Authors: J Kieboom, H Verkade,J Burgerhof, J Bierens, P van Rheenen, M Kneyber, M Albers
Journal: British Medical Journal, Feb 2015
Hypothermia plays an important role in the pathophysiology and treatment of resuscitation... that is about as much as we know. The degree to which it plays a role, and even whether its beneficial or detrimental, is not so clear. What we are pretty sure of is that, in general, hypothermia is a poor prognostic factor; what complicates things are the multiple case reports of survival with good neurologic outcome following prolonged submersion and cardiac arrest in very cold water. These are usually young patients with a rapid cooling due to fall in icy water, which differs greatly from some one who is hypothermic due to prolonged exposure in warmer water.
This article reports the findings from 20 years of retrospective analysis of pediatric patients in the Netherlands who were found to be hypothermic and in cardiac arrest due to drowning. The authors sought to determine the outcome of those patients who undergo prolonged resuscitation. Some current guidelines call for extending resuscitation in this patient population due to the possible neuroprotective properties of hypothermia and reports of survival after prolonged submersion.
Population: patients aged 16 and under, cardiac arrest due to drowning, hypothermic
Outcome measures: mortality, survival, neurologic outcome
Results
- 160 total patient
- 86% survived to ICU
- 44 survived to discharge (27%)
- 17 survived with no, mild, or moderate neuro insult (10% of total, 3% of survivors)
- Prolonged CPR (> 30 min)
- 89% death
- 11% severe neuro insult or vegetative state
- 0% good outcome
- Max CPR time with good neuro outcome was 25 min
- ECMO did not change outcome with prolonged CPR
- Effect of season (used as marker for water temp)
- More died from drowning in summer and spring
- Better survival rates with good neuro outcome in winter
- Submersion time
- Not known in most cases (3% witnessed)
- Longest submersion with good neuro outcome was 25 minutes
- Initial Cardiac rhythm
- 86% asystole
- 13% bradycardia
- 2% Vent fib
Link to PubMed abstract