Abstract
Abstract
Background
Accidental hypothermia designates an unintentional drop in body temperature below 35 °C. There is a major risk of ventricular fibrillation below 28 °C and cardiac arrest is almost inevitable below 24 °C. In such cases, conventional cardiopulmonary resuscitation is often inefficient. In urban areas with temperate climates, characterized by mild year-round temperatures, the outcome of patients with refractory hypothermic out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) remains uncertain.
Methods
We conducted a retrospective monocentric observational study involving patients admitted to a university hospital in Paris, France. We reviewed patients admitted between January 1, 2011 and April 30, 2022. The primary outcome was survival at 28 days with good neurological outcomes, defined as Cerebral Performance Category 1 or 2. We performed a subgroup analysis distinguishing hypothermic refractory OHCA as either asphyxic or non-asphyxic.
Results
A total of 36 patients were analysed, 15 of whom (42%) survived at 28 days, including 13 (36%) with good neurological outcomes. Within the asphyxic subgroup, only 1 (10%) patient survived at 28 days, with poor neurological outcomes. A low-flow time of less than 60 min was not significantly associated with good neurological outcomes (P = 0.25). Prehospital ECPR demonstrated no statistically significant difference in terms of survival with good neurological outcomes compared with inhospital ECPR (P = 0.55). Among patients treated with inhospital ECPR, the HOPE score predicted a 30% survival rate and the observed survival was 6/19 (32%).
Conclusion
Hypothermic refractory OHCA occurred even in urban areas with temperate climates, and survival with good neurological outcomes at 28 days stood at 36% for all patients treated with ECPR. We found no survivors with good neurological outcomes at 28 days in submersed patients.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine,Emergency Medicine
Reference30 articles.
1. Paal P, Brugger H, Strapazzon G. Accidental hypothermia. Handb Clin Neurol. 2018;157:547–63.
2. Paal P, Pasquier M, Darocha T, et al. Accidental hypothermia: 2021 update. Int J Environ Res Public Health. 2022;19:501.
3. Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021;161:152–219.
4. Working group of the French Language Resuscitation Society. Expert formalized recommendations on the management of cardiac arrest. French Language Resuscitation Society (FR). 2006. https://www.srlf.org/wpcontent/uploads/2015/12/2007_recommandations_formalisees_d_experts_arret_cardiaque_texte-court.pdf. Accessed 24 Feb 2023.
5. Pasquier M, Hugli O, Paal P, et al. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: the HOPE score. Resuscitation. 2018;126:58–64.