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March 28, 1980, Vol 243, No. 12 >
ARTICLE | March 28, 1980

Recovery After Prolonged Asystolic Cardiac Arrest in Profound Hypothermia: Title and subTitle BreakA Case Report and Literature Review FREE

Frederick S. Southwick, MD; Preston H. Dalglish, Jr, MD
[+] Author Affiliations

Reprint requests to Cox 6, Massachusetts General Hospital, Boston, MA 02114 (Dr Southwick).


JAMA. 1980;243(12):1250-1253. doi:10.1001/jama.1980.03300380030017
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References

Asystole can be the presenting ECG finding in accidental hypothermia when the core temperature is less than 28 °C. Even two hours of persistent asystole does not represent irreversible cardiac compromise. With cardiopulmonary support and active rewarming, resuscitation and survival without serious sequelae can be achieved. Case reports and electrophysiology studies suggest that asystole is a primary manifestation of hypothermia potentiated by carbon dioxide retention. However, ventricular fibrillation in this setting is probably a secondary complication of resuscitation efforts, being precipitated by hypocapnic alkalosis, physical manipulation of the heart, and rewarming.

(JAMA 243:1250-1253, 1980)

REFERENCES

1 +
Fell RH, Gunning AJ, Bardhan KD, et al:  Severe hypothermia as a result of barbiturate overdose complicated by cardiac arrest . Lancet 1:392-394, 1968;.
2 +
Linton AL, Ledingham IM:  Severe hypothermia with barbiturate intoxication . Lancet 1:24-26, 1966;.
3 +
Towne WD, Geiss WP, Yanes HO, et al:  Intractable ventricular fibrillation associated with profound accidental hypothermia . N Engl J Med 287:1135-1136, 1972;.
4 +
Wickstrom P, Rulz E, Lilja GP, et al:  Accidental hypothermia . Am J Surg 131:622-625, 1976;.
5 +
Truscott DG, Firor WB, Clein LJ:  Accidental profound hypothermia . Arch Surg 106:216-218, 1973;.
6 +
O'Keeffe KM:  Accidental hypothermia, a review of 62 cases . JACEP 6:491-495, 1977;.
7 +
Lash RF, Burdette JA, Ozdil T:  Accidental profound hypothermia and barbiturate intoxication . JAMA 201:269-270, 1967;.
8 +
Bristow G, Smith R, Lee J, et al:  Resuscitation from cardiopulmonary arrest during accidental hypothermia due to exhaustion and exposure . Can Med Assoc J 117:247-249, 1977;.
9 +
Welton DE, Mattox KL, Miller RR, et al:  Treatment of profound hypothermia . JAMA 240:2291-2292, 1978;.
10 +
Reuler JB:  Hypothermia: Pathophysiology, clinical settings and management . Ann Intern Med 89:519-527, 1978;.
11 +
Niazi SA, Lewis FJ:  Profound hypothermia in the monkey with recovery after long periods of cardiac standstill . J Appl Physiol 10:137-138, 1957;.
12 +
Niazi SA, Lewis FJ:  Profound hypothermia in man . Ann Surg 147:264-266, 1958;.
13 +
Barratt-Boyes BG, Simpson M, Neutze JM:  Intracardiac surgery in neonates and infants using deep hypothermia with surface cooling and limited cardiopulmonary bypass . Circulation 43( (suppl 1) ):25-30, 1971;.
14 +
Weyman AE, Greenbaum DM, Grace WJ:  Accidental hypothermia in an alcoholic population . Am J Med 56:13-21, 1974;.
15 +
Dominquez De Villota E, Barat G, Peral P, et al:  Recovery from profound hypothermia with cardiac arrest after immersion . Br Med J 4:394-395, 1973;.
16 +
Siebke H, Rod T, Breivik H, et al:  Survival after forty minutes submersion without cerebral sequelae . Lancet 1:1275-1277, 1975;.
17 +
Jessen K, Hagelsten JO:  Peritoneal dialysis in the treatment of profound accidental hypothermia . Aviat Space Environ Med 49:426-429, 1978;.
18 +
Hoffman BF:  Temperature effects on cardiac transmembrane potentials , in Dripps RD (ed): Physiology of Induced Hypothermia . Washington, DC, National Academy of Sciences, National Research Council, 1956;, pp 302-324.
19 +
Hegnauer AH, Covino BG:  Myocardial irritability in experimental immersion hypothermia , in Dripps RD (ed): Physiology of Induced Hypothermia . Washington, DC, National Academy of Sciences, National Research Council, 1956;, pp 327-340.
20 +
Lewis FJ:  Hypothermia . Int Abstracts Surg 113:307-336, 1961;.
21 +
Ritterhouse EA, Mohri H, Dillard DH, et al:  Deep hypothermia in cardiovascular surgery . Ann Thorac Surg 17:63-98, 1974;.
22 +
Han J, Moe GK:  Nonuniform recovery of excitability in ventricular muscle . Circulation Res 14:44-49, 1964;.
23 +
Covino BG, D'Amato HE:  Mechanism of ventricular fibrillation in hypothermia . Circulation Res 10:148-155, 1962;.
24 +
Coraboeuf E, Boistel J:  L'action des taux eleves de gaz carbonique sur le tissue cardiaque etudiee a l'aide de microelectrodes intracellulaires . C R Soc Biol 147:654-658, 1953;.
25 +
Brown EB, Miller F:  Ventricular fibrillation following rapid fall in alveolar carbon dioxide concentration . Am J Physiol 169:56-60, 1952;.
26 +
Lewis FJ, in Dripps RD (ed): Physiology of Induced Hypothermia . Washington, DC, National Academy of Sciences, National Research Council, 1956;, pp 340-344.
27 +
Reuler JB, Parker RA:  Peritoneal dialysis in the management of hypothermia . JAMA 240:2289-2290, 1978;.
28 +
Gregory RT, Patton JF:  Treatment after exposure to cold . Lancet 1:377, 1972;.

