Successful Non-Extracorporeal Rewarming from Hypothermic Cardiac Arrest: 2 Cases

Accidental hypothermia (core temperature <35°C) is a complication in persons who have fallen into crevasses; hypothermic cardiac arrest is the most serious complication. Extracorporeal life support (ECLS) is the optimal method for rewarming hypothermic cardiac arrest patients, but it may not be readily available and non-ECLS rewarming may be required. We report the medical course of 2 patients with hypothermic cardiac arrest, each of whom had fallen into a crevasse. They were treated successfully with non-ECLS rewarming using peritoneal and thoracic lavage. We discuss non-ECLS treatment options for hypothermic cardiac arrest and describe successful non-ECLS rewarming in an outlying hospital without ECLS rewarming capability in the Grossglockner region of Austria in 1990 and 2003. Both patients survived neurologically intact. Non-ECLS rewarming in a trauma center without ECLS capabilities is feasible and can result in a good outcome when ECLS is not available. The best non-ECLS rewarming method for hypothermic cardiac arrest patients has not yet been established. Non-ECLS rewarming should be adapted to local capabilities. To obtain more robust evidence, it seems reasonable to pool data on the treatment and outcome of non-ECLS rewarming in hypothermic cardiac arrest patients.