Terapia pozaustrojowa pacjentów w ciężkiej hipotermii

The discrepancy between heat production and increased heat loss leads to hypothermia. The stable body temperature kept throughout the thermoregulation ability applies only to the inside of the body, which for a healthy adult human means that the body core temperature is about 36–37°C, is irrespective of external conditions. The lowering of the body temperature directly influences the patient’s clinical condition. According to the European Resuscitation Council three types of hypothermia can be differentiated: mild hypothermia (oesophagus temperature between 35°C and 32°C), moderate hypothermia (32°C to 28°C) and deep hypothermia (below 28°C). The current ERC guidelines for hypothermia include treatment with venous-arterial extracorporeal membrane oxygenation (the blood is pumped from the venous system to the arterial side) [1].
A 61-year-old male was found unconscious in the utility room and was brought by the paramedics in severe condition due to significant heat loss. During the transport to the hospital (about 12 km) he suffered ventricular fibrillation that was successfully treated with defibrillation. Later he was subjected to cardiopulmonary resuscitation (CPR) with the aid of a chest compression device. He was heated with thermal blanket, and his body temperature was raised with 250 ml intravenous infusion of 0.9% NaCl to a temperature of 36°C. Physical examination showed slowed reaction and pale, dry, cold skin, especially on the head and upper and lower limbs, normal pupil size with a slow reaction to the light, moderate level of consciousness disturbances (10 points in Glasgow Coma Scale), unmeasurable blood pressure (RR), irregular heart rate of about 50 bpm, bradypnea (10 breaths/min), and hyperglycaemia (157 mg%). No injuries were detected. Deep hypothermia (23°C in the oesophagus) was diagnosed, and CPR procedures were continued with the use of a chest compression device. The Medical Rescue Team contacted the Cardiac Surgery Clinic to inform about the priority patient. At 8:05 a.m. the patient was admitted to the Hospital Emergency Department where the CPR was continued. Subsequently, he was transported to the Cardiac Surgery Clinic and at 8:30 a.m. he was transported to the surgical unit for ECMO (A-V ECMO). The procedure of extracorporeal membrane oxygenation in arteriovenous vein configuration was started about 100 min from the SCA. At 10 a.m. the patient was sedated and subdued to mechanical ventilation. He was administered...


Pełna treść artykułu...