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Schwere akzidentelle Hypothermie mit Kreislaufstillstand und extrakorporaler Erwärmung

Fallbericht eines 2-jährigen Kindes

Severe accidental hypothermia with cardiac arrest and extracorporeal rewarming

A case report of a 2-year-old child

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Zusammenfassung

Für Patienten mit schwerer Hypothermie und Kreislaufstillstand wird eine aktive Wiedererwärmung mithilfe der extrakorporalen Zirkulation an der Herz-Lungen-Maschine empfohlen. Neu ist in den aktuellen Leitlinien des European Resuscitation Council zur kardiopulmonalen Reanimation die Empfehlung, bei komatösen Patienten mit vorbestehender Hypothermie, die nach Kreislaufstillstand erfolgreich reanimiert wurden, eine aktive Wiedererwärmung lediglich bis zu einer Temperatur von 32–34°C durchzuführen und anschließend eine milde Hypothermie für 12–24 h aufrechtzuerhalten. Wir berichten über einen 2-jährigen Jungen, der nach einem Sturz in eiskaltes Wasser eine schwere Hypothermie erlitt. Beim Auffinden lag ein Kreislaufstillstand mit Asystolie vor; die erste gemessene Temperatur betrug 23,8°C. Nach der Durchführung von Reanimationsmaßnahmen zeigte sich eine Wiederkehr des Spontankreislaufs. Der Patient wurde mithilfe der extrakorporalen Zirkulation an der Herz-Lungen-Maschine bis 33°C wiedererwärmt und anschließend für weitere 12 h in milder Hypothermie gehalten. Am dritten Tag nach dem Unfallereignis konnte der Patient extubiert und nach weiteren 9 Tagen Krankenhausaufenthalt ohne Folgeschäden entlassen werden.

Abstract

In patients with severe hypothermia and cardiac arrest, active rewarming is recommended by extracorporeal circulation with cardiopulmonary bypass. The current guidelines for resuscitation of the European Resuscitation Council now include the recommendation regarding patients with hypothermia remaining comatose after initial resuscitation to accomplish an active rewarming only up to a temperature of 32–34°C and to maintain a mild hypothermia for 12–24 h. We report the case of a 2-year-old boy who suffered from severe hypothermia after falling into ice-cold water. On discovery cardiac arrest with asystole was present and the first measured temperature was 23.8°C. Resuscitation led to restoration of spontaneous circulation. The patient was rewarmed by extracorporeal circulation with cardiopulmonary bypass to 33°C then mild hypothermia was maintained for a further 12 h. On the third day after the accident the patient was extubated and after a further 9 days was discharged without any sequelae.

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Literatur

  1. Althaus U, Aeberhard P, Schüpbach P et al. (1982) Management of profound accidental hypothermia with cardiorespiratory arrest. Ann Surg 195: 492–495

    PubMed  Google Scholar 

  2. Bernard SA, Buist M (2003) Induced hypothermia in critical care medicine: a review. Crit Care Med 31: 2041–2051

    Article  PubMed  Google Scholar 

  3. Bernard SA, Gray TW, Buist MD et al. (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346: 557–563

    Article  PubMed  Google Scholar 

  4. Bierens JJLM, Knape JTA, Gelissen HPMM (2002) Drowning. Curr Opin Crit Care 8: 578–586

    Article  PubMed  Google Scholar 

  5. Danzl DF, Pozos RS (1994) Accidental hypothermia. N Engl J Med 331: 1756–1760

    Article  PubMed  Google Scholar 

  6. Eich C, Bräuer A, Kettler D (2005) Recovery of a hypothermic drowned child after resuscitation with cardiopulmonary bypass followed by prolonged extracorporeal membrane oxygenation. Resuscitation 67: 145–148

    Article  PubMed  Google Scholar 

  7. European Resuscitation Council (2005) Guidelines for Resuscitation 2005. Resuscitation 67 [Suppl 1]: S1–189

  8. European Resuscitation Council (2006) Kardiopulmonale Reanimation. Aktuelle Leitlinien des European Resuscitation Council. Notfall Rettungsmed 9: 4–170

