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Extracorporeal Rewarming Is Associated With Increased Survival Rate in Severely Hypothermic Patients With Preserved Spontaneous Circulation
P. Podsiadło, A. Smoleń, T. Brožek, S. Kosiński, M. Balik, H. Hymczak, E. Cools, B. Walpoth, E. Nowak, W. Dąbrowski, B. Miazgowski, A. Witt-Majchrzak, T. Jędrzejczak, K. Reszka, N. Segond, G. Debaty, M. Dudek, S. Górski, T. Darocha
Language English Country United States
Document type Review, Journal Article
- MeSH
- Adult MeSH
- Hypothermia * therapy MeSH
- Humans MeSH
- Extracorporeal Circulation adverse effects MeSH
- Survival Rate MeSH
- Multicenter Studies as Topic MeSH
- Cold Temperature MeSH
- Retrospective Studies MeSH
- Rewarming adverse effects methods MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Treatment recommendations for rewarming patients in severe accidental hypothermia with preserved spontaneous circulation have a weak evidence due to the absence of randomized clinical trials. We aimed to compare the outcomes of extracorporeal versus less-invasive rewarming of severely hypothermic patients with preserved spontaneous circulation. We conducted a multicenter retrospective study. The patient population was compiled based on data from the HELP Registry, the International Hypothermia Registry, and a literature review. Adult patients with a core temperature <28°C and preserved spontaneous circulation were included. Patients who underwent extracorporeal rewarming were compared with patients rewarmed with less-invasive methods, using a matched-pair analysis. The study population consisted of 50 patients rewarmed extracorporeally and 85 patients rewarmed with other, less-invasive methods. Variables significantly associated with survival included: lower age; outdoor cooling circumstances; higher blood pressure; higher PaCO 2 ; higher BE; higher HCO 3 ; and the absence of comorbidities. The survival rate was higher in patients rewarmed extracorporeally ( p = 0.049). The relative risk of death was twice as high in patients rewarmed less invasively. Based on our data, we conclude that patients in severe accidental hypothermia with circulatory instability can benefit from extracorporeal rewarming without an increased risk of complications.
Department of Acute Medicine Division of Anaesthesiology University Hospitals Geneva Switzerland
Department of Anaesthesiology and Intensive Care Medical University of Lublin Poland
Department of Anaesthesiology and Intensive Care Medical University of Silesia Katowice Poland
Department of Anaesthesiology and Intensive Care University Hospital Łódź Poland
Department of Cardiac Surgery Provincial Specialist Hospital Olsztyn Poland
Department of Cardiosurgery Pomeranian Medical University in Szczecin Poland
Department of Emergency Medicine Faculty of Health Sciences University of Bielsko Biała Poland
Department of Epidemiology and Clinical Research Methodology Medical University of Lublin Poland
Department of Medical Education Jagiellonian University Medical College Kraków Poland
Emergency Department University Hospital Pomeranian Medical University Szczecin Poland
Emeritus Department of Cardiovascular Surgery University Hospitals of Geneva Switzerland
Faculty of Health Sciences Jagiellonian University Medical College Kraków Poland
Faculty of Medicine and Health Sciences Andrzej Frycz Modrzewski Kraków University Kraków Poland
From the Department of Emergency Medicine Jan Kochanowski University Kielce Poland
Institute of Health Sciences Jan Kochanowski University Kielce Poland
Univ Grenoble Alpes CNRS UMR 5525 VetAgro Sup Grenoble INP CHU Grenoble Alpes TIMC Grenoble France
References provided by Crossref.org
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- $a Treatment recommendations for rewarming patients in severe accidental hypothermia with preserved spontaneous circulation have a weak evidence due to the absence of randomized clinical trials. We aimed to compare the outcomes of extracorporeal versus less-invasive rewarming of severely hypothermic patients with preserved spontaneous circulation. We conducted a multicenter retrospective study. The patient population was compiled based on data from the HELP Registry, the International Hypothermia Registry, and a literature review. Adult patients with a core temperature <28°C and preserved spontaneous circulation were included. Patients who underwent extracorporeal rewarming were compared with patients rewarmed with less-invasive methods, using a matched-pair analysis. The study population consisted of 50 patients rewarmed extracorporeally and 85 patients rewarmed with other, less-invasive methods. Variables significantly associated with survival included: lower age; outdoor cooling circumstances; higher blood pressure; higher PaCO 2 ; higher BE; higher HCO 3 ; and the absence of comorbidities. The survival rate was higher in patients rewarmed extracorporeally ( p = 0.049). The relative risk of death was twice as high in patients rewarmed less invasively. Based on our data, we conclude that patients in severe accidental hypothermia with circulatory instability can benefit from extracorporeal rewarming without an increased risk of complications.
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