Impact of rescue collapse on mortality rate in severe accidental hypothermia: A matched-pair analysis

Paweł Podsiadło; Agata Smoleń; Sylweriusz Kosiński; Hubert Hymczak; Szymon Waligórski; Anna Witt-Majchrzak; Dominik Drobiński; Ewelina Nowak; Barbara Barteczko-Grajek; Krzysztof Toczek; Radomir Skowronek; Tomasz Darocha

doi:10.1016/j.resuscitation.2021.04.019

Impact of rescue collapse on mortality rate in severe accidental hypothermia: A matched-pair analysis

Resuscitation. 2021 Jul:164:108-113. doi: 10.1016/j.resuscitation.2021.04.019. Epub 2021 Apr 27.

Affiliations

¹ Institute of Medical Sciences, Jan Kochanowski University, Kielce, Poland.
² Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Poland.
³ Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
⁴ Department of Anaesthesiology and Intensive Care, John Paul II Hospital, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.
⁵ Department of Cardiosurgery, Pomeranian Medical University, Szczecin, Poland.
⁶ Department of Cardiac Surgery Provincial Specialist Hospital, Olsztyn, Poland.
⁷ Cardiosurgery Clinic and Department of Cardiac Anaesthesia, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland.
⁸ Institute of Health Sciences, Jan Kochanowski University, Kielce, Poland.
⁹ Department and Clinic of Anaesthesiology and Intensive Care, Wrocław Medical University, Wrocław, Poland.
¹⁰ Department of Cardiac Surgery, 4th Military Hospital, Wrocław, Poland.
¹¹ Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland.
¹² Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland. Electronic address: tomekdarocha@wp.pl.

PMID: 33930504
DOI: 10.1016/j.resuscitation.2021.04.019

Abstract

Aim: To assess the impact of the occurrence of cardiac arrest associated with initial management on the outcome of severely hypothermic patients who were rewarmed with Extracorporeal Life Support (ECLS).

Methods: We collected the individual data of patients in a state of severe accidental hypothermia who were found with spontaneous circulation and rewarmed with ECLS, from cardiac surgery departments. Patients were divided into two groups: those with a subsequent cardiac arrest (RC group); and those with the retained circulation (HT3 group), and compared by using a matched-pair analysis. The mortality rates and the neurological status in survivors were compared as the main outcomes. The difference in the risk of death between the HT3 and RC groups was calculated.

Results: A total of 124 patients were included into the study: 45 in the HT3 group and 79 in the RC group. The matched cohorts consisted of 45 HT3 patients and 45 RC patients. The mortality rate in both groups was 24% and 49% (p = 0.02) respectively; the relative risk of death was 2.0 (p = 0.02). ICU length of stay was significantly longer in the RC group (p < 0.001). Factors associated with survival in the HT3 group included patient age, rewarming rate, and blood BE; while in the RC group, patient age and lactate concentration.

Conclusions: The occurrence of rescue collapse is linked to a doubling of the risk of death in severely hypothermic patients. Procedures which are known as potential triggers of rescue collapse should be performed with special attention, including in conscious patients.

Keywords: Accidental hypothermia; Cardiac arrest; Cardiopulmonary resuscitation; Extracorporeal rewarming; Rescue collapse.

MeSH terms

Cardiopulmonary Resuscitation*
Heart Arrest* / therapy
Humans
Hypothermia* / therapy
Matched-Pair Analysis
Rewarming