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Successful Resuscitation of a Child with Severe Hypothermia after Cardiac Arrest of 88 Minutes

Published online by Cambridge University Press:  28 June 2012

Ulf Schmidt ,
Karl-Wilhelm Fritz ,
Wolfgang Kasperczyk  and
Harald Tscherne
Ulf Schmidt*
Affiliation:
Medizinische Hochschule Hannover, Unfallchirurgische Klinik, Hannover, Germany
Karl-Wilhelm Fritz
Affiliation:
Nordwest-Krankenhaus Sanderbusch, Anaesthesie-Abteilung und Anaesthesiologische Intensivstation, Sande, Germany
Wolfgang Kasperczyk
Affiliation:
Medizinische Hochschule Hannover, Unfallchirurgische Klinik, Hannover, Germany
Harald Tscherne
Affiliation:
Medizinische Hochschule Hannover, Unfallchirurgische Klinik, Hannover, Germany
*
Medizinische Hoehschule, Unfallchirurgishe Klinik, 30625 Hannover, Germany
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Abstract

A 4-year-old boy broke through the ice of a frozen lake and drowned. The boy was extricated from the icy water by a rescue helicopter that was dispatched shortly after the incident. Although the boy was severely hypothermic, no cardiac response could be induced with field resuscitation measures, including intubation, ventilation, suction, and cardiopulmonary resuscitation.

On admission, the primary findings included fixed, nonreacting pupils and asystole. The first core temperature measured was 19.8° C (67.6° F). During active, external warming, the first ventricular beats were observed 20 minutes after admission, and changed 10 minutes later to a sinus rhythm. Continuous monitoring included repeated arterial blood gas and electrolyte tests; prophylaxis for cerebral edema was performed with hyperventilation and administration of sodium Brevimytal and dexamethasone. Seventy minutes after admission, hemodynamics stabilized and the boy was transferred to the pediatric intensive care unit (PICU), where active external warming was continued to raise the core temperature at a rate of 1° C/hour.

Adult respiratory distress syndrome developed, and the boy had to be ventilated in the PICU for 10 days. He was discharged home after another two weeks. He recovered fully. The rapid heat loss with the induction of severe hypothermia (<20° C; 68° F) was the main reason for survival in this rare event of a patient with cardiac arrest lasting 88 minutes after accidental hypotherma.

Keywords

accidental hypothermiaair rescuecardiac arrestdrowninghypothermiapost-resuscitation managementresuscitationrewarming
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 1 , March 1995 , pp. 60 - 62
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

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