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Akzidentelle Hypothermie

Accidental hypothermia

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Zusammenfassung

Bei Patienten mit schwerer akzidenteller Hypothermie besteht bis heute Unsicherheit in der Wahl der optimalen Behandlung und des Zielkrankenhauses. In dieser Arbeit werden Empfehlungen für die prä- und intrahospitale Versorgung sowie den Transport von akzidentell hypothermen Patienten vorgestellt. Fortschritte in der Behandlung und Verfügbarkeit von neuen Erwärmungstechniken haben die Prognose von Patienten mit akzidenteller Hypothermie deutlich verbessert. Patienten mit einer Körperkerntemperatur ≥ 28 °C und stabiler Hämodynamik sollen minimalinvasiv, aktiv extern erwärmt werden (warme Umgebung, Wärmepackung, warme Infusionen, Warmluftdecken). Bei instabiler Hämodynamik (systolischer Blutdruck < 90 mmHg, ventrikuläre Arrhythmie, Körperkerntemperatur < 28 °C) soll ebenfalls minimalinvasiv und aktiv extern erwärmt werden, jedoch in einem Krankenhaus mit Möglichkeit einer venoarteriellen extrakorporalen Membranoxygenierung (v.a.-ECMO) oder Herz-Lungen-Maschine (HLM). Bei Herzstillstand soll eine invasive Erwärmung durchgeführt werden; hierbei sollte die v.a.-ECMO der HLM vorgezogen werden, wobei Überlebensraten von bis zu 100% erreicht werden können im Vergleich zu ~ 10 % mit traditionellen Methoden (z.B. Körperhöhlen-Lavage). Hypotherme Patienten sollen direkt in ein Krankenhaus mit einer dem Schweregrad entsprechenden Therapiemöglichkeit transportiert werden, um Komplikationen vorzubeugen und das Überleben zu verbessern.

Abstract

Uncertainty exists on how to treat patients suffering from accidental hypothermia and on the optimal transport decisions. The aim of this review is to provide an updated evidence-based reference for the pre-hospital and in-hospital management of patients with accidental hypothermia and for the transport decisions required to facilitate treatment. Advances in the efficiency and availability of rewarming techniques have improved the prognosis for patients presenting with hypothermia. For hypothermic patients with a core body temperature ≥ 28 °C without cardiac instability there is increasing evidence to support the use of active external and minimally invasive rewarming techniques (e.g. chemical, electrical or forced air heating packs, blankets and warm parenteral fluids). Hypothermic patients with cardiac instability (i.e. systolic blood pressure < 90 mmHg, ventricular arrhythmia and core body temperature < 28 °C) should be rewarmed with active external and minimally invasive rewarming techniques in a hospital which also has circulation substituting venous-arterial extracorporeal membrane oxygenation (VA-ECMO) and cardiopulmonary bypass (CBP) facilities. In cardiac arrest patients VA-ECMO may be a better treatment option than CBP and survival rates of 100 % can be achieved compared to ~ 10 % with traditional methods (e.g. body cavity lavage). Early transport to a hospital appropriately equipped for rewarming has the potential to decrease complication rates and improve survival.

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Literatur

  1. Braun P, Wenzel V, Paal P (2010) Anesthesia in prehospital emergencies and in the emergency department. Curr Opin Anaesthesiol 23:500–506

    Article  PubMed  Google Scholar 

  2. Brown DJ, Brugger H, Boyd J, Paal P (2012) Accidental hypothermia. N Engl J Med 367:1930–1938

    Article  PubMed  CAS  Google Scholar 

  3. Brugger H, Durrer B, Elsensohn F et al (2012) Resuscitation of avalanche victims: evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM): intended for physicians and other advanced life support personnel. Resuscitation 84:539–546

    Article  PubMed  Google Scholar 

  4. Danzl DF, Pozos RS (1994) Accidental hypothermia. N Engl J Med 331:1756–1760

    Article  PubMed  CAS  Google Scholar 

  5. Durrer B, Brugger H, Syme D (2001) Advanced challenges in resuscitation: special challenges in EEC-hypothermia. Resuscitation 50:243–244

    Article  PubMed  CAS  Google Scholar 

  6. Ellerton J, Greene M, Paal P (2013) The use of analgesia in mountain rescue casualties with moderate or severe pain. Emerg Med J 30:501–505

    Article  PubMed  Google Scholar 

  7. Gilbert M, Busund R, Skagseth A et al (2000) Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet 355:375–376

    Article  PubMed  CAS  Google Scholar 

  8. Goheen MS, Ducharme MB, Kenny GP et al (1997) Efficacy of forced-air and inhalation rewarming by using a human model for severe hypothermia. J Appl Physiol 83:1635–1640

