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July 15, 1988, Vol 260, No. 3 >
ARTICLE | July 15, 1988

The Use of Extracorporeal Rewarming in a Child Submerged for 66 Minutes FREE

Robert G. Bolte, MD; Philip G. Black, MD; Robert S. Bowers, CCP; J. Kent Thorne, MD; Howard M. Corneli, MD
[+] Author Affiliations

Reprint requests to Emergency Services, Primary Children's Medical Center, 32012th Ave, Salt Lake City, UT 84103 (Dr Bolte).


JAMA. 1988;260(3):377-379. doi:10.1001/jama.1988.03410030093036
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Article
References

A 2 1/2year-old girl had a good neurologic recovery after submersion in cold water for at least 66 minutes; as far as we know, this is the longest time ever reported. Cardiopulmonary resuscitation was maintained for more than two hours before the initiation of extracorporeal rewarming in this child who had a core temperature of 19°C. To our knowledge, this is the first successful use of extracorporeal rewarming in a child suffering from accidental hypothermia. Extension of this technique to children offers rapid rewarming and cardiovascular support for pediatric victims of severe hypothermia. We emphasize the importance of a coordinated response by the entire emergency medical system integrated with hospital-based personnel. Where it is geographically feasible, regionalization of triage and care for the pediatric victim of severe accidental hypothermia should be considered.

(JAMA 1988;260:377-379)

