The purpose of this study was to examine the emergency department (ED) management of hypothermic
cardiac arrest and its outcome. The medical records of all patients with hypothermic
cardiac arrest treated in the ED from January 1, 1988 to January 31, 1999 were retrospectively reviewed. Data collected included initial body temperature, serum
potassium, methods of
rewarming, return of perfusing rhythm, and morbidity and mortality. Data were analyzed by descriptive methods. Eleven patients were treated in the ED
resuscitation room for hypothermic
cardiac arrest. Six patients were found in
cardiac arrest in the field, one patient arrested during transport, and four patients arrested after ED arrival. The average initial temperature was 79.1 degrees F (range 69.0 degrees F to 86.7 degrees F). Seven patients received an ED
thoracotomy with internal
cardiac massage and warm mediastinal irrigation. Four patients had
airway management in the ED and then direct transport to the operating room for cardiac bypass
rewarming. Three of the seven patients who received an ED
thoracotomy subsequently went to intraoperative cardiac bypass
rewarming. Five of the seven (71.4%) patients who received an ED
thoracotomy survived, versus none of the four patients (0%) who went directly to intraoperative cardiac bypass. A direct comparison of immediate ED
thoracotomy versus intraoperative cardiac bypass without ED
thoracotomy is cautiously made as this was an unmatched and nonrandomized study. Three of the surviving patients underwent intraoperative cardiac bypass
rewarming after receiving an ED
thoracotomy. In two of these patients a perfusing rhythm had been established after
thoracotomy in the ED and before transport to the operating room for cardiac bypass. Only one of seven (14.3%) patients who arrested prehospital survived versus four of four (100%) who arrested in the ED. ED
thoracotomy with internal
cardiac massage and mediastinal irrigation
rewarming is effective in the management of hypothermic
cardiac arrest.