Clinical paperOutcome of accidental hypothermia with or without circulatory arrest: Experience from the Danish Præstø Fjord boating accident☆
Section snippets
Methods
The study is based on 13 healthy (7 boys, 6 girls aged 15–17 years) students at a continuation high school, and two adult teachers (a 33 year old female that survived the accident and a 44 year old male who drowned). Victims and/or victim's parents provided informed consent to publication of this report.
The accident occurred February 11, 2011 on a 20 km2 fjord with a depth of 2–5 m. On the day of the accident the air temperature was 4 °C, the wind speed was 7 m/s, the water temperature was 2 °C, and
Results
Among the seven victims with circulatory arrest the first recorded temperature was a median of 18.4 °C (15.5–20.2 °C). All victims were pulseless with dilated pupils unresponsive to light (Table 1). Arterial blood gases analysed according to the Alpha-Stat principle demonstrated severe metabolic acidosis in all with a median pH of 6.61 (6.43–6.94), and lactate concentration a median of 21.0 mmol/l (9.4–24.0 mmol/l) (Table 1 and Fig. 2A). Six victims were weaned from ECMO when return of spontaneous
Discussion
The present analysis of a boating accident involving 13 teenagers and 2 adults provides a unique insight into the development of accidental profound hypothermia and 6-month outcomes. As opposed to previously reported individual case reports/case series, this report is able to describe an entire population, minimizing publication bias. In the group with circulatory arrest a regimen of extracorporeal rewarming followed by therapeutic hypothermia and normothermia with sedation and supportive
Conflict of interest statement
No conflict of interest exists for any of the authors.
Acknowledgements
We are indebted to the emergency physicians, paramedics, search and rescue teams and volunteers taking part in the rescue action on February 11, 2011, as well as the emergency staff at the primary care centres involved in the rescue and referral of victims to the tertiary centres. All provided an extraordinary effort that is the direct cause of the exceptionally high survival rate.
Contributors: Michael Wanscher contributed for the drafting of manuscript, participation in the collection of data;
References (20)
- et al.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution
Resuscitation
(2010) - et al.
Role of extracorporeal circulation in the management of accidental deep hypothermia
Heart Lung Circ
(2009) - et al.
Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest
Lancet
(2000) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support
Resuscitation
(2010) - et al.
Can early serum levels of S100B protein predict the prognosis of patients with out-of-hospital cardiac arrest?
Resuscitation
(2010) - et al.
Painful tonic heat stimulation induces GABA accumulation in the prefrontal cortex in man
Pain
(2009) - et al.
Immersion deaths and deterioration in swimming performance in cold water
Lancet
(1999) - et al.
Efficacy of portable and percutaneous cardiopulmonary bypass rewarming versus that of conventional internal rewarming for patients with accidental deep hypothermia
Crit Care Med
(2011) - et al.
Outcome of drowned hypothermic children with cardiac arrest treated with cardiopulmonary bypass
Acta Anaesthesiol Scand
(2010) - et al.
Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming
N Engl J Med
(1997)
Cited by (0)
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.05.009.