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"Dunn Matthew Dr. ACCIDENT & EMERGENCY - SwarkHosp-TR" wrote:
> Last time I looked, I don't think there was any evidence that bypass
> improved outcome- most of the papers were from Alpine areas where they used
> bypass and had some survivors or from Scandanavia where they didn't use
> bypass and actually had more survivors. I did not find any studies comparing
> the different methods of rewarming. There are also scattered studies looking
> at body cavity lavage, resuscitative thoracotomy etc. Best evidence remains
> case reports or series- whatever you do, some patients will survive. Whether
> more or less would have survived if you left them alone in a warm room is
> unproven. The closest thing I've seen to a clinical trial was one (non
> randomised study) showing that in that particular case series, patients put
> onto bypass did worse than those who had A and E thoracotomy and lavage.
>
> Recent personal experience: I had an elderly patient arrive hypothermic
> (urban- not seen for days, found on floor, pressure sores present) and
> asystolic. Turned out to have an advance directive. Stopped resuscitation.
> 15 minutes after we stopped resus she had a BP of 130/ 90 (AF, ventricular
> response about 80). Next morning sitting up in bed talking. All we did for
> her was put her under a Bair Hugger and ventilation, fluids etc after
> spontaneous output recovered; but she went from asystole to decent BP
> without any intervention other than leaving her in a warm(ish) room.
>
> Matt Dunn
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