Successful Resuscitation from Deep Hypothermia and Diabetic Coma Using Hemofiltration

Author(s): Abel, M., Zimmermann, R., Ruskowski, H.

Journal/Book: Anaesthesist. 1994; 43: 175 Fifth Ave, New York, NY 10010. Springer Verlag. 750-752.

Abstract: A 41-year-old woman with severe juvenile diabetes mellitus suffered from profound hypothermia after loss of thermoregulation in diabetic ketoacidosis. She was found unconscious, without measurable blood pressure; the electrocardiogram (ECG) showed bradycardia of 30/min and the rectal temperature was 23.7-degrees-C. The patient received mechanical ventilation, fluid therapy, warmed gastric lavage, and, unfortunately, inotropic medication. She was transferred to a department of cardiac surgery in order to continue the therapy with cardiopulmonary bypass (CPB). 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, and the blood pressure was 63/43 mmHg. We decided to use a rapidly available but not highly invasive venovenous hemofiltration technique for slowly rewarming the patient. Vascular access was achieved by percutaneous femoral vein cannulation with a Shaldon catheter. The hemofiltration system (Gambro AK-10, Gambro AB, Sweden) was instituted with a blood flow rate of 200 ml/min. The hemofiltration monitor controls the pumps for filtering and substituting fluid volumes and allows the infusion solutions to be heated up to 40-degrees-C. Sinus rhythm resumed without antiarrhythmic medications at a temperature of 29.5-degrees-C, and within 8 h the patient was rewarmed to 35.5-degrees-C. After treatment of the adult respiratory distress syndrome caused by pneumonia, she was discharged from the intensive care unit to complete treatment with no evidence of any permanent organ damage. We conclude that hemofiltration may be the method of choice for rewarming deeply hypothermic patients when their circulation is preserved. Under these circumstances, it is preferable to external rewarming techniques, as it avoids the disadvantages of temperature afterdrop and rewarming shock. Rewarming rates of 1.5-degrees-C/h seem to be adequate. Hemofiltration systems are more widespread, less invasive, and easier to handle compared to CPB techniques, which should be preferred in situations of prolonged unsuccessful cardiopulmonary resuscitation with cardiac arrest and deep core temperatures.

Note: Article K Hekmat, Univ Cologne, Herzchirurg Klin & Poliklin, Joseph Stelzmannstr 9, D-50924 Cologne, Germany

Keyword(s): Accidental Hypothermia; Diabetic Comahaemofiltration; Resuscitation; ACCIDENTAL HYPOTHERMIA; EXTRACORPOREAL-CIRCULATION; ARREST

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