Extracorporeal Cardiopulmonary Resuscitation for Hypothermic Refractory Cardiac Arrests in Urban Areas with Temperate Climates

Overview

Journal Scand J Trauma Resusc Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2023 Nov 1

PMID 37907994

Authors

Tal Soumagnac

Jean-Herle Raphalen

Wulfran Bougouin

Damien Vimpere

Hatem Ammar

Samraa Yahiaoui

Christelle Dagron

Kim An

Akshay Mungur

Pierre Carli

Alice Hutin

Lionel Lamhaut

Affiliations

Soon will be listed here.

Abstract

Background: Accidental hypothermia designates an unintentional drop in body temperature below 35 °C. There is a major risk of ventricular fibrillation below 28 °C and cardiac arrest is almost inevitable below 24 °C. In such cases, conventional cardiopulmonary resuscitation is often inefficient. In urban areas with temperate climates, characterized by mild year-round temperatures, the outcome of patients with refractory hypothermic out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) remains uncertain.

Methods: We conducted a retrospective monocentric observational study involving patients admitted to a university hospital in Paris, France. We reviewed patients admitted between January 1, 2011 and April 30, 2022. The primary outcome was survival at 28 days with good neurological outcomes, defined as Cerebral Performance Category 1 or 2. We performed a subgroup analysis distinguishing hypothermic refractory OHCA as either asphyxic or non-asphyxic.

Results: A total of 36 patients were analysed, 15 of whom (42%) survived at 28 days, including 13 (36%) with good neurological outcomes. Within the asphyxic subgroup, only 1 (10%) patient survived at 28 days, with poor neurological outcomes. A low-flow time of less than 60 min was not significantly associated with good neurological outcomes (P = 0.25). Prehospital ECPR demonstrated no statistically significant difference in terms of survival with good neurological outcomes compared with inhospital ECPR (P = 0.55). Among patients treated with inhospital ECPR, the HOPE score predicted a 30% survival rate and the observed survival was 6/19 (32%).

Conclusion: Hypothermic refractory OHCA occurred even in urban areas with temperate climates, and survival with good neurological outcomes at 28 days stood at 36% for all patients treated with ECPR. We found no survivors with good neurological outcomes at 28 days in submersed patients.

References

Perkins G, Jacobs I, Nadkarni V, Berg R, Bhanji F, Biarent D . Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison.... Resuscitation. 2014; 96:328-40. DOI: 10.1016/j.resuscitation.2014.11.002. View

Hutin A, Abu-Habsa M, Burns B, Bernard S, Bellezzo J, Shinar Z . Early ECPR for out-of-hospital cardiac arrest: Best practice in 2018. Resuscitation. 2018; 130:44-48. DOI: 10.1016/j.resuscitation.2018.05.004. View

Walpoth B, Mattle H, Radanov B, Schroth G, Schaeffler L, Fischer A . Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med. 1997; 337(21):1500-5. DOI: 10.1056/NEJM199711203372103. View

Swol J, Darocha T, Paal P, Brugger H, Podsiadlo P, Kosinski S . Extracorporeal Life Support in Accidental Hypothermia with Cardiac Arrest-A Narrative Review. ASAIO J. 2021; 68(2):153-162. PMC: 8797003. DOI: 10.1097/MAT.0000000000001518. View

Sawamoto K, Bird S, Katayama Y, Maekawa K, Uemura S, Tanno K . Outcome from severe accidental hypothermia with cardiac arrest resuscitated with extracorporeal cardiopulmonary resuscitation. Am J Emerg Med. 2014; 32(4):320-4. DOI: 10.1016/j.ajem.2013.12.023. View

. Guidelines for indications for the use of extracorporeal life support in refractory cardiac arrest. French Ministry of Health. Ann Fr Anesth Reanim. 2009; 28(2):182-90. DOI: 10.1016/j.annfar.2008.12.011. View

