Wickstrom P, Ruiz E, Lija G P, Hinterkopf J P, Haglin J J
Am J Surg. 1976 May;131(5):622-5. doi: 10.1016/0002-9610(76)90029-5.
Three patients with profound hypothermia were treated by rewarming on partial bypass. Two surivived and have normal mental and metabolic functions. The resuscitation of the hypothermic patient should be approached with enthusiasm since the outcome is often much better than expected from initial vital signs and neurologic examination. To avoid ventricular fibrillation the patient should be handled gently and an effort should be made to keep the patient well oxygenated and the pH normal. Blood gases should be measured often and corrected for temperature. The potassium concentration and hydration status of the patient should also be monitored closely. The rewarming of profoundly hypothermic patients can readily be accomplished with a pump oxygenator and heat exchanger. The indications for this method are not established from our small experience and the few cases reported in the literature. Certainly ventricular fibrillation is a compelling indication. Patients with frozen extremities might also benefit from this method since theoretically tissue salvage would be increased. Finally, those patients who do not respond rapidly to external rewarming may be at less risk of ventricular fibrillation if rewarmed on bypass.
三名深度低温患者通过部分体外循环复温进行治疗。两名患者存活，精神和代谢功能正常。对于低温患者的复苏应积极进行，因为其结果往往比根据初始生命体征和神经系统检查预期的要好得多。为避免心室颤动，应轻柔地处理患者，并努力使患者保持良好的氧合状态和正常的pH值。应经常测量血气并根据体温进行校正。还应密切监测患者的钾浓度和水合状态。使用泵氧合器和热交换器可以很容易地实现深度低温患者的复温。根据我们的少量经验和文献中报道的少数病例，这种方法的适应证尚未确立。当然，心室颤动是一个令人信服的适应证。肢体冻伤的患者也可能从这种方法中受益，因为从理论上讲可以增加组织挽救。最后，那些对外周复温反应不迅速的患者，如果在体外循环下复温，发生心室颤动的风险可能较小。
