Open Access Emergency Medicine (Nov 2020)
Case of Severe Accidental Hypothermia Cardiac Arrest in a Subtropical Climate and Review of Management
Abstract
Terence Chau, 1,* Merlyn Joseph, 2,* Jesus Ledesma Jr, 3 David Wei Hau Hsu 3 1Department of Pharmacy, Cooper University Hospital, Camden, NJ, 08103, USA; 2Texas A&M University, Irma Lerma Rangel College of Pharmacy, Houston, TX 77030, USA; 3Emergency Department, Memorial Hermann Memorial City Medical Center, Houston, TX, 77024, USA*These authors contributed equally to this workCorrespondence: Terence ChauCooper University Hospital, One Cooper Plaza, Camden, NJ 08103, USATel +1 856 342 2975Fax +1 856 968 8408Email [email protected]: A patient was brought to the hospital with severe accidental hypothermia due to cold exposure associated with acute alcohol intoxication. Initial bladder core temperature was 21°C (70°F). The patient was agitated and combative with altered mental status and suffered rescue collapse during transport. Initial rhythm was ventricular fibrillation and we initiated a standard advanced cardiac life support (ACLS) protocol with rewarming measures. The patient received 28 mg of epinephrine and 13 shocks. Active and passive rewarming were initiated without extracorporeal rewarming. The patient achieved return of spontaneous circulation (ROSC) at a core temperature of 23.8°C (74.8°F). Patient was discharged 15 days later neurologically intact with no organ damage. The clinical management and implications for further research in severe accidental hypothermia management are discussed. In patients with severe accidental hypothermia (defined as < 30°C or < 86°F) in cardiac arrest, the optimal rewarming technique, use of epinephrine, and time when defibrillation should be attempted remain controversial. In our patient, the patient achieved ROSC in less than 2 hours with standard ACLS procedures despite a minimal increase in core temperature (21°C to 23.8°C or 70°F to 73.9°F).Keywords: accidental severe hypothermia, cardiac arrest, ACLS
