Rewarming from accidental hypothermia by extracorporeal circulation. A retrospective study

Recovery of a hypothermic drowned child after resuscitation with cardiopulmonary bypass followed by prolonged extracorporeal membrane oxygenation

Drowning is a leading cause of death in children worldwide. However, there is uncertainty about the initiation and the extent of adequate therapeutic interventions after drowning accidents. As prediction of outcome in drowned children remains difficult, initial maximum life support appears to be generally justified. We present the case of a 3-year-old drowned girl in refractory cardiorespiratory arrest who was resuscitated successfully with cardiopulmonary bypass (CPB) followed by extracorporeal membrane oxygenation (ECMO) for 4 days. After a prolonged period in a vegetative state eventually she made an almost complete neurological recovery. We do not have knowledge of any case of drowning reported with a favourable neurological outcome after such a prolonged period of ECMO.

Point-of-care testing in the cardiovascular operating theatre

Point-of-care testing (POCT) remains under scrutiny by healthcare professionals because of its ill-tried, young history. POCT methods are being developed by a few major equipment companies based on rapid progress in informatics and nanotechnology. Issues as POCT quality control, comparability with standard laboratory procedures, standardisation, traceability and round robin testing are being left to hospitals. As a result, the clinical and operational benefits of POCT were first evident for patients on the operating table. For the management of cardiovascular surgery patients, POCT technology is an indispensable aid. Improvement of the technology has meant that clinical laboratory pathologists now recognise the need for POCT beyond their high-throughput areas.

Clin Chem Lab Med 2006;44:1060–5.

Accidental Hypothermia

Hypothermia is a multi-system disorder that significantly increases morbidity and mortality in the injured patient. It is an environmental hazard that can kill in its own right. The most difficult differentiation and management decisions are likely to be with victims in Stage II or Stage III hypothermia. Following successful rescue in these cases, arresting any further cooling of the core temperature, instituting rewarming strategies and careful patient handling will be the key factors in reducing morbidity and mortality.

Successful use of venovenous extracorporeal membrane oxygenation in accidental hypothermic cardiac arrest

Cardiopulmonary bypass is usually used for rewarming and for providing cardiac support in patients with severe hypothermia and cardiovascular instability. We report the first case of accidental severe hypothermia associated with prolonged cardiac arrest that was successfully managed by venovenous extracorporeal membrane oxygenation.