REFERENCES

1 +
Derbyshire DR, Clark RG:  Cerebral recovery after prolonged global brain ischemia . Lancet 1980;;2:637.
2 +
Kugelberg J, Schuller H, Berg B, et al:  Treatment of accidental hypothermia . Scand J Thorac Cardiovasc Surg 1967;;1:142-146.
3 +
Fell RH, Gunning AJ, Bardhan KD, et al:  Severe hypothermia as a result of barbiturate overdose complicated by cardiac arrest . Lancet 1968;;1:392-394.
4 +
Truscott DG, Firor WB, Clein LJ:  Accidental profound hypothermia: Successful resuscitation by core rewarming and assisted circulation . Arch Surg 1973;;106:216-218.
5 +
Althaus U, Aeberhard P, Schupbach P, et al:  Management of profound accidental hypothermia with cardiorespiratory arrest . Ann Surg 1982;; 195:492-495.
6 +
Thorpe AD, White DE:  Accidental hypothermia treated by cardiopulmonary bypass . ICPS Digest 1986;;1:3-8.
7 +
Wickstrom P, Ruiz E, Lilja GP, et al:  Accidental hypothermia: Core rewarming with partial bypass . Am J Surg 1976;;131:622-625.
8 +
Towne WD, Geiss WP, Yanes HO:  Intractable ventricular fibrillation associated with profound accidental hypothermia: Successful treatment with partial cardiopulmonary bypass . N Engl J Med 1972;;287:1135-1136.
9 +
Baker SP, O'Neill B, Karpf RS:  Drowning , in Baker SP, O'Neill B, Karpf RS (eds): The Injury Fact Book . Lexington, Mass, DC Heath & Co, 1984;, pp 155-165.
10 +
Orlowski JP:  Drowning, near-drowning, and ice-water submersions . Pediatr Clin North Am 1987;;34:75-92.
11 +
Conn AW, Barker GA, Edmonds JF, et al:  Submersion hypothermia and near-drowning , in Pozos RS, Wittmers LE Jr (eds): The Nature and Treatment of Hypothermia . Minneapolis, University of Minnesota Press, 1983;, pp 152-164.
12 +
Young RSK, Zalneraitis EL, Dooling EC:  Neurological outcome in cold water drowning . JAMA 1980;;244:1233-1235.
13 +
Southwick FS, Dalglish PH Jr:  Recovery after prolonged asystolic cardiac arrest in profound hypothermia . JAMA 1980;;243:1250-1253.
14 +
Danzl DF, Pozos RS:  Multicenter hypothermia survey . Ann Emerg Med 1987;;16:1042-1055.
15 +
Jessen K, Hagelsten JO:  Peritoneal dialysis in the treatment of profound accidental hypothermia . Aviat Space Environ Med 1978;;49:426-429.
16 +
Klarskov P, Amter F:  Hypothermia following submersion corrected by peritoneal dialysis . Ugeskr Laeg 1976;;138:1937-1940.
17 +
De Villota ED, Barat G, Peral P, et al:  Recovery from profound hypothermia with cardiac arrest after immersion . Br Med J 1973;;17:394-395.
18 +
Reuler JB:  Hypothermia: Pathophysiology, clinical settings, and management . Ann Intern Med 1978;;89:519-527.
19 +
Wong KC:  Physiology and pharmacology of hypothermia . West J Med 1983;;138:227-232.
20 +
Feldman KW, Morray JP, Schaller RT:  Thermal injury caused by hot pack application in hypothermic children . Am J Emerg Med 1985;;3:38-41.
21 +
Abramowicz M (ed):  Treatment of hypothermia . Med Lett Drugs Ther 1983;;25:9-11.
22 +
Martin TG:  Neardrowning and cold water immersion . Ann Emerg Med 1984;;13:263-273.
23 +
Harries MG, Golden FC, Fowler M:  Ventricular fibrillation as a complication of salt-water immersion . Br Med J 1981;;283:347-348.
24 +
O'Keeffe KM:  Accidental hypothermia: A review of 62 cases . J Am Coll Emerg Phys 1977;;6:491-496.
25 +
Mahajan S, Myers TJ, Baldini MG:  Disseminated intravascular coagulation during rewarming following hypothermia . JAMA 1981;;245:2517-2518.
26 +
Kirklin JW, Barratt-Boyes BG:  Hypothermia, circulatory arrest, and cardiopulmonary bypass , in Kirklin JW, Barratt-Boyes BG (eds): Cardiac Surgery: Morphology, Diagnostic Criteria, Natural History, Techniques, Results, and Indications . New York, John Wiley & Sons Inc, 1986;, pp 29-76.
27 +
Sloan REG, Keatinge WR:  Cooling rates of young people swimming in cold water . J Appl Physiol 1973;;35:371-375.
28 +
Gooden BA:  Drowning and the diving reflex in man . Med J Aust 1972;;2:583-587.
29 +
Hayward JS, Hay C, Matthews BR, et al:  Temperature effect on the human dive response in relation to cold water near-drowning . J Appl Physiol 1984;;56:202-206.
30 +
Wittmers LE Jr, Pozos RS, Fall G, et al:  Cardiovascular responses to face immersion (the diving reflex) in human beings after alcohol consumption . Ann Emerg Med 1987;;16:1031-1036.
31 +
Conn AW, Barker GA:  Fresh water drowning and near-drowning: An update . Can Anaesth Soc J 1984;;31:S38-S44.
32 +
Ornato JP:  The resuscitation of near-drowning victims . JAMA 1986;;256:75-77.
33 +
Stern WE, Good RG:  Studies on the effect of hypothermia upon cerebrospinal fluid, oxygen tension, and carotid blood flow . Surgery 1960;;48:13-30.
34 +
Kopf G, Mirvis D, Meyers R:  Central nervous system tolerance to cardiac arrest during profound hypothermia . J Surg Res 1975;;18:29-34.
35 +
Stevenson JG, Stone EF, Dillard DH, et al:  Intellectual development of children subjected to prolonged circulatory arrest during hypothermic open heart surgery in infancy . Circulation 1974;;49 and 50( (suppl 2) ):54-59.
36 +
Wagner HR, Subramanian S:  Deep hypothermia in infant cardiac surgery . Pediatrics 1978;;61:479-483.
37 +
Cales RH:  Trauma mortality in Orange County: The effect of implementation of a regional trauma system . Ann Emerg Med 1984;;13:1-10.
38 +
Clemmer TP, Orme JF, Thomas F, et al:  Prospective evaluation of the CRAMS scale for triaging major trauma . J Trauma 1985;;25:188-191.
39 +
Seuffert G:  An Alaskan experience with cardiopulmonary bypass in resuscitating patients with profound hypothermia and cardiac arrest . Alaska Med 1984;;26:31-33.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Derbyshire DR, Clark RG:  Cerebral recovery after prolonged global brain ischemia . Lancet 1980;;2:637.
