Complete Neurological Recovery after Severe Accidental Hypothermia: Two Cases and a Novel Algorithm Proposal

Khortnal Delvecchio^1, , Alexander L Marinica¹, Calvin Williams¹, Thomas Hanna¹, Susan Seman¹, Zewditu Asfaw¹ and Ingida Asfaw¹

¹Department of Surgery, Detroit Medical Center - Sinai Grace Hospital, Detroit, USA

Cite this paper

Khortnal Delvecchio, Alexander L Marinica, Calvin Williams, Thomas Hanna, Susan Seman, Zewditu Asfaw and Ingida Asfaw. Complete Neurological Recovery after Severe Accidental Hypothermia: Two Cases and a Novel Algorithm Proposal. American Journal of Medical Case Reports. 2019; 7(6):100-103. doi: 10.12691/AJMCR-7-6-2

Abstract

Primary accidental hypothermia results from endogenous thermoregulatory mechanisms being overwhelmed by environmental stressors. Vulnerable populations include the elderly, mentally ill, homeless, and chemically dependent. When core temperatures fall below 35°C, the resulting metabolic derangements provoke cardiopulmonary compromise and dysrhythmia. Due to the human body’s innate protective mechanisms there are reports of patients making complete neurologic recovery after exposure to extreme temperatures and prolonged cardiopulmonary arrest. We describe two cases from our institution demonstrating appropriate treatment methods for the two most severe stages of hypothermia. A 57-year-old male with a core temperature of 27°C who was successfully resuscitated with warm bladder and thoracic lavage and a 34-year-old female with a core temperature of 22°C that fully recovered after 5 hours of external cardiopulmonary bypass. From our experience and a review of the literature, we have developed a modified version of the Swiss staging model and incorporated it into a novel treatment algorithm for in-hospital adult accidental hypothermia patients presenting to urban community hospitals. The two example cases described highlight how appropriate utilization of this novel algorithm can lead to positive outcomes in otherwise critical clinical scenarios.

Keywords

hypothermia, cardiopulmonary bypass, extracorporeal membrane oxygenation, rewarming, case report, algorithms

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Brown DJ, Brugger H, Boyd J, Paal P. “Accidental hypothermia,” N Engl J Med, 367 (20), 1930-8. Jan. 2012
[2]	Petrone P, Asensio JA, Marini CP. “Management of accidental hypothermia and cold injury,” Curr Probl Surg, 51 (10), 417-31. Jul. 2016.
[3]	Kempainen RR, Brunette DD. “The evaluation and management of accidental hypothermia,” Respir Care, 49 (2), 192-205. Feb. 2004.
[4]	Paal P, Gordon L, Strapazzon G, Brodmann Maeder M, Putzer G, Walpoth B, et al. “Accidental hypothermia-an update: The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM),” Scand J Trauma Resusc Emerg Med, 24 (1), 111. Sep.2016.
[5]	Mair P, Kornberger E, Furtwaengler W, Balogh D, Antretter H. “Prognostic markers in patients with severe accidental hypothermia and cardiocirculatory arrest,” Resuscitation, 27 (1), 47-54. Jan. 1994.
[6]	Klein LR, Huelster J, Adil U, Rischall M, Brunette DD, Kempainen RR, et al. “Endovascular rewarming in the emergency department for moderate to severe accidental hypothermia,” Am J Emerg Med, 35 (11), 1624-1629. May.2017.
[7]	Turtiainen J, Halonen J, Syväoja S, Hakala T. “Rewarming a patient with accidental hypothermia and cardiac arrest using thoracic lavage,” Ann Thorac Surg, 97 (6), 2165-6. Jun.2014
[8]	Svendsen ØS, Grong K, Andersen KS, Husby P. “Outcome After Rewarming From Accidental Hypothermia by Use of Extracorporeal Circulation,” Ann Thorac Surg, 103 (3) 920-925. Sep.2017.
[9]	Darocha T, Sobczyk D, Kosiński S, Jarosz A, Gałązkowski R, Nycz K, et al. “Electrocardiographic Changes Caused by Severe Accidental Hypothermia,” J Cardiothorac Vasc Anesth, 29 (6), e83-6. Jul. 2015.