Reported Resuscitation of a Hypothermic Avalanche Victim With Assisted Ventilation in 1939.

We present a historical case of a 12-year-old boy who survived a reported avalanche burial in 1939 in the Upper Peninsula of Michigan. The boy was completely buried for at least 3 h, head down, at a depth of about 1 m. He was extricated without signs of life and likely hypothermic by his father, who took him to his home. There, the father performed assisted ventilation for 3 hours using the Schäfer method, a historical method of artificial ventilation, without any specific rewarming efforts. The boy recovered neurologically intact. This case illustrates the importance of attempting resuscitation, possibly prolonged, of victims of hypothermia, even those who are apparently dead.

Problems and challenges in the early period of rehabilitating patients with severe hypothermia treated using ecmo support.

The objectives: To show and discuss the most frequent functional problems encountered in patients who underwent extracorporeal membrane oxygenation (ECMO) treatment after severe hypothermia and point out appropriate physiotherapy procedures used in order to diminish the effects of hypothermia on the human organism. It is necessary to look for effective physiotherapeutic solutions, especially that the number of scientific publications on the subject is very limited. DESIGN: Retrospective analysis Setting: Severe Accidental Hypothermia Center ( medical intensive care unit of a university hospital) Patients or participants: Nineteen patients who were qualified for ECMO in Severe Accidental Hypothermia Center Intervention: At least three times a day rehabilitation session (physiotherapeutic procedures adequate to patient problems) and interventions in case of emergency. Physiotherapy staff in the Center has regular work hours and night duties, so can provide round-the clock rehabilitation treatment adjusted to the dynamically changing clinical picture of the patient. METHODS AND RESULTS: We analyzed the group of patients who were treated in our center from July 2013 to March 2015. The degree of functional complications increased with the duration and extent of hypothermia and time of conducting extracorporeal therapy. The frequent problems were: respiratory failure due to sputum retention (25%) or sternum fracture due to resuscitation (25%), lower and upper extremity muscle weakening (75%), peroneal nerve palsy (25%). In the first period of hospitalization all of patients have generalised edema. As a result of the treatment and rehabilitation, full stabilization of the cardiovascular - respiratory system and full recovery of neurological functions was achieved in 14 persons (73.68%). CONCLUSION: early and round-the clock physiotherapy treatment adequate to appearing patient's syndromes seems crucial for his physical and mental recovery after severe accidental hypothermia treated by ECMO support. In order to attain therapeutic success, it is indispensable to work in experienced, multidisciplinary team.

Physiological and Perceived Effects of Forearm or Head Cooling During Simulated Firefighting Activity and Rehabilitation.

CONTEXT: Cooling devices aim to protect firefighters by attenuating a rise in body temperature. Devices for head cooling (HC) while firefighting and forearm cooling (FC) during rehabilitation (RHB) intervals are commonly marketed, but research regarding their efficacy is limited. OBJECTIVE: To investigate the physiological and perceived effects of HC and FC during firefighting drills and RHB. DESIGN: Randomized controlled clinical trial. SETTING: Firefighter training center. PATIENTS OR OTHER PARTICIPANTS: Twenty-seven male career firefighters (age = 39 ± 7 years; height = 169 ± 7 cm; weight = 95.4 ± 16.8 kg). INTERVENTION(S): Firefighters were randomly assigned to 1 condition: HC (n = 9), in which participants completed drills wearing a cold gel pack inside their helmet; FC (n = 8), in which participants sat on a collapsible chair with water-immersion arm troughs during RHB; or control (n = 10), in which participants used no cooling devices. Firefighters completed four 15-minute drills (D1-D4) wearing full bunker gear and breathing apparatus. Participants had a 15-min RHB after D2 (RHB1) and D4 (RHB2). MAIN OUTCOME MEASURE(S): Change (Δ) in gastrointestinal temperature (TGI), heart rate (HR), physiological strain index, and perceived thermal sensation. RESULTS: The TGI increased similarly in the HC and control groups, respectively (D1: 0.57°C ± 0.41°C, 0.73°C ± 0.30°C; D2: 0.92°C ± 0.28°C, 0.85°C ± 0.27°C; D3: -0.37°C ± 0.34°C, -0.01°C ± 0.72°C; D4: 0.25°C ± 0.42°C, 0.57°C ± 0.26°C; P > .05). The ΔHR, Δ physiological strain index, and Δ thermal sensation were similar between the HC and control groups during drills (P > .05). The FC group demonstrated a decreased TGI compared with the control group after RHB1 (-1.61°C ± 0.35°C versus -0.23°C ± 0.34°C; P < .001) and RHB2 (-1.40°C ± 0.38°C versus -0.38°C ± 0.24°C; P < .001). The physiological strain index score decreased in the FC group compared with the control group after RHB1 (-7.9 ± 1.3 versus -2.6 ± 1.7; P < .001) and RHB2 (-7.9 ± 1.6 versus -3.6 ± 1.1; P < .001), but no differences between groups were demonstrated for ΔHR or Δ thermal sensation (P > .05). CONCLUSIONS: The HC did not attenuate rises in physiological or perceptual variables during firefighting drills. The FC effectively reduced TGI and the physiological strain index score but not HR or thermal sensation during RHB. Clinicians and firefighters should not recommend the use of HC during firefighting but can consider using FC during RHB intervals in the field.

