OUTCOME OF SURVIVORS OF ACCIDENTAL DEEP HYPOTHERMIA AND CIRCULATORY ARREST TREATED WITH EXTRACORPOREAL BLOOD WARMING

Background Cardiopulmonary bypass has been used to rewarm victims of a ccidental deep hypothermia. Unlike other rewarming techniques, it rest ores organ perfusion immediately in patients with inadequate circulati on. This study evaluated the long-term outcome of survivors of acciden tal deep hypothermia with circulatory arrest who had been rewarmed wit h cardiopulmonary bypass. Methods Deep hypothermia (core temperature, <28 degrees C) with circulatory arrest was found in 46 of 234 patients with accidental hypothermia. In 32 of the 46 patients, rewarming with cardiopulmonary bypass was attempted, resulting in 15 long-term survi vors. In most of these patients, deep hypothermia developed after moun taineering accidents or suicide attempts. After an average (+/-SD) of 6.7+/-4.0 years of follow-up, we obtained the patients' medical histor ies and performed neurologic and neuropsychological examinations, neur ovascular ultrasound studies, electroencephalography, and magnetic res onance imaging of the brain. Results The average age of the patients w as 25.2+/-9.9 years; seven were female and eight were male. The mean i nterval from discovery of the pa tient to rewarming with cardiopulmona ry bypass was 141+/-50 minutes (range, 30 to 240). At follow-up there were no hypothermia-related sequelae that impaired quality of life. Ne urologic and neuropsychological deficits observed in the early period after rewarming had fully or almost completely disappeared. One patien t had cerebellar atrophy on magnetic resonance imaging with mild clini cal signs, a condition that may have been caused by hypothermia. Other clinical abnormalities were either preexisting or due to injuries not related to hypothermia. Conclusions This clinical experience demonstr ates that young, otherwise healthy people can survive accidental deep hypothermia with no or minimal cerebral impairment, even with prolonge d circulatory arrest. Cardiopulmonary bypass appears to be an efficaci ous rewarming technique. (C) 1997, Massachusetts Medical Society.