Department of Anesthesiology and Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark.
Resuscitation. 2012 Sep;83(9):1078-84. doi: 10.1016/j.resuscitation.2012.05.009. Epub 2012 May 24.
Resuscitation guidelines for the treatment of accidental hypothermia are based primarily on isolated cases. Mortality rates are high despite aggressive treatment aimed at restoring spontaneous circulation and normothermia.
The present report is based on a boating accident where 15 healthy subjects (median age 16 (range 15-45) years) were immersed in 2 °C salt water. Seven victims were recovered in circulatory arrest with a median temperature of 18.4 °C (range 15.5-20.2 °C). They were all rewarmed with extracorporeal membrane oxygenation (ECMO) and were subsequently evaluated with advanced neuroradiological and functional testing. The remaining 7 had established spontaneous circulation without the use of ECMO. One victim drowned in the accident.
The victims that survived the accident without circulatory arrest were predominantly females with a higher body mass index. Victims with circulatory arrest pH on arrival was a median of 6.61 (range 6.43-6.94), with ECMO being established a median of 226 (178-241)min after the accident. Magnetic resonance spectroscopy showed neuronal dysfunction in five. In five victims initial normal white matter spectra progressed to show evidence of abnormal axonal membranes. Based on the seven-level Functional Independence Measure test functional outcome was good in six circulatory arrest victims and in all without circulatory arrest. Mild to moderate cognitive dysfunction was seen in six and severe dysfunction in one circulatory arrest victim.
Seven patients with profound accidental hypothermic circulatory arrest were successfully resuscitated using a management approach that included extracorporeal rewarming, followed by successive periods of therapeutic hypothermia and sedated normothermia and intensive neurorehabilitation. Seven other hypothermic victims (core temperature as low as 23 °C) that did not suffer circulatory arrest also survived the accident.
意外低温治疗的复苏指南主要基于孤立病例。尽管采取了积极的治疗措施来恢复自主循环和正常体温，但死亡率仍然很高。
本报告基于一起划船事故，15 名健康受试者（中位数年龄 16 岁（范围 15-45 岁））被浸入 2°C 的盐水中。7 名受害者因循环骤停而被恢复，体温中位数为 18.4°C（范围 15.5-20.2°C）。他们都接受了体外膜氧合（ECMO）复温，随后进行了高级神经影像学和功能测试评估。其余 7 名受害者在没有使用 ECMO 的情况下自主循环恢复。一名受害者在事故中溺水身亡。
没有循环骤停的事故幸存者主要是女性，体重指数较高。循环骤停时 pH 值中位数为 6.61（范围 6.43-6.94），事故发生后中位数 226 分钟（178-241 分钟）建立 ECMO。磁共振波谱显示五名患者存在神经元功能障碍。在五名患者中，最初正常的白质光谱进展为显示异常轴突膜的证据。根据七级功能独立性测量测试，六名循环骤停受害者的功能结果良好，所有无循环骤停的患者的功能结果也良好。六名循环骤停患者出现轻度至中度认知功能障碍，一名循环骤停患者出现严重认知功能障碍。
采用包括体外复温、随后进行治疗性低温和镇静性正常体温以及强化神经康复的管理方法，成功复苏了 7 名深度意外低温循环骤停患者。另外 7 名体温较低（核心温度低至 23°C）但未发生循环骤停的低温受害者也在事故中幸存。
