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Hypothermic Cardiac Arrest

Date Last Search Run: Aug 01, 2024
Table last updated: Feb 27, 2024
Data last added: Feb 05, 2024

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)      
2 (fair evidence exists)    
3 (weak evidence exists)    


Interventions

AER (Active External Rewarming)
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Mortality Process Walpoth BH, Brodmann Maeder M, Courvosier DS, Meyer M, Cools E, Darocha T, et al. Hypothermic Cardiac Arrest - Retrospective cohort study from the International Hypothermia Registry. Resuscitation 2021;167:58–65. Medline
III Supportive (Green) Rewarming Patient PH-Paramedic Kornberger E., Schwartz B., Linder KH., Mair P. Forced air surface re-warming in patients with severe accidental hypothermia. Resuscitation 1991; 41:105-11. Medline
III Supportive (Green) Successful resuscitation without deficit Patient PH-Paramedic Schmidt U., Fritz KW., Kasperczyk W., Tscherne H. Successful resuscitation of a child with severe hypothermia after cardiac arrest of 88 minutes. Prehosp Disaster Med 1995; 10(1):60-2. Medline
III Supportive (Green) Successful resuscitation Patient ED-MD Thompson DA., Anderson N. Successful resuscitation of a severely hypothermic neonate. Ann Emerg Med 1994; 23(6):1390-1393. Medline
III Neutral (Yellow) Efficacy Patient Little G. Accidental hypothermic cardiac arrest and rapid mediastinal warming with pleural lavage: a survivor after 3.5 hours of manual CPR. BMJ case reports 2017. Medline

Chest Compression devices
Level Direction Primary Outcome Patient/Process Setting Reference

Delayed Defibrillation
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Neurologically favorable 1-month survival Patient PH-Paramedic & CCT Ushimoto T, Murasaka K, Wato Y, Inaba H. Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis. Med April 2023; 102(17):e33618. Medline

Delayed Drug Administration
Level Direction Primary Outcome Patient/Process Setting Reference

Prolonged Resuscitation
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Survival Patient PH-Paramedic Masaki F., et al. Revival from deep hypothermia after 4 hours of cardiac arrest without the use of extracorporeal circulation. J Trauma. 2009; 67(5):E173-6. Medline
III Supportive (Green) Survival Patient ED-MD Chochinov AH., Baydock BM., Bristow GK., Giesbrecht GG. Recovery of a 62-year-old man from prolonged cold water submersion. Ann Emerg Med 1998; 31(1):127-31. Medline
III Supportive (Green) neurocognitive outcome Process PH-Paramedic & CCT Kriz D., Piantino J., Fields D., Williams C. Pediatric Hypothermic Submersion Injury and Protective Factors Associated with Optimal Outcome A Case Report and Literature Review. Children (Basel, Switzerland) 2017; 5(1). Medline
III Supportive (Green) Survival Patient ED-MD Lee CH., Van Gelder C., Burns K., Cone DC. Advanced cardiac life support and defibrillation in severe hypothermic cardiac arrest. Prehosp Emerg Care 2009; 13(1):85-9. Medline
III Supportive (Green) Survival Process ED-MD Little G. Accidental hypothermic cardiac arrest and rapid mediastinal warming with pleural lavage a survivor after 3.5 hours of manual CPR. BMJ case reports 2017; 2017. Medline
III Supportive (Green) Successful resuscitation without deficit Patient PH-Paramedic Schmidt U., Fritz KW., Kasperczyk W., Tscherne H. Successful resuscitation of a child with severe hypothermia after cardiac arrest of 88 minutes. Prehosp Disaster Med 1995; 10(1):60-2. Medline
III Supportive (Green) Successful resuscitation Patient ED-MD Thompson DA., Anderson N. Successful resuscitation of a severely hypothermic neonate. Ann Emerg Med 1994; 23(6):1390-1393. Medline
III Neutral (Yellow) Efficacy Patient Little G. Accidental hypothermic cardiac arrest and rapid mediastinal warming with pleural lavage: a survivor after 3.5 hours of manual CPR. BMJ case reports 2017. Medline
III Neutral (Yellow) Restoration of spontaneous circulation Patient ED-MD Sumann G., Krismer AC., Wenzel V., et al. Cardiopulmonary resuscitation after near drowning and hypothermia: Restoration of spontaneous circulation after vasopressin. Acta Anaesthesiol Scand 2003; 47(3):363-365. Medline
III Neutral (Yellow) Case report Patient ED-MD Wik L., Kiil S. Use of an automatic mechanical chest compression device (LUCAS) as a bridge to establishing cardiopulmonary bypass for a patient with hypothermic cardiac arrest. Resuscitation 2005; 66(3):391-394. Medline

Temperature Monitoring
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Sensitivity and Specificity Process Niven DJ., Gaudet JE., Laupland KB., Mrklas KJ., Roberts DJ., Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163:768-77. Medline

Transport to an ECMO capable facility
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Survival with good neurological outcome Process ED-MD Podsiadło P, Darocha T, Svendsen ØS, Kosiński S, Silfvast T, Blancher M, et al. Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review. Artif Organs 2020. Medline
III Neutral (Yellow) Survival Patient Other Gordon L, Ferris J, Pauli H. Rewarming from unwitnessed hypothermic cardiac arrest with good neurological recovery using extracorporeal membrane oxygenation. Perfusion Nov 2023; 38(8):1734-7. Medline
X Not Yet Graded (White) - Subedi A, Khanal K, Regmi A, et al. Hypothermic Cardiac Arrest: A Case Report of an Unexpected Survivor Using Air Medical Transportation in Nepal. Air Med J. March 2024; 43(2):171-3. Medline


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