title: Extracorporeal Life Support for Refractory Cardiac Arrest from Accidental Hypothermia: A 10-Year Experience in Edinburgh.
abstract: BACKGROUND
  Cardiac arrest caused by accidental hypothermia is a rare phenomenon with a significant mortality rate if untreated. The consensus is that these patients should be rewarmed with extracorporeal life support (ECLS) with the potential for excellent survival and neurologic outcomes. However, given the lack of robust data and clinical trials, the optimal management of such patients remains elusive.
  
  
  OBJECTIVE
  In this single-center study, we looked at the outcomes of all adult patients undergoing salvage ECLS for cardiac arrest caused by accidental hypothermia over a 10-year period from June 2006 to June 2016.
  
  
  METHODS
  These data were obtained from the Royal Infirmary of Edinburgh cardiothoracic surgery database. The patients' hard copy case notes, TrakCare (InterSystems Corp, Cambridge, MA), picture archiving and communications system (PACS), and WardWatcher databases were used to cross-check the accuracy of the acquired data.
  
  
  RESULTS
  Eleven patients met the inclusion criteria. The etiology of hypothermia was exposure to cold air (64%) and cold water immersion (36%). Two (18%) were treated with extracorporeal membrane oxygenation and the rest with cardiopulmonary bypass. The mean age was 51 years (range 32-73), and the mean core body temperature on admission was 20.6°C (range <18-24°C). The overall survival rate to hospital discharge was 72%, with 75% of survivors having no chronic neurologic impairment.
  
  
  CONCLUSIONS
  Our case series shows the remarkable salvageability of patients suffering prolonged cardiac arrest caused by accidental hypothermia, particularly in the absence of asphyxia, trauma, or severe hyperkalemia. ECLS is a safe and effective rewarming treatment and should be used to aggressively manage this patient group.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Maziar
authors.initials: M
authors.lastname: Khorsandi
authors.affiliation: Department of Internal Medicine, Belau National Hospital, Koror, Republic of Palau.
authors.forename: Scott
authors.initials: S
authors.lastname: Dougherty
authors.affiliation: Department of Critical Care Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Young
authors.affiliation: Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Dean
authors.initials: D
authors.lastname: Kerslake
authors.affiliation: Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Giordano
authors.affiliation: Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Lendrum
authors.affiliation: Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Walker
authors.affiliation: Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Vipin
authors.initials: V
authors.lastname: Zamvar
authors.affiliation: Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Ivan
authors.initials: I
authors.lastname: Yim
authors.affiliation: Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Renzo
authors.initials: R
authors.lastname: Pessotto
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000150:complications / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017694:Rewarming / Q000379:methods / Q000706:statistics & numerical data; D012606:Scotland / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
keywords: extracorporeal membrane oxygenation; heart arrest; hypothermia