Department of Acute Medicine, Division of Anaesthesiology, University Hospitals Geneva, 1205 Geneva, Switzerland.
Department of Anaesthesiology, Centre Hospitalier University Vaudois, 1011 Lausanne, Switzerland.
Int J Environ Res Public Health. 2022 Mar 29;19(7):4059. doi: 10.3390/ijerph19074059.
The aim of our study is to investigate successful pre-rewarming resuscitation after hypothermic cardiac arrest (HCA). The hypothermic heart may be insensitive to defibrillation when core temperature is below 30 °C and after successful defibrillation, sinus rhythm often returns into ventricular fibrillation. Recurrent defibrillation attempts may induce myocardial injury. Discrepancy exists concerning pre-rewarming defibrillation between the guidelines of the European Resuscitation Council and American Heart Association. The International Hypothermia Registry (IHR) gathers hypothermia cases. The primary outcome was survival. Secondary outcomes were the characteristics of defibrillation, the effect of Adrenaline administration under 30 °C, and the duration of CPR. Of the 239 patients, eighty-eight were in cardiac arrest at arrival of the rescue team. Successful pre-rewarming resuscitation was obtained in 14 patients. The outcome showed: seven deaths, one vegetative state, two patients with reversible damage, and four patients with full recovery. A total of five patients had a shockable rhythm, and defibrillation was successful in four patients. The response rate to Adrenaline was reported as normal in six patients. There were no statistically significant differences in the presence of a shockable rhythm, the success of defibrillation, and the effect on Adrenaline administration between the survivors and non-survivors. Successful resuscitation in severe hypothermia is possible before active rewarming and arrival in the hospital, thus improving the chance of survival.
我们的研究目的是调查低温心脏骤停（HCA）后成功的预复温复苏。当核心温度低于 30°C 时，低温心脏对除颤可能不敏感，并且除颤成功后，窦性心律通常会恢复为心室颤动。反复除颤尝试可能会导致心肌损伤。欧洲复苏委员会和美国心脏协会的指南在预复温除颤方面存在差异。国际低温登记处（IHR）收集低温病例。主要结局是生存。次要结局是除颤的特征、30°C 以下肾上腺素的给药效果以及 CPR 的持续时间。在 239 名患者中，88 名在救援团队到达时处于心脏骤停状态。14 名患者成功进行了预复温复苏。结果显示：7 人死亡，1 人处于植物人状态，2 人有可逆性损伤，4 人完全康复。共有 5 名患者出现可电击节律，其中 4 名患者除颤成功。报告称，6 名患者的肾上腺素反应正常。在幸存者和非幸存者之间，可电击节律的存在、除颤的成功率和肾上腺素给药的效果没有统计学上的显著差异。在积极复温并到达医院之前，严重低温症患者的复苏是可能的，从而提高了生存机会。
