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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