    PubMed  CAS  Google Scholar 

  9. Haegeli P, Falk M, Brugger H et al (2011) Comparison of avalanche survival patterns in Canada and Switzerland. CMAJ 183:789–795

    Article  PubMed  Google Scholar 

  10. Henriksson O, Lundgren JP, Kuklane K et al (2009) Protection against cold in prehospital care – thermal insulation properties of blankets and rescue bags in different wind conditions. Prehosp Disaster Med 24:408–415

    PubMed  Google Scholar 

  11. Lexow K (1991) Severe accidental hypothermia: survival after 6 hours 30 min of cardiopulmonary resuscitation. Arctic Med Res 50(Suppl 6):112–114

    PubMed  Google Scholar 

  12. Marland S, Ellerton J, Andolfatto G et al (2013) Ketamine: use in anesthesia. CNS Neurosci Ther 19:381–389

    Article  PubMed  CAS  Google Scholar 

  13. Nolan JP, Soar J, Wenzel V, Paal P (2012) Cardiopulmonary resuscitation and management of cardiac arrest. Nat Rev Cardiol 9:499–511

    Article  PubMed  CAS  Google Scholar 

  14. Paal P, Beikircher W, Brugger H (2006) Der Lawinennotfall. Eine aktuelle Übersicht. Anaesthesist 55:314–324

    Article  PubMed  CAS  Google Scholar 

  15. Paal P, Brugger H, Kaser G et al (2012) Surviving six days in a crevasse. Lancet 381:506

    Article  Google Scholar 

  16. Paal P, Herff H, Mitterlechner T et al (2010) Anaesthesia in prehospital emergencies and in the emergency room. Resuscitation 81:148–154

    Article  PubMed  Google Scholar 

  17. Paal P, Milani M, Brown D et al (2012) Termination of cardiopulmonary resuscitation in mountain rescue. High Alt Med Biol 13:200–208

    Article  PubMed  Google Scholar 

  18. Paal P, Strapazzon G, Braun P et al (2012) Factors affecting survival from avalanche burial– A randomised prospective porcine pilot study. Resuscitation 84:239–243

    Article  PubMed  Google Scholar 

  19. Putzer G, Braun P, Zimmermann A et al (2012) LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue–a prospective, randomized, cross-over manikin study. Am J Emerg Med 31:384–389

    Article  PubMed  Google Scholar 

  20. Putzer G, Tiefenthaler W, Mair P, Paal P (2012) Near-infrared spectroscopy during cardiopulmonary resuscitation of a hypothermic polytraumatised cardiac arrest patient. Resuscitation 83:e1–e2

    Article  PubMed  Google Scholar 

  21. Rajagopalan S, Mascha E, Na J, Dessler DI (2008) The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology 108:71–77

    Article  PubMed  Google Scholar 

  22. Ruttmann E, Weissenbacher A, Ulmer H et al (2007) Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. J Thorac Cardiovasc Surg 134:594–600

    Article  PubMed  Google Scholar 

  23. Soar J, Perkins GD, Abbas G et al (2010) 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 81:1400–1433

    Article  PubMed  Google Scholar 

  24. Strapazzon G, Beikircher W, Procter E, Brugger H (2012) Electrical heart activity recorded during prolonged avalanche burial. Circulation 125:646–647

    Article  PubMed  Google Scholar 

  25. Sumann G, Putzer G, Brugger H, Paal P (2012) Pulmonary edema after complete avalanche burial. High Alt Med Biol 13:295–296

    Article  PubMed  Google Scholar 

  26. Walpoth BH, Walpoth-Aslan BN, Mattle HP et al (1997) Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 337:1500–1505

    Article  PubMed  CAS  Google Scholar 

  27. Wanscher M, Agersnap L, Ravn J et al (2012) Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Praesto Fjord boating accident. Resuscitation 83:1078–1084

    Article  PubMed  Google Scholar 

  28. Wenzel V, Russo SG, Arntz HR et al (2010) Comments on the 2010 guidelines on cardiopulmonary resuscitation of the European Resuscitation Council. Anaesthesist 59:1105–1123

    Article  PubMed  CAS  Google Scholar 

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. H. Brugger, G. Putzer und P. Paal geben an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. EURAC Institut für Alpine Notfallmedizin, Bozen, Italien

    H. Brugger

  2. Medizinische Universität Innsbruck, Innsbruck, Österreich

    H. Brugger

  3. Univ.-Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Innsbruck, Österreich

    G. Putzer & P. Paal

Authors
  1. H. Brugger
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  2. G. Putzer
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  3. P. Paal
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Corresponding author

Correspondence to G. Putzer.

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Brugger, H., Putzer, G. & Paal, P. Akzidentelle Hypothermie. Anaesthesist 62, 624–631 (2013). https://doi.org/10.1007/s00101-013-2205-7

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  • DOI: https://doi.org/10.1007/s00101-013-2205-7

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