Vretenar D F, Urschel J D, Parrott J C, Unruh H W
Department of Surgery, University of Alberta, Edmonton, Canada.
Ann Thorac Surg. 1994 Sep;58(3):895-8. doi: 10.1016/0003-4975(94)90784-6.
Many victims of accidental hypothermia have been successfully resuscitated with cardiopulmonary bypass, but questions remain regarding treatment indications and efficacy. To assess the role of cardiopulmonary bypass in resuscitation from hypothermia, a collective literature review was performed. Data on 68 hypothermic patients resuscitated with cardiopulmonary bypass were analyzed. Impairment from alcohol, drug abuse, or mental illness was the most common predisposing factor for accidental hypothermia. Mean initial core temperature was 21 degrees C. Sixty-one patients (90%) were in cardiac arrest. Femoral-femoral bypass was used in 72% of patients. Overall survival was 60%. Eighty percent of survivors returned to their previous level of function. Sixty-seven percent of nonsurvivors died because of inability to establish a cardiac rhythm or wean from bypass. Patient age, type of cardiopulmonary bypass (femoral-femoral or atrial-aortic), and initial core temperature were not significant prognostic indicators. There were no survivors among the 6 patients with a core temperature less than 15 degrees C. Patients in cardiac arrest had a higher mortality than patients who were not (p = 0.02). Climbing and avalanche victims had a higher mortality than other hypothermic patients (p = 0.003). The possibility of publication bias must be considered before firm conclusions can be drawn from this collective literature review. Controlled studies comparing the efficacy of cardiopulmonary bypass and alternative warming techniques have not been done. Nevertheless, cardiopulmonary bypass has several advantages over other warming methods for profoundly hypothermic patients. Tissue perfusion and oxygenation are maintained while rapid warming occurs. Cardiopulmonary bypass resuscitation is recommended for hypothermic patients in arrest and for patients with core temperatures lower than 25 degrees C, irrespective of rhythm. Patients in stable condition with temperatures between 25 degrees and 28 degrees C can be treated with cardiopulmonary bypass or conventional warming methods.
许多意外低温症患者通过体外循环成功复苏，但在治疗指征和疗效方面仍存在问题。为评估体外循环在低温复苏中的作用，进行了一项综合文献回顾。分析了68例通过体外循环复苏的低温患者的数据。酒精、药物滥用或精神疾病导致的损害是意外低温症最常见的诱发因素。平均初始核心体温为21摄氏度。61例患者（90%）发生心脏骤停。72%的患者使用股-股旁路。总体生存率为60%。80%的幸存者恢复到了之前的功能水平。67%的非幸存者因无法建立心律或脱离旁路而死亡。患者年龄、体外循环类型（股-股或心房-主动脉）和初始核心体温不是显著的预后指标。6例核心体温低于15摄氏度的患者无一存活。心脏骤停患者的死亡率高于未发生心脏骤停的患者（p = 0.02）。登山和雪崩受害者的死亡率高于其他低温患者（p = 0.003）。在从这一综合文献回顾得出确凿结论之前，必须考虑发表偏倚的可能性。尚未进行比较体外循环和其他升温技术疗效的对照研究。然而，对于深度低温患者，体外循环比其他升温方法有几个优点。在快速升温的同时维持组织灌注和氧合。建议对心脏骤停的低温患者以及核心体温低于25摄氏度的患者进行体外循环复苏，无论其心律如何。体温在25至28摄氏度之间且病情稳定的患者可用体外循环或传统升温方法治疗。
