Hypothermic Cardiac Arrest

Hypothermic Cardiac Arrest

Approx 30 y/o male - found face down in a river. 45 mins of pre-hospital ALS and he has remained in asystole.
— PMH & Meds: unknown

Clinical Findings

  • Unresponsive and in cardiac arrest

  • No airway interventions

  • Hypothermic: 32°C with tympanic thermometer

Why We Simulated

With colder weather hypothermia secondary to exposure is more likely to be seen. In the context of cardiac arrest it can present particular challenges. Discussion over the expression "they are not dead until they are warm and dead" should perhaps be expanded to include: "are they dead because they are cold or cold because they are dead?"

Remember also that hypothermia is a special circumstance and the ALS algorithm should be modified.

When presented with a no win situation, particularly in younger patients it can be very difficult to make decisions about stopping resuscitation and understanding prognostic factors is important for decision making. 

Factors associated with improved survival are (Malhotra 2013):

  • Early BLS/CPR

  • Shockable Rhythms (and early defibrillation)

  • ROSC prior to arrival at hospital

Equally important is understanding the thoughts of other members of the team as some may not be ready to stop. Discussion around this is vital either during Resus or in a formal debrief after.

Finally it should also be stressed that if family are present the decision to stop needs to be communicated to them and it is a process they may wish to participate in.

Further Reading:

Learning Points

  1. Without a definitive airway the ratio of compression to ventilation is 30:2

  2. Consider drownings as trauma if the mechanism is unknown. This should include c-spine immobilisation.

  3. "Historical clinical signs of poor neurological progress, including absent pupillary and motor reactions, are likely to require a prolonged period of at least 72 h to be reliable" (Temple 2012).

Positive Feedback

  • Good allocation of roles and leader.

  • Team members verbalised when they were unable to perform tasks.

  • Considered the use of an automated CPR device (LUCAS in our trust) for prolonged resuscitation.

A guide on how to use a LUCAS™ device

References:

Edit & Peer Review by Rebecca Prest
Festive Fever

Festive Fever

Lightning Learning: Hypothermia

Lightning Learning: Hypothermia