Thoracic lavage in accidental hypothermia with cardiac arrest — report of a case and review of the literature

Abstract Background: Accidental hypothermia resulting in cardiac arrest poses numerous therapeutic challenges. Cardiopulmonary bypass (CPB) should be used if feasible since it optimally provides both central rewarming and circulatory support. However, this modality may not be available or is contraindicated in certain cases. Thoracic lavage (TL) provides satisfactory heat transfer and may be performed by a variety of physicians. This paper presents the physiological rationale, technique, and role for TL in accidental hypothermia with cardiac arrest. Methods: A patient with hypothermic cardiac arrest, treated by the author using TL, serves as the basis for this report. A search of the English language literature using PubMed ® (National Library of Medicine, Bethesda, Maryland) was conducted from 1966 to 2003 and 13 additional patients were identified. Demographic information, lavage method, rewarming rate, complications, and neurological outcome were analysed. Results: There were numerous causes for hypothermia, with drug and alcohol intoxication being the most common ( n  = 4; 28.6%). Patient age ranged from 8 to 72 years (median = 36 years). Mean core temperature was 24.5  ±  0.60 °C. Most patients were without blood pressure or pulse upon presentation to the Emergency Department and the predominant cardiac rhythm was ventricular fibrillation (VF) ( n  = 9; 64.3%). Thoracic lavage was accomplished by thoracotomy in seven patients and tube thoracotomy in the remaining seven. Median rewarming rate was 2.95 °C/h. Median time until sinus rhythm was restored was 120 min. Median length of hospital stay was 2 weeks. Four (28.6%) patients died. Complications were seen in 12 (85.7%) patients. Among survivors, neurological outcome was normal in 8 (80%) while two were left with residual impairments. Conclusions: Patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen. Thoracic lavage should be strongly considered for these patients if CPB is not available or contraindicated.