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

    http://dx.doi.org/10.1136/emj.18.1.60

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      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.

      View this table:
      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

      1. Vretenar DF, Urschel JD, Parrot JC, et al. Cardiopulmonary bypass resuscitation for accidental hypothermia. Ann Thorac Surg1994;58:895–8.
        OpenUrlCrossRefPubMedWeb of Science
      2. Koller R, Schnider TW, Neidhart P. Deep accidental hypothermia and cardiac arrest-rewarming with forced air. Acta Anaesth Scand1997;41:1359–64.
        OpenUrlPubMedWeb of Science
      3. Walpoth BH, Walpoth-Alsan BN, Mattle HP, et al. Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med1997;337:1500–5.
        OpenUrlCrossRefPubMedWeb of Science