Successful recovery of severe hypothermia with minimally invasive central catheter.

BACKGROUND

Severe hypothermia can result in malignant arrhythmias or cardiac arrest and require invasive central rewarming modalities due to a core body temperature < 28 °C. Difficult rescue missions can make continuous CPR challenging, but the decrease in oxygen consumption at these low temperatures allows for successful recovery despite the delay. Although other active warming techniques, such as peritoneal lavage, intravascular warming catheter, and renal replacement therapy can be beneficial, the consensus statements recommend extracorporeal life support as the preferred rewarming method.

CASE PRESENTATION: A 42-year-old female was found in a pond after presumed exposure for 30-40 min with an outside temperature of 17 °F (-8 °C) and was found to be in ventricular fibrillation. ACLS protocol was then initiated. At the hospital, she was intubated and sedated with continuous CPR during multimodal rewarming, including active internal via the ZOLL Icy catheter. One hour after rewarming, with core temperature above 29 °C, she was defibrillated and achieved ROSC. As she continued to warm, she made purposeful movement and was warmed and maintained at euthermia. She was initiated on antibiotics due to aspiration concerns and titrated off vasopressors with extubation on day 2 of hospitalization. She had mild complaints of extremity numbness and chest pain from compressions prior to discharge on hospitalization day 4.

CONCLUSIONS

This case has a successful resuscitation of severe hypothermia associated with cardiac arrest. The patient was warmed at greater than 4 °C/h with a less invasive, quicker and potentially more available approach to warming. With equipment improvements, the ability to provide prolonged CPR while rewarming may suggest that transferring to an extracorporeal life support center is not necessary.