Profound accidental hypothermia in the deep South: clinical experience

Accidental hypothermia resulting from exposure is generally associated with frigid regions and not with the more temperate areas of the South. However, we present clinical experience from two cases in which the victims of motor vehicle accidents were exposed to the elements for prolonged periods and became profoundly hypothermic. The first patient was a 21-year-old male who was ejected from, and pinned under, his vehicle for approximately four hours in -15 degrees C ambient temperature. Upon admission to the Emergency Room, the patient was unresponsive with fixed and dilated pupils and his core temperature was 25 degrees C. After a prolonged period of cardiopulmonary resuscitation, percutaneous femoral to femoral cardiopulmonary bypass (CPB) was instituted for core rewarming. After reaching 37 degrees C, the patient was removed from bypass. The patient was discharged from the hospital on the fourth postoperative day. The second patient was a 40-year-old male who was ejected from his vehicle into a stream, where he was partially submerged for several hours. Although the ambient temperature was approximately 22 degrees C, his core temperature at admission was 27 degrees C. After a positive peritoneal lavage, the patient was taken to the Operating Room and placed on percutaneous femoral to femoral CPB for core rewarming. During rewarming, an exploratory laparotomy and a splenectomy were performed. The patient was discharged from the hospital on the seventh postoperative day. These cases are unique in that both were trauma patients with suspected internal injuries which required the avoidance of anticoagulation. Therefore, both cases utilized a Carmeda-bonded circuit without systemic anticoagulation.