Management of Hypothermic Cardiac Arrest with Hemoperitoneum from LUCAS Device: A Case Report

BACKGROUND Witnessed hypothermic cardiac arrest is a rare injury with high mortality, particularly at extreme temperatures. We describe a case of witnessed accidental hypothermia with a profoundly low core temperature of 20°C, resulting in pre-hospital cardiac arrest. The patient was successfully treated with cardiopulmonary bypass rewarming, but the clinical course was further complicated by a liver injury from device-assisted cardiopulmonary resuscitation (CPR), necessitating exploratory laparotomy. CASE REPORT A 30-year-old man was found roadside in -15°C weather and suffered pre-hospital cardiac arrest, witnessed by emergency medical personnel. Rewarming treatment with cardiopulmonary bypass was performed at our level-1 trauma center after the patient presented with a core temperature of 20°C and underwent 195 minutes of CPR. Intraoperatively, he was noted to have constant loss of volume on bypass as well as a tense, distended abdomen. Exploratory laparotomy was performed showing hemoperitoneum from a liver laceration secondary to CPR with a Lund University Cardiopulmonary Assist System (LUCAS) device. Delayed sternal and abdominal closure was performed with definitive closure occurring on hospital day 3. The patient experienced full neurologic recovery and was discharged home on hospital day 23. CONCLUSIONS Extracorporeal rewarming is a definitive treatment for cardiac arrest from accidental severe hypothermia and can be accomplished with cardiopulmonary bypass. Providers should have heightened clinical suspicion for solid organ injury when CPR is facilitated by a LUCAS device rather than manual compressions. Disproportionately low return volumes on the cardiopulmonary bypass circuit should prompt consideration of a differential diagnosis which in post-resuscitation patients can include traumatic hemoperitoneum.