Jump to content
Sign in to follow this  
EMEDPA

Hypothermic cardiac arrest

Recommended Posts

Recently ran a hypothermic arrest at a rural hospital. As expected, it did not go well for the patient. In brief:

Found with agonal respirations and coarse vfib  after long downtime lying outside in the snow after syncope of unknown cause for 3-12 hrs based on family estimates. Older patient with multiple bad comorbidities(DM, Afib/anticoagulation, htn, etc). Cpr started in field by medics and IV line started. epi x 1 given and 1 shock for coarse vfib. BVM only as they could not open pts mouth at all. core temp on arrival approx 24c/75f. Sux x 2 rounds and ketamine x 1 relaxes jaw enough for placement of king lt airway. considered fiberoptic nasal, but decided to focus on other priorities. Foley placed and bladder continuously irrigated with warm saline. warm IV fluids and warmed, humidified o2. bear hugger placed. continuous cpr. end tidal  co2 in 12-15 range(8 at the cessation of efforts at 45 min). standard acls to include multiple rounds of epi, lido, amio for persistent coarse vfib. defib x 2.  d50, narcan, bicarb given. decision made to hold on additional drugs or defib attempts until temp raised. considered, but decided against peritoneal lavage and thoracic/chest tube warmed lavage as likely futile. In consultation with hospitalist and family present at bedside opted to stop efforts after unable to raise temp more than 2 degrees in 45 min in dept after 30 min in field. I know at a big center there are lots of options like ecmo, hyperbaric o2, etc. Anyone here run hypothermic codes and do you have any wisdom to share? This case presented immediately(2 min) after the paced 2nd degree type 2 HB pt discussed in the em quiz post recently had left the dept.

Share this post


Link to post
Share on other sites
1 hour ago, bike mike said:

At my old job this pt probably wouldn’t be a candidate for ECMO given that long of a downtime and unlikely neurological recovery. 

I know the "not dead until warm and dead", but there was no getting this pt warm. I also know the "they are dead with end tidal co2 less than 10 at 20 min into the code", but don't think that applies in hypothermia due to slowed metabolism. I knew it was futile, but wanted someone else to agree with me, so called in the hospitalist to sign off on cessation of efforts.

Share this post


Link to post
Share on other sites

Only did this once, and it wasn't a cardiac arrest, but the femoral caths used for post-arrest hypothermia can be used for re-warming.  Still, I don't think there was any way for that resuscitation to be successful.

Share this post


Link to post
Share on other sites
1 minute ago, ohiovolffemtp said:

Only did this once, and it wasn't a cardiac arrest, but the femoral caths used for post-arrest hypothermia can be used for re-warming.  Still, I don't think there was any way for that resuscitation to be successful.

Thanks. All the research I read basically said if temp on presentation is less than 80 degrees F it will be a futile effort.

Share this post


Link to post
Share on other sites

Just took ATLS at OHSU the last two days and this subject actually came up.  The trauma doc leading it said they can be "cold and dead"  IF their potassium is over 10 OR their pH is 7 or below.  This only applies in adults as it hasn't been verified in kids.   I'm not sure what study she was talking about, though.

Share this post


Link to post
Share on other sites
14 minutes ago, AprilMedicPA said:

Just took ATLS at OHSU the last two days and this subject actually came up.  The trauma doc leading it said they can be "cold and dead"  IF their potassium is over 10 OR their pH is 7 or below.  This only applies in adults as it hasn't been verified in kids.   I'm not sure what study she was talking about, though.

Good Lord, a K+ over 10.....yeah, they’re dead. 

Share this post


Link to post
Share on other sites
36 minutes ago, bike mike said:

Good Lord, a K+ over 10.....yeah, they’re dead. 

Yep, but if you want to stop and they are cold.... get a K and/or a pH and call it good.  Extreme cold, like falling into an ice-covered lake and being pulled out and resuscitation attempted, is more likely to come in with super high K.  In this situation, it would be nice to know the chance of getting them warm and alive is nil.

 

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  

×

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More