Resuscitation of the hypothermic patient

A case of cardiac arrest following hypothermia due to cold-water immersion is presented. Following rescue and initiation of cardiopulmonary resuscitation, the patient was transported by helicopter to a facility where rewarming using cardiopulmonary bypass was possible. Initial rectal temperature in the emergency department was 28 degrees C. Initial prehospital rhythm was ventricular fibrillation persisting approximately 1.5 hours until the patient was successfully cardioverted after 25 minute of femoral artery/femoral venous partial cardiopulmonary bypass rewarming. Temperature at the time of cardioversion was 30 degrees C (esophageal). Despite extended cardiac arrest and profound metabolic acidosis (pH = 6.41 at 37 degrees C), he recovered uneventfully and is neurologically normal. A protocol for the management of a patient with hypothermic cardiac arrest is included.