Successful Defibrillation of Four Hypothermic Patients with Witnessed Cardiac Arrest

Because of the limited evidence available, recommendations for defibrillation of hypothermic patients vary among published guidelines.

To report successful defibrillation of four severely hypothermic patients with witnessed cardiac arrest.

During a four-year period from 2014 to 2017, four of five hypothermic patients admitted to our institution with a history of sudden, unexpected ventricular fibrillation (core temperature: 24°C-27°C) were successfully defibrillated. Restoration of spontaneous circulation (ROSC) was possible after a single defibrillator shock (two patients) or during prolonged advanced life support cardiopulmonary resuscitation (two patients). Our patients and additional cases identified in the literature indicate that successful defibrillation is predominantly found in hypothermic patients with a core temperature above 24°C.

Our data demonstrate that successful defibrillation and ROSC are possible in selected patients with severe accidental hypothermia and are perhaps more common than widely believed. These findings are of particular importance for mountain and wilderness rescue missions when transfer of an arrested patient to the nearest hospital providing extracorporeal rewarming is not possible. An automatic external defibrillator should be part of the medical equipment on any search or mountain rescue mission, in which the victim may have sustained accidental hypothermia.