SUCCESSFUL RESUSCITATION FROM DEEP HYPOTH ERMIA AND DIABETIC COMA USING HEMOFILTRATION

A 41-year-old woman with severe juvenile diabetes mellitus suffered fr om profound hypothermia after loss of thermoregulation in diabetic ket oacidosis. She was found unconscious, without measurable blood pressur e; the electrocardiogram (ECG) showed bradycardia of 30/min and the re ctal temperature was 23.7-degrees-C. The patient received mechanical v entilation, fluid therapy, warmed gastric lavage, and, unfortunately, inotropic medication. She was transferred to a department of cardiac s urgery in order to continue the therapy with cardiopulmonary bypass (C PB). On arrival, the patient had a rectal temperature of 27.3-degrees- C, the ECG showed an absolute arrhythmia with a frequency of 70/min, a nd the blood pressure was 63/43 mmHg. We decided to use a rapidly avai lable but not highly invasive venovenous hemofiltration technique for slowly rewarming the patient. Vascular access was achieved by percutan eous femoral vein cannulation with a Shaldon catheter. The hemofiltrat ion system (Gambro AK-10, Gambro AB, Sweden) was instituted with a blo od flow rate of 200 ml/min. The hemofiltration monitor controls the pu mps for filtering and substituting fluid volumes and allows the infusi on solutions to be heated up to 40-degrees-C. Sinus rhythm resumed wit hout antiarrhythmic medications at a temperature of 29.5-degrees-C, an d within 8 h the patient was rewarmed to 35.5-degrees-C. After treatme nt of the adult respiratory distress syndrome caused by pneumonia, she was discharged from the intensive care unit to complete treatment wit h no evidence of any permanent organ damage. We conclude that hemofilt ration may be the method of choice for rewarming deeply hypothermic pa tients when their circulation is preserved. Under these circumstances, it is preferable to external rewarming techniques, as it avoids the d isadvantages of temperature afterdrop and rewarming shock. Rewarming r ates of 1.5-degrees-C/h seem to be adequate. Hemofiltration systems ar e more widespread, less invasive, and easier to handle compared to CPB techniques, which should be preferred in situations of prolonged unsu ccessful cardiopulmonary resuscitation with cardiac arrest and deep co re temperatures.