Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-27T04:58:37.703Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of severe accidental hypothermia with intermittent hemodialysis

Published online by Cambridge University Press:  21 May 2015

Nabil Sultan ,
Karl D. Theakston ,
Ron Butler  and
Rita S. Suri
Nabil Sultan
Affiliation:
Division of Nephrology, University of Western Ontario, London, Ont.
Karl D. Theakston
Affiliation:
Division of Emergency Medicine, University of Western OntarioLondon, Ont.,
Ron Butler
Affiliation:
Division of Critical Care, University of Western Ontario, London, Ont.
Rita S. Suri*
Affiliation:
Division of Nephrology, University of Western Ontario, London, Ont.
*
Kidney Clinical Research Unit, Rm. ELL-119, Victoria Hospital, London Health Sciences Centre, 800 Commissioners Rd. E, London ON N6A 4G5, rita.suri@lhsc.on.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The optimal management of moderate-to-severe hypothermia with hemodynamic instability remains unclear. Although cardiopulmonary bypass offers the most rapid rate of rewarming and has been suggested as the method of choice in the presence of circulatory arrest, there is no evidence to support the use of this highly invasive technique over other rewarming modalities in the absence of circulatory collapse. We report the successful treatment of hemodynamically unstable hypothermia with conventional hemodialysis in a patient with normal renal function, after initial efforts of rewarming using conventional strategies had failed. This case report and review of the literature highlights the advantages and the challenges of using hemodialysis in this setting, and suggests a potential role for hemodialysis in the routine management of moderate-to-severe hypothermia in the absence of circulatory arrest.

Keywords

hypothermiadialysisrewarmingafter-drophypotension
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 2 , March 2009 , pp. 174 - 177
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

1.Jolly, BT, Ghezzi, KT. Accidental hypothermia. Emerg Med Clin North Am 1992;10:311–27.Google Scholar
2.Centers for Disease Control and Prevention. Hypothermia-related deaths — United States, 2003. MMWR Morb Mortal Wkly Rep 2004;53:172–3.Google Scholar
3.Vassal, T, Benoit-Gonin, B, Carrat, F, et al. Severe accidental hypothermia treated in an ICU: prognosis and outcome. Chest 2001;120:1998–2003.Google Scholar
4.Aslam, AF, Aslam, AK, Vasavada, BC, et al. Hypothermia: evaluation, electrocardiographic manifestations, and management. Am J Med 2006;119:297–301.Google Scholar
5.Nicolas, F, Nicolas, G, Heurtel, A, et al. [24 cases of accidental hypothermia] [article in French]. Anesth Analg 1974;31:485–538.Google Scholar
6.Danzl, DF, Pozos, RS, Auerbach, PS, et al. Multicenter hypothermia survey. Ann Emerg Med 1987;16:1042–55.Google Scholar
7.White, JD. Hypothermia: the Bellevue experience. Ann Emerg Med 1982;11:417–24.Google Scholar
8.Mair, P, Schwarz, B, Kornberger, E, et al. Case 5–1997. Successful resuscitation of a patient with severe accidental hypothermia and prolonged cardiocirculatory arrest using cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1997;11:901–4.CrossRefGoogle ScholarPubMed
9.Komatsu, S, Shimomatsuya, T, Kobuchi, T, et al. Severe accidental hypothermia successfully treated by rewarming strategy using continuous venovenous hemodiafiltration system. J Trauma 2007;62:775–6.Google Scholar
10.Steele, MT, Nelson, MJ, Sessler, DI, et al. Forced air speeds rewarming in accidental hypothermia. Ann Emerg Med 1996;27:479–84.CrossRefGoogle ScholarPubMed
11.Britt, LD, Dascombe, WH, Rodriguez, A. New horizons in management of hypothermia and frostbite injury. Surg Clin North Am 1991;71:345–70.CrossRefGoogle ScholarPubMed
12.Shann, KG, Likosky, DS, Murkin, JM, et al. An evidence-based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J Thorac Cardiovasc Surg 2006;132:283–90.Google Scholar
13.Hernandez, E, Praga, M, Alcazar, JM, et al. Hemodialysis for treatment of accidental hypothermia. Nephron 1993;63:214–6.Google Scholar
14.Carr, ME Jr, Wolfert, AI. Rewarming by hemodialysis for hypothermia: failure of heparin to prevent DIC. J Emerg Med 1988;6:277–80.CrossRefGoogle ScholarPubMed
15.Walpoth, BH, Walpoth-Aslan, BN, Mattle, HP, et al. Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 1997; 337:1500–5.Google ScholarPubMed
16.Owda, A, Osama, S. Hemodialysis in management of hypothermia. Am J Kidney Dis 2001;38:E8.Google Scholar
17.Spooner, K, Hassani, A. Extracorporeal rewarming in a severely hypothermic patient using venovenous haemofiltration in the accident and emergency department. J Accid Emerg Med 2000;17:422–4.CrossRefGoogle Scholar
18.Yokoyama, M, Noto, Y, Kida, H. Hypothermia with acute renal failure in a patient suffering from diabetic nephropathy and malnutrition. Diabetes Metab 2000;26:145–7.Google Scholar
19.Mehrotra, R. Peritoneal dialysis in adult patients without endstage renal disease. Adv Perit Dial 2000;16:67–72.Google Scholar