Case reportSuccessful defibrillation in profound hypothermia (core body temperature 25.6°C)
Introduction
Accidental hypothermia is associated with both benign and malignant cardiac arrhythmias [1]. Cardiac arrest, secondary to ventricular fibrillation is the commonest cause of death in accidental hypothermia in man [2], [3], [4], and in experimental animals [5]. Hypothermia itself induces characteristic electrophysiological and mechanical alterations in the heart that predispose to arrhythmogenesis [6]. Progression to pre-terminal or fatal arrhythmia may be precipitated by fluid maldistribution, continued body cooling of the body or anything but the most gentle handling of the casualty [7]. It is recognised that defibrillation of severely cold myocardium is difficult [8]. This may be due to the decrease in fibrillation threshold observed as cardiac temperature falls [9]. Part of the rationale behind rapid rewarming techniques such as extra-corporeal bypass is to raise the deep body temperature above such a ‘fibrillation threshold’. Extra-corporeal bypass techniques are beyond the facilities and capabilities of some hospitals.
Section snippets
Case report
An 82-year-old female was found lifeless in her unheated living room by her neighbours at 09:00 h. Ambient air temperature was 13°C. Her general practitioner attended 10 min later, and found her apnoeic, blue, apparently lifeless and commenced confirmation of death. Heart sounds were heard, and a faint carotid pulsation was detected at a rate of 25 beats per min (bpm). Basic life support was commenced and an ambulance was called to the scene. By 09:31 h the ambulance had arrived, tracheal
Discussion
Successful defibrillation occurred at a core temperature below 26°C. Published literature [10], [11], [12], [13], [14] and resuscitation texts [15], [16], [17] comment on the difficulty of defibrillating cold myocardium. A recent case report of successful defibrillation at a core temperature of 25.9°C [18] confirms that our experience is not unique and therefore indicates the potential value of attempting defibrillation in such circumstances.
Primary hypothermia may occur with normal
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- 1
Now of: Department of Anaesthetics, North Hampshire Hospital Basingstoke, Hampshire, RG 24 9NA, UK.