Neurological outcome scale for traumatic brain injury: III. Criterion-related validity and sensitivity to change in the NABIS hypothermia-II clinical trial.

The neurological outcome scale for traumatic brain injury (NOS-TBI) is a measure assessing neurological functioning in patients with TBI. We hypothesized that the NOS-TBI would exhibit adequate concurrent and predictive validity and demonstrate more sensitivity to change, compared with other well-established outcome measures. We analyzed data from the National Acute Brain Injury Study: Hypothermia-II clinical trial. Participants were 16-45 years of age with severe TBI assessed at 1, 3, 6, and 12 months postinjury. For analysis of criterion-related validity (concurrent and predictive), Spearman's rank-order correlations were calculated between the NOS-TBI and the glasgow outcome scale (GOS), GOS-extended (GOS-E), disability rating scale (DRS), and neurobehavioral rating scale-revised (NRS-R). Concurrent validity was demonstrated through significant correlations between the NOS-TBI and GOS, GOS-E, DRS, and NRS-R measured contemporaneously at 3, 6, and 12 months postinjury (all p<0.0013). For prediction analyses, the multiplicity-adjusted p value using the false discovery rate was <0.015. The 1-month NOS-TBI score was a significant predictor of outcome in the GOS, GOS-E, and DRS at 3 and 6 months postinjury (all p<0.015). The 3-month NOS-TBI significantly predicted GOS, GOS-E, DRS, and NRS-R outcomes at 6 and 12 months postinjury (all p<0.0015). Sensitivity to change was analyzed using Wilcoxon's signed rank-sum test of subsamples demonstrating no change in the GOS or GOS-E between 3 and 6 months. The NOS-TBI demonstrated higher sensitivity to change, compared with the GOS (p<0.038) and GOS-E (p<0.016). In summary, the NOS-TBI demonstrated adequate concurrent and predictive validity as well as sensitivity to change, compared with gold-standard outcome measures. The NOS-TBI may enhance prediction of outcome in clinical practice and measurement of outcome in TBI research.

[Cardiac arrest due to accidental hypothermia and prolonged cardiopulmonary resuscitation]. / Parada cardíaca por hipotermia accidental y resucitación cardiopulmonar prolongada.

In cardiac arrest produced by accidental hypothermia, cardiopulmonary resuscitation must be prolonged until normal body temperature is achieved. There are different rewarming methods. In theory, the more invasive ones are elective in patients with cardiac arrest because of their higher rewarming speed. However, it has not been proven that these methods are better than the non-invasive ones. We present a case report of a patient with cardiac arrest due to accidental hypothermia who was treated without interruption for three hours with heart massage. This is the longest successful cardiopulmonary resuscitation known up-to-date in Spain. In order to rewarm the body, a combination of non-invasive methods was used: active external rewarming with convective warm air, gastric and bladder lavage with warm saline solution and intravenous warm saline infusion. This case shows that it is possible to treat hypothermic cardiac arrest successfully through these rewarming methods, which are both easy to apply and feasible in any hospital.

