Article Text

PDF

Bypass or external rewarming after hypothermic cardiac arrest
  1. Claudia Webster-Smith,
  2. Angaj Ghosh
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M139WL, UK

    Statistics from Altmetric.com

    Report by Claudia Webster-Smith, Medical Student Search checked by Angaj Ghosh, Senior Clinical Fellow

    Clinical scenario

    A 24 year old woman is brought into the emergency department having fallen into a frozen lake. Passers by heard her cries for help and alerted the emergency services who rescued her 15 minutes later. On the way to hospital she suffered a cardiac arrest. Her core temperature on arrival is 25 degrees centigrade. You know that she needs rewarming but wonder whether her eventual outcome will be improved by cardiopulmonary bypass rather than external rewarming.

    Three part question

    In [severely hypothermic patients who have suffered cardiac arrest] is [core rewarming by cardiopulmonary bypass better than external rewarming] at [re-establishing spontaneous circulation and leading to eventual discharge]?

    Search strategy

    Medline 1966–09/00 using the OVID interface. ([exp heart arrest OR cardiac arrest.mp] AND [exp hypothermia OR hypothermia.mp OR hypothermic.mp OR exp body temperature] AND [exp heat OR exp heating OR exp rewarming OR warming.mp OR rewarming.mp]) LIMIT to human AND english.

    Search outcome

    Altogether 114 papers found of which 111 were irrelevant or of insufficient quality. The remaining three papers are shown in table 2.

    Table 2

    Comments

    None of the studies directly answer the question. It seems that there is a significant functional recovery after severe hypothermic cardiac arrest, and cardiopulmonary bypass seems to be an efficacious treatment. The number of patients treated by external rewarming is very small and more work will be needed before this can be recommended in preference to bypass.

    Clinical bottom line

    In severely hypothermic patients in cardiac arrest cardiopulmonary bypass should be considered.

    Report by Claudia Webster-Smith, Medical Student Search checked by Angaj Ghosh, Senior Clinical Fellow

    References

    View Abstract

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.