Outcomes of Extracorporeal Life Support Use in Accidental Hypothermia: A Systematic Review.
Publication/Presentation Date
12-1-2020
Abstract
BACKGROUND: Extracorporeal life support (ECLS) has been used in the treatment of accidental hypothermia with hemodynamic instability, with promising outcomes. This systematic review examines ECLS treatment of accidental hypothermia to assess outcomes.
METHODS: An electronic search was performed to identify articles reporting ECLS use for treatment of accidental hypothermia. Only reports describing patients aged more than 16 years after January 1, 2005, were included. Nineteen studies were identified comprising 47 patients. Demographic information, perioperative variables, and outcomes were extracted for analysis.
RESULTS: Median patient age was 48 years (interquartile range (IQR), 29 to 56), and 72.3% (34 of 47) were male. On presentation, median body temperature was 24.6°C (IQR, 22.2° to 26°C), median potassium level 4.3 mmol/L (IQR, 3.4 to 4.6 mmol/L), and median Glasgow Coma Scale score 3 (IQR, 3 to 7). Cardiac arrest occurred in 35 of 47 patients (74.5%). Median time to ECLS initiation from scene was 155 minutes (IQR, 113 to 245). Median ECLS duration was 18 hours (IQR, 4 to 27), with median rewarming rate of 2°C per hour (IQR, 1.5° to 4°). Median intensive care unit stay and hospital length of stay were 8 days (IQR, 2 to 16) and 17 days (IQR, 10 to 36), respectively. Inhospital mortality was 19.1% (9 of 47). Median discharge Glasgow Coma Scale score was 15 (IQR, 15 to 15) with minor long-term cognitive impairments noted in 6 of 47 patients (19.4%). Survival was significantly associated with potassium on presentation (P < .001), initial body temperature (P < .001), and ECLS rewarming rate (P < .001).
CONCLUSIONS: Extracorporeal life support is a viable cardiac support option for rewarming patients with accidental hypothermia, and initial potassium level, initial body temperature, and ECLS rewarming rate appear to be significantly associated with survival.
Volume
110
Issue
6
First Page
1926
Last Page
1932
ISSN
1552-6259
Published In/Presented At
Austin, M. A., Maynes, E. J., O'Malley, T. J., Mazur, P., Darocha, T., Entwistle, J. W., Guy, T. S., Massey, H. T., Morris, R. J., & Tchantchaleishvili, V. (2020). Outcomes of Extracorporeal Life Support Use in Accidental Hypothermia: A Systematic Review. The Annals of thoracic surgery, 110(6), 1926–1932. https://doi.org/10.1016/j.athoracsur.2020.04.076
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
32504609
Department(s)
Administration and Leadership
Document Type
Article