title: Minimally invasive extracorporeal circulation resuscitation in hypothermic cardiac arrest.
abstract: Current guidelines for the treatment of hypothermic cardiocirculatory arrest recommend extracorporeal life support and rewarming, using cardiopulmonary bypass or extracorporeal membrane oxygenation circuits. Both have design-related shortcomings which may result in prolonged reperfusion time or insufficient oxygen delivery to vital organs. This article describes clear advantages of minimally invasive extracorporeal circulation systems during emergency extracorporeal life support in hypothermic arrest. The technique of minimally invasive extracorporeal circulation for reperfusion and rewarming is represented by the case of a 59-year-old patient in hypothermic cardiocirculatory arrest at 25.3°C core temperature, with multiple trauma. With femoro-femoral cannulation performed under sonographic and echocardiographic guidance, extracorporeal life support was initiated using a minimally invasive extracorporeal circulation system. Perfusing rhythm was restored at 28°C. During rewarming on the mobile circuit, trauma surveys were completed and the treatment initiated. Normothermic weaning was successful on the first attempt, trauma surgery was completed and the patient survived neurologically intact. For extracorporeal resuscitation from hypothermic arrest, minimally invasive extracorporeal circulation offers all the advantages of conventional cardiopulmonary bypass and extracorporeal membrane oxygenation systems without their shortcomings.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland bernhard.winkler@insel.ch.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Winkler
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Hans Jörg
authors.initials: HJ
authors.lastname: Jenni
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Erich
authors.initials: E
authors.lastname: Gygax
authors.affiliation: Department of Visceral- and Transplant Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Schnüriger
authors.affiliation: Department of Anesthesiology, University Hospital Berne, Berne, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Seidl
authors.affiliation: Department of Anesthesiology, University Hospital Berne, Berne, Switzerland.
authors.forename: Gabor
authors.initials: G
authors.lastname: Erdoes
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kadner
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Department of Anesthesiology, University Hospital Berne, Berne, Switzerland.
authors.forename: Balthasar
authors.initials: B
authors.lastname: Eberle
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000150:complications*; D008297:Male; D008875:Middle Aged
keywords: cardiopulmonary bypass; extracorporeal perfusion; hypothermia; resuscitation