Extracorporeal membrane oxygenation implantation via median sternotomy for fulminant pulmonary edema after cold water submersion with cardiac arrest.

d p a a h c a s m SEVERE HYPOTHERMIA with core temperatures 28°C secondary to environmental exposure (eg, drowning in cold water) has an estimated mortality rate of 30% to 80%.1,2 The ost important and detrimental consequence of drowning is ypoxia.3 In the pediatric population 5 years of age, submersion injuries rank as the second most frequent cause of death.4 Children who survive drowning are at an increased risk of developing an acute respiratory distress syndrome (ARDS).5 Various techniques have been used successfully for resuscitation from severe hypothermia, yet the optimal therapy remains controversial. Several advisory statements and guidelines have proposed cardiopulmonary bypass (CPB) for the rewarming of children.6-8 Although functional modifications, such as extracorporeal membrane oxygenation (ECMO) implantation, have been advocated,6,9 their use has been reported only anecdotally1,10-13 and the reports have referred primarily to ewarming using femorofemoral cannulation. This report decribes a boy who was resuscitated successfully and recovered ompletely without major neurologic deficits from severe hyothermia and a cardiac arrest 75 minutes using CPB and CMO therapy.