1245 Management of Hypothermic Cardiac Arrest with Cardiopulmonary Bypass

Abstract Aim Hypothermic patients are at major risk of cardiac arrest. Accidental hypothermia is an unintentional drop in core temperature below 35 °C. Cardiopulmonary bypass may be used to rewarm patients in the surgical setting. Method A 48-year-old male was found after attempting suicide by carbon monoxide inhalation and Diazepam overdose. Recorded temperature on arrival of paramedics was 26 °C. He initially had a recordable blood pressure, but on transfer to the ambulance developed ventricular fibrillation secondary to rescue collapse, and CPR was commenced. One unsuccessful DC shock was delivered. The man was intubated, LUCAS machine was applied, and external warming measures were carried out. He arrived in resus over 2 hours after being found, with persistent ventricular fibrillation. Core temperature remained at 27-28 °C despite warming techniques. Cardiothoracic Surgery were contacted for consideration of a cardiopulmonary bypass to rewarm the patient. The patient was cannulated peripherally via the left femoral artery and vein, allowing the LUCAS machine to continue until institution of cardiopulmonary bypass. He was cardioverted from VF to NSR and rewarmed until temperature was 36.4 °C. He was weaned off bypass after 130 minutes and transferred to cardiac ICU. Results Extubated after 2 days with no neurological deficits. Self-ventilating and haemodynamically stable by day 3. Discharged from Cardiac Intensive Care Unit 7 days post-op with no neurological deficits to inpatient psychiatric unit. Conclusions Hypothermic arrests warrant continuous CPR as chances of survival and favourable neurological outcome are higher than for normothermic arrests.