Schober A, Sterz F, Handler C, Kurkciyan I, Laggner A, Roggla M . Cardiac arrest due to accidental hypothermia--a 20 year review of a rare condition in an urban area. Resuscitation. 2014; 85(6):749-56. DOI: 10.1016/j.resuscitation.2014.01.027. View

Paal P, Pasquier M, Darocha T, Lechner R, Kosinski S, Wallner B . Accidental Hypothermia: 2021 Update. Int J Environ Res Public Health. 2022; 19(1). PMC: 8744717. DOI: 10.3390/ijerph19010501. View

Pasquier M, Rousson V, Darocha T, Bouzat P, Kosinski S, Sawamoto K . Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: An external validation of the HOPE score. Resuscitation. 2019; 139:321-328. DOI: 10.1016/j.resuscitation.2019.03.017. View

10.

Pasquier M, Paal P, Blancher M, Darocha T . Higher survival chances of hypothermic vs. normothermic cardiac arrest patients with ECLS re-warming. Resuscitation. 2018; 134:161-162. DOI: 10.1016/j.resuscitation.2018.11.004. View

11.

Lamhaut L, Jouffroy R, Kalpodjian A, Deluze T, Phillipe P, Vivien B . Successful treatment of refractory cardiac arrest by emergency physicians using pre-hospital ECLS. Resuscitation. 2012; 83(8):e177-8. DOI: 10.1016/j.resuscitation.2012.03.016. View

12.

Kraai E, Wray T, Ball E, Tawil I, Mitchell J, Guliani S . E-CPR in Cardiac Arrest due to Accidental Hypothermia Using Intensivist Cannulators: A Case Series of Nine Consecutive Patients. J Intensive Care Med. 2022; 38(2):215-219. DOI: 10.1177/08850666221116594. View

13.

Phelps R, Dumas F, Maynard C, Silver J, Rea T . Cerebral Performance Category and long-term prognosis following out-of-hospital cardiac arrest. Crit Care Med. 2013; 41(5):1252-7. DOI: 10.1097/CCM.0b013e31827ca975. View

14.

Beck H, Zimmermann N, McVicar T, Vergopolan N, Berg A, Wood E . Present and future Köppen-Geiger climate classification maps at 1-km resolution. Sci Data. 2018; 5:180214. PMC: 6207062. DOI: 10.1038/sdata.2018.214. View

15.

Mehran R, Rao S, Bhatt D, Gibson C, Caixeta A, Eikelboom J . Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011; 123(23):2736-47. DOI: 10.1161/CIRCULATIONAHA.110.009449. View

16.

Tipton M, Golden F . A proposed decision-making guide for the search, rescue and resuscitation of submersion (head under) victims based on expert opinion. Resuscitation. 2011; 82(7):819-24. DOI: 10.1016/j.resuscitation.2011.02.021. View

17.

Champigneulle B, Bellenfant-Zegdi F, Follin A, Lebard C, Guinvarch A, Thomas F . Extracorporeal life support (ECLS) for refractory cardiac arrest after drowning: an 11-year experience. Resuscitation. 2014; 88:126-31. DOI: 10.1016/j.resuscitation.2014.11.023. View

18.

Lamhaut L, Jouffroy R, Soldan M, Phillipe P, Deluze T, Jaffry M . Safety and feasibility of prehospital extra corporeal life support implementation by non-surgeons for out-of-hospital refractory cardiac arrest. Resuscitation. 2013; 84(11):1525-9. DOI: 10.1016/j.resuscitation.2013.06.003. View

19.

Svendsen O, Grong K, Andersen K, Husby P . Outcome After Rewarming From Accidental Hypothermia by Use of Extracorporeal Circulation. Ann Thorac Surg. 2016; 103(3):920-925. DOI: 10.1016/j.athoracsur.2016.06.093. View

20.

Paal P, Brugger H, Strapazzon G . Accidental hypothermia. Handb Clin Neurol. 2018; 157:547-563. DOI: 10.1016/B978-0-444-64074-1.00033-1. View