    Article  Google Scholar 

  9. Farstad M, Andersen KS, Koller ME et al. (2001) Rewarming from accidental hypothermia by extracorporeal circulation. A retrospective study. Eur J Cardiothorac Surg 20: 58–64

    Article  PubMed  Google Scholar 

  10. Gilbert M, Busund R, Skagseth A et al. (2000) Resuscitation from accidental hypothermia of 13.7°C with circulatory arrest. Lancet 355: 375–376

    Article  PubMed  Google Scholar 

  11. Husby R, Andersen KS, Owen-Falkenberg A et al. (1990) Accidental hypothermia with cardiac arrest: complete recovery after prolonged resuscitation and rewarming by extracorporeal circulation. Intensive Care Med 16: 69–72

    Article  PubMed  Google Scholar 

  12. Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346: 549–556

    Article  PubMed  Google Scholar 

  13. Ibsen LM, Koch T (2002) Submersion and asphyxial injury. Crit Care Med 30 [Suppl 11]: S402–408

    Google Scholar 

  14. Langouche L, Berghe G van den (2006) Glucose metabolism and insulin therapy. Crit Care Clin 22: 119–129

    PubMed  Google Scholar 

  15. Larach MG (1995) Accidental hypothermia. Lancet 345: 493–498

    Article  PubMed  Google Scholar 

  16. Lazar HL (1997) The treatment of hypothermia. N Engl J Med 337: 1545–1547

    Article  PubMed  Google Scholar 

  17. Nolan JP, Morley PT, Hoek TL van den, Hickey RW (2003) Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life Support Task Force of the International Liaison Committee on Resuscitation. Resuscitation 57: 231–235

    Article  PubMed  Google Scholar 

  18. Papenhausen M, Burke L, Antony A, Philips JD (2001) Severe hypothermia with cardiac arrest: complete neurologic recovery in a 4-year-old child. J Pediatr Surg 36: 1590–1592

    Article  PubMed  Google Scholar 

  19. Poldermann KH (2004) Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality – Part 2: practical aspects and side effects. Intensive Care Med 30: 757–769

    Article  PubMed  Google Scholar 

  20. Schmidt U, Fritz KW, Kasperczyk W, Tscherne H (1995) Successful resuscitation of a child with severe hypothermia after cardiac arrest of 88 minutes. Prehospital Disaster Med 10: 60–62

    PubMed  Google Scholar 

  21. Thüner C, Sefrin P (2006) Ertrinkungsunfälle im Kindesalter. Intensivmedizin 43: 111–122

    Article  Google Scholar 

  22. Ujhelyi MR, Sims JJ, Dubin SA et al. (2001) Defibrillation energy requirements and electrical heterogeneity during total body hypothermia. Crit Care Med 29: 1006–1011

    Article  PubMed  Google Scholar 

  23. Vargas Hein O, Triltsch A, Buch C von et al. (2004) Mild hypothermia after near drowning in twin toddlers. Crit Care 8: R353–357

    Article  PubMed  Google Scholar 

  24. Vretenar DF, Urschel JD, Parrott JCW, Unruh HW (1994) Cardiopulmonary bypass resuscitation for accidental hypothermia. Ann Thorac Surg 58: 895–898

    PubMed  Google Scholar 

  25. Walpoth BH, Locher T, Leupi F et al. (1990) Accidental deep hypothermia with cardiopulmonary arrest: extracorporeal blood rewarming in 11 patients. Eur J Cardiothorac Surg 4: 390–393

    Article  PubMed  Google Scholar 

  26. Walpoth BH, Walpoth-Aslan BN, Mattle HP et al. (1997) Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 337: 1500–1505

    Google Scholar 

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Maisch, S., Ntalakoura, K., Boettcher, H. et al. Schwere akzidentelle Hypothermie mit Kreislaufstillstand und extrakorporaler Erwärmung. Anaesthesist 56, 25–29 (2007). https://doi.org/10.1007/s00101-006-1110-8

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  • DOI: https://doi.org/10.1007/s00101-006-1110-8

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