors.affiliation: Dept of Cardiothoracic Surgery, Royal Perth Hospital, Wellington St, Perth WA 6011, Australia.
authors.forename: Erasmia
authors.initials: E
authors.lastname: Christou
authors.affiliation: Dept of Intensive Care, Royal Perth Hospital, Wellington St, Perth WA 6011, Australia.
authors.forename: Oonagh
authors.initials: O
authors.lastname: Duff
authors.affiliation: Dept of Cardiothoracic Surgery, Royal Perth Hospital, Wellington St, Perth WA 6011, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Merry
mesh_terms: D018572:Disease-Free Survival; D005112:Extracorporeal Circulation / Q000379:methods*; D006324:Heart Arrest, Induced / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007035:Hypothermia / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D017694:Rewarming / Q000379:methods*; D015996:Survival Rate
keywords: Cardiac arrest; ECMO; Extra Corporeal Membrane Oxygenation; Extra-Corporeal Assisted Rewarming; Hypothermia