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Previous Volume 337:1500-1505 November 20, 1997 Number 21 Next

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ABSTRACT

Background Cardiopulmonary bypass has been used to rewarm victims of accidental deep hypothermia. Unlike other rewarming techniques, it restores organ perfusion immediately in patients with inadequate circulation. This study evaluated the long-term outcome of survivors of accidental deep hypothermia with circulatory arrest who had been rewarmed with cardiopulmonary bypass.

Methods Deep hypothermia (core temperature, <28°C) with circulatory arrest was found in 46 of 234 patients with accidental hypothermia. In 32 of the 46 patients, rewarming with cardiopulmonary bypass was attempted, resulting in 15 long-term survivors. In most of these patients, deep hypothermia developed after mountaineering accidents or suicide attempts. After an average (±SD) of 6.7±4.0 years of follow-up, we obtained the patients' medical histories and performed neurologic and neuropsychological examinations, neurovascular ultrasound studies, electroencephalography, and magnetic resonance imaging of the brain.

Results The average age of the patients was 25.2±9.9 years; seven were female and eight were male. The mean interval from discovery of the patient to rewarming with cardiopulmonary bypass was 141±50 minutes (range, 30 to 240). At follow-up there were no hypothermia-related sequelae that impaired quality of life. Neurologic and neuropsychological deficits observed in the early period after rewarming had fully or almost completely disappeared. One patient had cerebellar atrophy on magnetic resonance imaging with mild clinical signs, a condition that may have been caused by hypothermia. Other clinical abnormalities were either preexisting or due to injuries not related to hypothermia.

Conclusions This clinical experience demonstrates that young, otherwise healthy people can survive accidental deep hypothermia with no or minimal cerebral impairment, even with prolonged circulatory arrest. Cardiopulmonary bypass appears to be an efficacious rewarming technique.

Source Information

From the Departments of Thoracic and Cardiovascular Surgery (B.H.W., B.N.W.-A., U.A.), Neurology (H.P.M., L.S.), Psychiatry (B.P.R.), and Neuroradiology (G.S.), University of Bern, Inselspital, Bern; the Department of Cardiovascular Surgery, University Hospital of Lausanne, Lausanne (A.P.F., L.v.S.); and the Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich (L.v.S.) — all in Switzerland.

Address reprint requests to Dr. Walpoth at the Department of Thoracic and Cardiovascular Surgery, University of Bern, Inselspital, 3010 Bern, Switzerland.

Full Text of this Article

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Accidental Deep Hypothermia
Offenstadt G., Harries M., MacKenzie M. A., Walpoth B. H., Mattle H. P., Althaus U.
Extract | Full Text  
N Engl J Med 1998; 338:1160-1162, Apr 16, 1998. Correspondence

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