Severe hypothermia with cardiac arrest: Complete neurologic recovery in a 4-year-old child

A 4-year-old girl was lost for 17 hours in a snowstorm. Upon discovery, her core temperature was 72 degreesF (22 degreesC). While undergoing endotrach eal intubation in the emergency department, she experienced sudden ventricu lar fibrillation and cardiac arrest. Closed chest cardiopulmonary resuscita tion (CPR) was instituted, and standard rewarming measures were begun. Desp ite this, neither core temperature, nor the patient's arrhythmia, changed. An infraumbilical "mini-laparotomy" incision was made, with placement of a large silicone peritoneal dialysis catheter into the abdomen. This was then connected to a rapid infuser device, with the delivery of 1L of warmed, no rmal saline every 90 seconds. The core temperature reached 29 degreesC in 1 5 minutes, and a palpable pulse was detected. Lavage was continued until co re temperature reached 34 degreesC, at which time transport to the pediatri c intensive care unit was arranged. She was extubated the next day and disc harged home, on the fourth hospital day, with apparent complete neurologic recovery. This is the first report of the successful use of rapid high-volu me peritoneal lavage for the treatment of accidental severe hypothermia in a pediatric patient. Copyright (C) 2001 by W.B. Saunders Company.