title: Problems and Pitfalls of Qualification for Extracorporeal Rewarming in Severe Accidental Hypothermia.
abstract: OBJECTIVE
  When establishing the Severe Hypothermia Treatment Centre, certain problems and pitfalls regarding the qualification for extracorporeal rewarming were encountered. The authors shared their experience and opened a discussion with other centers that deal with severe, accidental hypothermia.
  
  
  METHODS
  Retrospective analysis of medical records of all patients examined by the hypothermia coordinator.
  
  
  METHODS
  Patients consulted and treated by the Severe Hypothermia Treatment Centre.
  
  
  METHODS
  Patients who underwent accidental hypothermia.
  
  
  METHODS
  From July 2013 until January 2016, hypothermia coordinators at the Severe Hypothermia Treatment Centre examined the cases of 152 hypothermic patients. Of those cases, 127 patients were subjected to noninvasive rewarming in referral hospitals and 25 were accepted to the center for extracorporeal rewarming.
  
  
  RESULTS
  Difficulties that deferred or delayed the implementation of extracorporeal membrane oxygen rewarming were identified and addressed, including low platelet/red blood count, intraperitoneal fluid of unknown origin, abnormal results of head computed tomography, extremes of age, bleeding from the external auditory meatus, inaccuracy of infrared-based thermometers, iatrogenic trauma to the femoral vessels, chronic/terminal comorbidities, poisonings, pregnancy, hypoglycemia, hemodynamic stability despite severe hypothermia, and decontamination protocol.
  
  
  CONCLUSIONS
  The problems discussed may delay the use of extracorporeal membrane oxygen rewarming in hypothermic patients but should not discourage medical teams from the implementation of extracorporeal rewarming. The prognosis for severe hypothermia is favorable, even with a long resuscitation time and low core temperatures.
authors.affiliation: Department of Anaesthesiology and Intensive Care, John Paul II Hospital, Collegium Medicum, Jagiellonian University, Krakow, Poland. Electronic address: Anna-jarosz@hotmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Jarosz
authors.affiliation: Department of Anaesthesiology and Intensive Care, Pulmonary Hospital and; Tatra Mountains Rescue Service, Zakopane, Poland.
authors.forename: Sylweriusz
authors.initials: S
authors.lastname: Kosiński
authors.affiliation: Department of Anaesthesiology and Intensive Care, John Paul II Hospital, Collegium Medicum, Jagiellonian University, Krakow, Poland; Polish Medical Air Rescue and.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Darocha
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria; Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, United Kingdom; International Commission for Mountain Emergency Medicine (ICAR MEDCOM).
authors.forename: Peter
authors.initials: P
authors.lastname: Paal
authors.affiliation: Polish Medical Air Rescue and; Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Gałązkowski
authors.affiliation: Department of Anaesthesiology and Intensive Care, John Paul II Hospital, Collegium Medicum, Jagiellonian University, Krakow, Poland.
authors.forename: Hubert
authors.initials: H
authors.lastname: Hymczak
authors.affiliation: Department of Anaesthesiology and Intensive Care, John Paul II Hospital, Collegium Medicum, Jagiellonian University, Krakow, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Drwiła
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D017694:Rewarming / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: advanced cardiac life support; cardiac arrest; cardiopulmonary resuscitation; extracorporeal life support; hypothermia; rewarming