Evans Stuart
West Midlands Ambulance Service University NHS Foundation Trust.
Br Paramed J. 2023 Mar 1;7(4):46-50. doi: 10.29045/14784726.2023.3.7.4.46.
Hypothermia is an uncommon cause of cardiac arrest in the United Kingdom, and more commonly occurs in countries experiencing avalanches and significant winter climates; however, this case demonstrates that the presentation occur in the United Kingdom. This case adds to a body of evidence that prolonged resuscitation can be successful in patients suffering a cardiac arrest secondary to hypothermia, leading to a good neurological outcome.
The patient suffered a witnessed out-of-hospital cardiac arrest following rescue from a free-flowing river, and underwent prolonged resuscitation. The patient presented in persistent ventricular fibrillation, unresponsive to defibrillation attempts. An oesophageal probe recorded the patient's temperature as 24°C. Rescuers were guided by the Resuscitation Council UK advanced life support algorithm to withhold drug therapy and limit defibrillation attempts to three, until the patient had been rewarmed to above 30°C. Appropriate triage of the patient to an extracorporeal life support (ECLS) capable centre allowed specialised treatment to be initiated, and culminated in successful resuscitation once normothermia was restored. After a short stay in intensive care, the patient was discharged for rehabilitation due to a hypoxic spinal cord injury before discharge home.
This case highlights that hypothermia is a reversible cause of cardiac arrest, which needs to be recognised and acted upon appropriately to provide the best possible chance for a positive outcome. Low-reading thermometers capable of identifying the temperature thresholds stated in the Resuscitation Council UK guidelines are required, to allow clinicians to adapt their practice according to the presenting situation. Tympanic thermometers are often limited to their lowest recordable temperature, and invasive monitoring such as oesophageal or rectal probes are not common in UK ambulance service practice. With the necessary equipment, patients can be triaged to an ECLS-capable centre, allowing them to receive the specialist rewarming that they require.
在英国，体温过低是心脏骤停的罕见原因，更常见于经历雪崩和严寒冬季气候的国家；然而，本病例表明这种情况在英国也会出现。该病例补充了一系列证据，即对于因体温过低继发心脏骤停的患者，延长复苏时间可能成功，并带来良好的神经学预后。
患者从一条水流湍急的河中获救后，在院外发生心脏骤停，并接受了长时间复苏。患者呈现持续性室颤，对除颤尝试无反应。一根食管探头记录患者体温为24°C。救援人员遵循英国复苏委员会高级生命支持算法，在患者体温回升至30°C以上之前，暂停药物治疗并将除颤尝试限制在三次。将患者合理分诊至具备体外生命支持（ECLS）能力的中心，从而能够启动专门治疗，一旦恢复正常体温，最终成功复苏。在重症监护病房短暂停留后，患者因缺氧性脊髓损伤在出院前被转至康复机构。
本病例强调体温过低是心脏骤停的一个可逆转原因，需要予以识别并采取适当行动，以提供获得良好预后的最佳机会。需要能够识别英国复苏委员会指南中所述温度阈值的低读数温度计，以便临床医生根据具体情况调整治疗方法。鼓膜温度计通常限于其可记录的最低温度，而诸如食管或直肠探头等侵入性监测在英国救护车服务实践中并不常见。有了必要的设备，患者可以被分诊至具备ECLS能力的中心，使其能够接受所需的专业复温治疗。
