ABSTRACT
BACKGROUND: The elderly are vulnerable to cold and prone to accidental hypothermia, both because of environmental and endogenous factors. The incidence of severe accidental hypothermia among the elderly is poorly described, but many cases probably go unrecorded. Going through literature one finds few publications on severe hypothermia among the elderly, and, to our knowledge, nothing about extracorporeal re-warming of geriatric hypothermia victims. CASE PRESENTATION: We present a case were a 95 year-old man with severe accidental hypothermia and circulatory arrest was brought to our hospital under on-going CPR, and was successfully resuscitated with extracorporeal circulation. He was discharged to his home without physical sequelae a few weeks later. CONCLUSION: The decision whether or not to continue resuscitation of a nonagenarian can be difficult in many respects. Knowing that resuscitation with extracorporeal circulation is resource intensive may complicate the discussion. In light of our experience with this case we discuss medical and ethical aspects of modern treatment of severe accidental hypothermia.
Subject(s)
Extracorporeal Circulation , Heart Arrest/etiology , Heart Arrest/therapy , Hypothermia/complications , Hypothermia/therapy , Age Factors , Aged, 80 and over , Humans , Male , Patient Discharge , RewarmingABSTRACT
BACKGROUND: Accidental hypothermia with cardiac arrest represents a challenge for pre-hospital rescuers as well as in-hospital staff. For pre-hospital personnel, the main focus is to get the patient to the correct destination without unnecessary delay. For in-hospital personnel early information is vital to assess the possibility for resuscitation with extracorporeal re-warming. The challenge is augmented when rescuers must cross national borders to reach and/or deliver the patients. We present a case where three adolescent boys suffered severe hypothermia after a canoeing accident in Sweden. CASE PRESENTATION: Three 14-year-old boys were canoeing a mountain lake close to the Norwegian border when their boat capsized and they all fell into the cold water. The rescue operation was hampered by rough weather conditions, and immersion times spanned from 63 to 125 min. Flight times from the scene of accident to the nearest ECMO center in Norway (Trondheim) and Sweden (Umeå) were about 30 and 90 min respectively. Two of the victims showed no vital signs after retrieval from the water and had extremely low body temperatures. They were brought to Trondheim University Hospital where they were resuscitated successfully with extracorporeal re-warming. Unable to be weaned from ECMO in the initial phase, both patients were retrieved by mobile ECMO teams to Karolinska University Hospital, from where they were discharged to their homes with good outcomes, although with some sequelae. A third victim with moderate to severe hypothermia without cardiac arrest was treated at a local hospital, from where he after a short stay was discharged without physical sequelae. CONCLUSION: These cases are a reminder of the traditional mantra that «no one is dead until warm and dead¼. Good communication between pre- and in-hospital staff can be vital for optimizing patient treatment when handling victims of severe hypothermia, and especially when there is multiple victims. Communication between neighboring countries, but even neighboring regions within the same country, can be challenging. We encourage regions similar to ours to review protocols regarding hypothermia management, making them more robust before incidents like this take place.
Subject(s)
Heart Arrest/therapy , Hypothermia/therapy , Accidents , Adolescent , Communication , Extracorporeal Membrane Oxygenation , Humans , Male , Norway , Resuscitation , Rewarming , Sweden , Transportation of PatientsSubject(s)
Heart Arrest/complications , Shock, Cardiogenic/diagnosis , Shock/diagnosis , Systemic Inflammatory Response Syndrome/etiology , Aged , Cardiopulmonary Resuscitation/adverse effects , Critical Illness/therapy , Diagnosis, Differential , Heart Arrest/therapy , Humans , Male , Risk Factors , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapyABSTRACT
BACKGROUND: An increase in fatal accidents in helicopter ambulance missions in Norway has put focus on the guidelines for use. METHODS: Ambulance records from the physician-staffed SeaKing rescue helicopter in Bodø, Northern Norway, from 1988 to 1998 were analysed retrospectively. RESULTS: 2,498 ambulance missions carried 2,590 patients. Median time to lift-off was 29 minutes, and one-way median flying time was 26 minutes. Four local communities with a total of 12,000 residents (6.3% of the population served by the helicopter) ordered 70% of the missions. 35% of the patients suffered from cardiovascular disease, 12% were in labour, 3.2% were seriously traumatized, while 20% had minor injuries. A total of 107 patients (4%) received advanced pre-hospital emergency treatment. Thirty-eight (1.5%) were intubated and received cardiopulmonary resuscitation, of whom two survived to discharge. Over a period of 11 years, 53 patients were intubated by the anaesthesiologist. Oxygen or intravenous lines as the only treatment effort were given to 72%. INTERPRETATION: It takes about an hour to reach remote locations by rescue helicopter. A substantial amount of the transports could have been carried out by ground ambulance without loss of health benefit. We question the need for an on-board anaesthesiologist.