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1 +
Fell RH, Gunning AJ, Bardhan KD, et al:  Severe hypothermia as a result of barbiturate overdose complicated by cardiac arrest . Lancet 1:392-394, 1968;.
2 +
Linton AL, Ledingham IM:  Severe hypothermia with barbiturate intoxication . Lancet 1:24-26, 1966;.
3 +
Towne WD, Geiss WP, Yanes HO, et al:  Intractable ventricular fibrillation associated with profound accidental hypothermia . N Engl J Med 287:1135-1136, 1972;.
4 +
Wickstrom P, Rulz E, Lilja GP, et al:  Accidental hypothermia . Am J Surg 131:622-625, 1976;.
5 +
Truscott DG, Firor WB, Clein LJ:  Accidental profound hypothermia . Arch Surg 106:216-218, 1973;.
6 +
O'Keeffe KM:  Accidental hypothermia, a review of 62 cases . JACEP 6:491-495, 1977;.
7 +
Lash RF, Burdette JA, Ozdil T:  Accidental profound hypothermia and barbiturate intoxication . JAMA 201:269-270, 1967;.
8 +
Bristow G, Smith R, Lee J, et al:  Resuscitation from cardiopulmonary arrest during accidental hypothermia due to exhaustion and exposure . Can Med Assoc J 117:247-249, 1977;.
9 +
Welton DE, Mattox KL, Miller RR, et al:  Treatment of profound hypothermia . JAMA 240:2291-2292, 1978;.
10 +
Reuler JB:  Hypothermia: Pathophysiology, clinical settings and management . Ann Intern Med 89:519-527, 1978;.
11 +
Niazi SA, Lewis FJ:  Profound hypothermia in the monkey with recovery after long periods of cardiac standstill . J Appl Physiol 10:137-138, 1957;.
12 +
Niazi SA, Lewis FJ:  Profound hypothermia in man . Ann Surg 147:264-266, 1958;.
13 +
Barratt-Boyes BG, Simpson M, Neutze JM:  Intracardiac surgery in neonates and infants using deep hypothermia with surface cooling and limited cardiopulmonary bypass . Circulation 43( (suppl 1) ):25-30, 1971;.
14 +
Weyman AE, Greenbaum DM, Grace WJ:  Accidental hypothermia in an alcoholic population . Am J Med 56:13-21, 1974;.
15 +
Dominquez De Villota E, Barat G, Peral P, et al:  Recovery from profound hypothermia with cardiac arrest after immersion . Br Med J 4:394-395, 1973;.
16 +
Siebke H, Rod T, Breivik H, et al:  Survival after forty minutes submersion without cerebral sequelae . Lancet 1:1275-1277, 1975;.
17 +
Jessen K, Hagelsten JO:  Peritoneal dialysis in the treatment of profound accidental hypothermia . Aviat Space Environ Med 49:426-429, 1978;.
18 +
Hoffman BF:  Temperature effects on cardiac transmembrane potentials , in Dripps RD (ed): Physiology of Induced Hypothermia . Washington, DC, National Academy of Sciences, National Research Council, 1956;, pp 302-324.
19 +
Hegnauer AH, Covino BG:  Myocardial irritability in experimental immersion hypothermia , in Dripps RD (ed): Physiology of Induced Hypothermia . Washington, DC, National Academy of Sciences, National Research Council, 1956;, pp 327-340.
20 +
Lewis FJ:  Hypothermia . Int Abstracts Surg 113:307-336, 1961;.
21 +
Ritterhouse EA, Mohri H, Dillard DH, et al:  Deep hypothermia in cardiovascular surgery . Ann Thorac Surg 17:63-98, 1974;.
22 +
Han J, Moe GK:  Nonuniform recovery of excitability in ventricular muscle . Circulation Res 14:44-49, 1964;.
23 +
Covino BG, D'Amato HE:  Mechanism of ventricular fibrillation in hypothermia . Circulation Res 10:148-155, 1962;.
24 +
Coraboeuf E, Boistel J:  L'action des taux eleves de gaz carbonique sur le tissue cardiaque etudiee a l'aide de microelectrodes intracellulaires . C R Soc Biol 147:654-658, 1953;.
25 +
Brown EB, Miller F:  Ventricular fibrillation following rapid fall in alveolar carbon dioxide concentration . Am J Physiol 169:56-60, 1952;.
26 +
Lewis FJ, in Dripps RD (ed): Physiology of Induced Hypothermia . Washington, DC, National Academy of Sciences, National Research Council, 1956;, pp 340-344.
27 +
Reuler JB, Parker RA:  Peritoneal dialysis in the management of hypothermia . JAMA 240:2289-2290, 1978;.
28 +
Gregory RT, Patton JF:  Treatment after exposure to cold . Lancet 1:377, 1972;.

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