Elsevier

Resuscitation

Volume 76, Issue 2, February 2008, Pages 311-313
Resuscitation

Case report
Therapeutic hypothermia induced during cardiopulmonary resuscitation using large-volume, ice-cold intravenous fluid

https://doi.org/10.1016/j.resuscitation.2007.07.017Get rights and content

Summary

Introduction

Therapeutic hypothermia after resuscitation improves outcome following prolonged out-of-hospital cardiac arrest. Laboratory studies suggest that this therapy may improve outcome further when induced during cardiopulmonary resuscitation. We report a case where therapeutic hypothermia was induced during cardiopulmonary resuscitation using large-volume (40 mL/kg), ice-cold (4 °C) intravenous fluid.

Design

Case report.

Setting

A tertiary level hospital in Victoria, Australia.

Case report

The patient suffered a cardiac arrest secondary to pericardial tamponade following right ventricular perforation during cardiac catheterisation. Percutaneous needle drainage was unsuccessful and open drainage via a left emergency thoracotomy was performed. Therapeutic hypothermia during cardiopulmonary resuscitation was induced using of a rapid infusion of large-volume (40 mL/kg), ice-cold (4 °C) crystalloid fluid. A spontaneous circulation was restored after 37 min of cardiac arrest. The patient made a satisfactory neurological recovery.

Conclusion

Treatment with a rapid intravenous infusion of large-volume (40 mL/kg), ice-cold (4 °C) fluid during cardiopulmonary resuscitation induces mild hypothermia and may provide neurological protection. Further clinical studies of this approach are warranted.

Introduction

Treatment with mild hypothermia (33 °C) induced after cardiopulmonary resuscitation (CPR) is recommended for treatment of neurological injury following prolonged out-of-hospital cardiac arrest,1, 2 based on the findings of two randomised, controlled clinical trials.3, 4 However, the optimal timing and technique of induction of hypothermia remain uncertain. Laboratory studies in animal models have suggested that outcomes may be further improved if hypothermia is induced during CPR.5, 6

One possible technique for the induction of hypothermia during CPR is a rapid intravenous infusion (>100 mL/min) of large-volume (40 mL/kg), ice-cold (4 °C) crystalloid fluid (LVICF). Preliminary clinical experience with LVICF after CPR suggests that this approach decreases core temperature without pulmonary oedema.7, 8, 9, 10, 11 Unlike surface cooling, this treatment would be feasible if given during CPR, however there have been no previous reports of this treatment. Here, we report the case of a patient who had therapeutic hypothermia induced using LVICF during prolonged CPR to provide neurological protection.

Section snippets

Case report

A 60-year-old 72 kg female was admitted for investigation of hypoxaemia. Three weeks earlier, the patient had undergone right upper lobectomy for carcinoma. The post-operative care had been complicated by persistent pulmonary infection and mild hypoxaemia. The patient was discharged to a sub-acute care facility on day 14. However, the hypoxaemia persisted and the patient was readmitted to hospital for further investigation.

A number of investigations to evaluate the cause of hypoxaemia were

Discussion

This case is the first clinical report of hypothermia induced during CPR using a rapid infusion (150 mL/min) of large-volume (40 mL/kg), ice-cold crystalloid fluid in a patient with prolonged cardiac arrest. The duration of the cardiac arrest was reliably documented as 37 min, with no external chest compressions performed for at least 10 min of the arrest during attempts at percutaneous needle drainage. This duration of cardiac arrest would be expected to cause significant neurological injury.

Conflict of interest

None.

References (14)

There are more references available in the full text version of this article.

Cited by (37)

  • Prehospital therapeutic hypothermia after out-of-hospital cardiac arrest: a systematic review and meta-analysis

    2016, American Journal of Emergency Medicine
    Citation Excerpt :

    Animal studies proved that initiating hypothermia during CPR was better than cooling after ROSC for both survival and neurological outcomes [8,23]. A case report showed that using ice-cold fluid during cardiopulmonary resuscitation decreased body temperature and provided neurological protection [24]. Second, the optimal target temperature was not achieved by prehospital cooling because of the short transport time and limited cold liquid.

  • Part 8: Advanced life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

    2010, Resuscitation
    Citation Excerpt :

    One study indicated that ED thoracotomy may be especially beneficial if gross blood causes clotting and blocking of a pericardiocentesis needle (LOE 2).716 Two studies indicated that emergency thoracotomy may also be beneficial in patients who have postprocedure complications (LOE 4).682,717 One study indicated that a more definitive sternotomy or thoracotomy in an operating room may also be beneficial if transportation to the operating room does not introduce significant delay (LOE 5).718

  • Cardio-respiratory reanimation: The brain is the target organ

    2010, Current Anaesthesia and Critical Care
  • Therapeutic hypothermia for heart attack: Yes, we can

    2009, Revista Espanola de Cardiologia
View all citing articles on Scopus

A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.07.017.

View full text