2 +
Kugelberg J, Schuller H, Berg B, et al:  Treatment of accidental hypothermia . Scand J Thorac Cardiovasc Surg 1967;;1:142-146.
3 +
Fell RH, Gunning AJ, Bardhan KD, et al:  Severe hypothermia as a result of barbiturate overdose complicated by cardiac arrest . Lancet 1968;;1:392-394.
4 +
Truscott DG, Firor WB, Clein LJ:  Accidental profound hypothermia: Successful resuscitation by core rewarming and assisted circulation . Arch Surg 1973;;106:216-218.
5 +
Althaus U, Aeberhard P, Schupbach P, et al:  Management of profound accidental hypothermia with cardiorespiratory arrest . Ann Surg 1982;; 195:492-495.
6 +
Thorpe AD, White DE:  Accidental hypothermia treated by cardiopulmonary bypass . ICPS Digest 1986;;1:3-8.
7 +
Wickstrom P, Ruiz E, Lilja GP, et al:  Accidental hypothermia: Core rewarming with partial bypass . Am J Surg 1976;;131:622-625.
8 +
Towne WD, Geiss WP, Yanes HO:  Intractable ventricular fibrillation associated with profound accidental hypothermia: Successful treatment with partial cardiopulmonary bypass . N Engl J Med 1972;;287:1135-1136.
9 +
Baker SP, O'Neill B, Karpf RS:  Drowning , in Baker SP, O'Neill B, Karpf RS (eds): The Injury Fact Book . Lexington, Mass, DC Heath & Co, 1984;, pp 155-165.
10 +
Orlowski JP:  Drowning, near-drowning, and ice-water submersions . Pediatr Clin North Am 1987;;34:75-92.
11 +
Conn AW, Barker GA, Edmonds JF, et al:  Submersion hypothermia and near-drowning , in Pozos RS, Wittmers LE Jr (eds): The Nature and Treatment of Hypothermia . Minneapolis, University of Minnesota Press, 1983;, pp 152-164.
12 +
Young RSK, Zalneraitis EL, Dooling EC:  Neurological outcome in cold water drowning . JAMA 1980;;244:1233-1235.
13 +
Southwick FS, Dalglish PH Jr:  Recovery after prolonged asystolic cardiac arrest in profound hypothermia . JAMA 1980;;243:1250-1253.
14 +
Danzl DF, Pozos RS:  Multicenter hypothermia survey . Ann Emerg Med 1987;;16:1042-1055.
15 +
Jessen K, Hagelsten JO:  Peritoneal dialysis in the treatment of profound accidental hypothermia . Aviat Space Environ Med 1978;;49:426-429.
16 +
Klarskov P, Amter F:  Hypothermia following submersion corrected by peritoneal dialysis . Ugeskr Laeg 1976;;138:1937-1940.
17 +
De Villota ED, Barat G, Peral P, et al:  Recovery from profound hypothermia with cardiac arrest after immersion . Br Med J 1973;;17:394-395.
18 +
Reuler JB:  Hypothermia: Pathophysiology, clinical settings, and management . Ann Intern Med 1978;;89:519-527.
19 +
Wong KC:  Physiology and pharmacology of hypothermia . West J Med 1983;;138:227-232.
20 +
Feldman KW, Morray JP, Schaller RT:  Thermal injury caused by hot pack application in hypothermic children . Am J Emerg Med 1985;;3:38-41.
21 +
Abramowicz M (ed):  Treatment of hypothermia . Med Lett Drugs Ther 1983;;25:9-11.
22 +
Martin TG:  Neardrowning and cold water immersion . Ann Emerg Med 1984;;13:263-273.
23 +
Harries MG, Golden FC, Fowler M:  Ventricular fibrillation as a complication of salt-water immersion . Br Med J 1981;;283:347-348.
24 +
O'Keeffe KM:  Accidental hypothermia: A review of 62 cases . J Am Coll Emerg Phys 1977;;6:491-496.
25 +
Mahajan S, Myers TJ, Baldini MG:  Disseminated intravascular coagulation during rewarming following hypothermia . JAMA 1981;;245:2517-2518.
26 +
Kirklin JW, Barratt-Boyes BG:  Hypothermia, circulatory arrest, and cardiopulmonary bypass , in Kirklin JW, Barratt-Boyes BG (eds): Cardiac Surgery: Morphology, Diagnostic Criteria, Natural History, Techniques, Results, and Indications . New York, John Wiley & Sons Inc, 1986;, pp 29-76.
27 +
Sloan REG, Keatinge WR:  Cooling rates of young people swimming in cold water . J Appl Physiol 1973;;35:371-375.
28 +
Gooden BA:  Drowning and the diving reflex in man . Med J Aust 1972;;2:583-587.
29 +
Hayward JS, Hay C, Matthews BR, et al:  Temperature effect on the human dive response in relation to cold water near-drowning . J Appl Physiol 1984;;56:202-206.
30 +
Wittmers LE Jr, Pozos RS, Fall G, et al:  Cardiovascular responses to face immersion (the diving reflex) in human beings after alcohol consumption . Ann Emerg Med 1987;;16:1031-1036.
31 +
Conn AW, Barker GA:  Fresh water drowning and near-drowning: An update . Can Anaesth Soc J 1984;;31:S38-S44.
32 +
Ornato JP:  The resuscitation of near-drowning victims . JAMA 1986;;256:75-77.
33 +
Stern WE, Good RG:  Studies on the effect of hypothermia upon cerebrospinal fluid, oxygen tension, and carotid blood flow . Surgery 1960;;48:13-30.
34 +
Kopf G, Mirvis D, Meyers R:  Central nervous system tolerance to cardiac arrest during profound hypothermia . J Surg Res 1975;;18:29-34.
35 +
Stevenson JG, Stone EF, Dillard DH, et al:  Intellectual development of children subjected to prolonged circulatory arrest during hypothermic open heart surgery in infancy . Circulation 1974;;49 and 50( (suppl 2) ):54-59.
36 +
Wagner HR, Subramanian S:  Deep hypothermia in infant cardiac surgery . Pediatrics 1978;;61:479-483.
37 +
Cales RH:  Trauma mortality in Orange County: The effect of implementation of a regional trauma system . Ann Emerg Med 1984;;13:1-10.
38 +
Clemmer TP, Orme JF, Thomas F, et al:  Prospective evaluation of the CRAMS scale for triaging major trauma . J Trauma 1985;;25:188-191.
39 +
Seuffert G:  An Alaskan experience with cardiopulmonary bypass in resuscitating patients with profound hypothermia and cardiac arrest . Alaska Med 1984;;26:31-33.

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