Accidental Hypothermia: Pre- and In-hospital resuscitation strategies

Accidental hypothermia with or without circulatory arrest: the experience from the Danish Præstø Fjord boating accident in 2011.

The European Association of Surfing Doctors (EASD) are delighted to welcome Dr. Michael Wanscher and Dr. Steen Barnung to Ireland to speak on Pre- and In-hospital resuscitation strategies in accidental hypothermia at the 3rd Annual Conference in Surfing Medicine, The Glasshouse, Sligo on 10th September 2014.

 

Resuscitation strategies in case of accidental hypothermia

Dr. Barnung and Wanscher will share their experience from the Danish Præstø Fjord boating accident in 2011 where 15 healthy subjects (median age 16 (range 15-45) years) were immersed in 2 °C salt water.

Seven (7) patients were found with profound (Median Temperature: 18.4°C; Range: 15.5-20.2°C) accidental hypothermic circulatory arrest were successfully resuscitated using a management approach that employed extracorporeal membrane oxygenation (ECMO) rewarming, successive periods of therapeutic hypothermia and sedated normothermia, and intensive neurorehabilitation.

They were all rewarmed with extracorporeal membrane oxygenation (ECMO) and were subsequently evaluated with advanced neuroradiological and functional testing.

Furthermore, seven (7) other hypothermic victims (Minimum Core Temperature: 23°C) that did not suffer circulatory arrest also survived the accident.

 

Accidental hypothermia without circulatory arrest: results of the study

The victims that survived the accident without circulatory arrest were predominantly females with a higher body mass index.

Victims with circulatory arrest pH on arrival was a median of 6.61 (range 6.43-6.94), with ECMO being established a median of 226 (178-241)min after the accident.

Magnetic resonance spectroscopy showed neuronal dysfunction in five. In five victims initial normal white matter spectra progressed to show evidence of abnormal axonal membranes.

Based on the seven-level Functional Independence Measure test functional outcome was good in six circulatory arrest victims and in all without circulatory arrest. Mild to moderate cognitive dysfunction was seen in six and severe dysfunction in one circulatory arrest victim.

 

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