Hypothermic cardiac arrest rescued with cardiopulmonary bypass and decompressive laparotomy.

Hypothermic cardiac arrest is a relatively uncommon presentation to United States Emergency Departments. During 1979-2002, the Centers for Disease Control reported that an average of 689 deaths per year in the US were attributed to exposure to excessive natural cold. Severe hypothermia (<30°C) confers marked depression of critical metabolic and biochemical functions, but may also provide protection to the brain and other organs while resuscitation is undertaken. For all hypothermic patients, measures designed to prevent further heat loss and begin rewarming should be instituted, but should not delay routine Advanced Cardiac and Trauma Life Support procedures. Rewarming methods include passive rewarming (insulation, removal from environment), active external rewarming (heating blankets, radiant heat, warm water immersion), and active core rewarming (warm inhalation, warmed intravenous fluids, gastrointestinal irrigation, bladder irrigation, dialysis, thoracostomy lavage, and cardiopulmonary bypass).