La hipotermia / Hypothermia

Un profundo conocimiento sobre las causas y situaciones que predisponen a la hipotermia puede evitar su progresión y la aparición de complicaciones que comportan riesgo vital y deterioro orgánico irreversible. Los distintos niveles de la misma precisan un diagnóstico y abordaje terapéutico distinto compartiendo pilares comunes basados en: la instauración de medidas generales, que contrarresten el deterioro de los distintos órganos producidos por la pérdida de calor; y en medidas de recalentamiento interno o externo que variarán en función del grado de hipotermia y la estabilidad hemodinámica del paciente. El rol de enfermería en los casos de moderada y severa, como actividad de colaboración, presta especial atención a una estrecha monitorización de las constantes vitales, signos neurológicos, metabólicos y cardiorrespiratorios así como la colaboración en distintos procedimientos terapéuticos. La hipotermia como diagnóstico de enfermería se refiere a aquellas situaciones en las que la competencia profesional capacita para llevar a cabo actuaciones que resuelvan esta situación perjudicial para el individuo(AU)

A deep understanding about the causes and situations which predispose a patient to hypothermia can prevent its progression and the emergence of complications which present life-threatening risks and can lead to irreversible organ deterioration. The distinct degrees of hypothermia require a diagnosis and a distinct therapeutic treatment which share common pillars based on: the need to employ general measures which counterarrest the deterioration of those organs caused by heat loss; and the use of internal or external reheating methods which vary due to the degree of hypothermia and the hemodynamic stability of the patient. In moderate or severe cases, a nurse’s role, as one who collaborates in patient treatment, requires paying special attention to strict monitoring of vital constants, neurological, metabolic and cardio-respiratory signs, as well as collaborating in various therapeutic procedures. As a nursing diagnosis, hypothermia refers to those situations in which a nurse’s professional competence capacitates he/she to carry out actions which resolve that prejudicial situation a patient faces(AU)

Body cooling and the diving capabilities of muskrats (Ondatra zibethicus): a test of the adaptive hypothermia hypothesis.

We tested the hypothesis that immersion hypothermia enhances the diving capabilities of adult and juvenile muskrats by reducing rates of oxygen consumption (V O2). Declines in abdominal body temperature (T(b)) comparable to those observed in nature (0.5-3.5 degrees C) were induced by pre-chilling animals in 6 degrees C water. Pre-chilling did not reduce diving V O2 of any animal tested in 10 degrees C or 30 degrees C water, irrespective of the nature of the dive. Most behavioural indices of dive performance, including average and cumulative dive times, were unaffected by T(b) reduction in adults, but depressed in hypothermic juveniles (200-400 g). Hypothermia reduced diving heart rate only on short (<25s) dives (16% reduction, P=0.01), but did not affect the temporal onset of diving bradycardia. Post-immersion V O2 was higher for pre-chilled than for normothermic muskrats, but the difference became insignificant on longer (>90 s) dives. Our findings suggest that the mild hypothermia experienced by muskrats in nature has minimal effect on diving and post-immersion metabolic costs, and thus has little impact on the dive performance of this northern semi-aquatic mammal.

Cold injury amputees--a psychosocial problem?

The rehabilitation of 8 cold injury lower limb amputees is described, 7 of whom were alcoholic and had significant personality disorders. Delayed wound healing was the only common physical problem but the psychosocial difficulties were substantial and were the principal determinant of outcome following rehabilitation.

[Recovery from apparently hopeless fresh-water drowning (author's transl)]. / Uberleben bei scheinbar aussichtslosen Ertrinkungs-unfällen.

Report of 3 cases of drowning (children). 2 patients survived without severe injury, 1 patient died after 13 days. The protective action of hypothermia to the brain and heart in hypothermic drowning is emphasized. Even in apparently hopeless cases resuscitation should be started immediately and should not be discontinued too early. Especially in hypothermic drowning efforts can be successful after more than 60 min. of resuscitation. In cases of drowning an emergency physician should be called immediately (emergency-ambulance, rescue-helicopter). A short survey of pathologic physiology, emergency therapy and intensive care of drowning is given.