title: New diastolic cardiomyopathy in patients with severe accidental hypothermia after ECMO rewarming: a case-series observational study.
abstract: BACKGROUND
  Accidental hypothermia is a condition associated with significant morbidity and mortality. Hypothermia has been reported to affect left ventricular systolic and diastolic function. However, most of the data come from animal experimental studies.
  
  
  OBJECTIVE
  The purpose of the present study was to assess the impact of severe accidental hypothermia on systolic and diastolic ventricular function in patients treated using veno-arterial extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  We prospectively assessed nine hypothermic patients (8 male, age 25-78 years) who were transferred to the Severe Accidental Hypothermia Center and treated with ECMO. Transthoracic echocardiography was performed on admission (in patients without cardiac arrest) and on discharge from ICU after achieving cardiovascular stability. Cardiorespiratory stability and full neurologic recovery was achieved in all patients.
  
  
  RESULTS
  Biomarkers of myocardial damage (CK, CKMB, hsTnT) were significantly elevated in all study patients. Admission echocardiography performed in patients in sinus rhythm, revealed moderate-severe bi-ventricular systolic dysfunction and moderate bi-ventricular diastolic dysfunction. Discharge echocardiography showed persistent mild bi-ventricular diastolic dysfunction, although systolic function of both ventricles returned to normal. Discharge echocardiography in patients admitted with cardiac arrest showed normal (5 patients) or moderately impaired (1 patient) global LV systolic function on discharge. However, mild or moderate LV diastolic dysfunction was observed in all 6 patients. Discharge RV systolic function was normal, whereas mild RV diastolic dysfunction was present in these patients.
  
  
  CONCLUSIONS
  After severe accidental hypothermia bi-ventricular diastolic dysfunction persists despite systolic function recovery in survivors treated with ECMO.
authors.affiliation: Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland. tomekdarocha@wp.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Darocha
authors.affiliation: Department of Interventional Cardiology, The John Paul II Hospital, Pradnicka 80, 31 202, Cracow, Poland. dorotasobczyk@yahoo.com.
authors.forename: Dorota
authors.initials: D
authors.lastname: Sobczyk
authors.affiliation: Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland. kosa@mp.pl.|Tatra Mountain Rescue Service, Zakopane, Poland. kosa@mp.pl.
authors.forename: Sylweriusz
authors.initials: S
authors.lastname: Kosiński
authors.affiliation: Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland. mikaczuuu@hotmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Jarosz
authors.affiliation: Department of Emergency Medical Services, Medical University of Warsaw, Polish Medical Air Rescue, Warsaw, Poland. r.galazkowski@lpr.com.pl.
authors.forename: Robert
authors.initials: R
authors.lastname: Gałązkowski
authors.affiliation: Department of Interventional Cardiology, The John Paul II Hospital, Pradnicka 80, 31 202, Cracow, Poland. krzysztofnycz@yahoo.com.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Nycz
authors.affiliation: Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland. r.drwila@szpitaljp2.krakow.pl.
authors.forename: Rafał
authors.initials: R
authors.lastname: Drwiła
mesh_terms: D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000209:etiology*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017694:Rewarming / Q000009:adverse effects*; D013318:Stroke Volume; D014463:Ultrasonography