Clinical paper| Volume 164, P108-113, July 2021

Impact of rescue collapse on mortality rate in severe accidental hypothermia: A matched-pair analysis



      To assess the impact of the occurrence of cardiac arrest associated with initial management on the outcome of severely hypothermic patients who were rewarmed with Extracorporeal Life Support (ECLS).


      We collected the individual data of patients in a state of severe accidental hypothermia who were found with spontaneous circulation and rewarmed with ECLS, from cardiac surgery departments. Patients were divided into two groups: those with a subsequent cardiac arrest (RC group); and those with the retained circulation (HT3 group), and compared by using a matched-pair analysis. The mortality rates and the neurological status in survivors were compared as the main outcomes. The difference in the risk of death between the HT3 and RC groups was calculated.


      A total of 124 patients were included into the study: 45 in the HT3 group and 79 in the RC group. The matched cohorts consisted of 45 HT3 patients and 45 RC patients. The mortality rate in both groups was 24% and 49% (p = 0.02) respectively; the relative risk of death was 2.0 (p = 0.02). ICU length of stay was significantly longer in the RC group (p < 0.001). Factors associated with survival in the HT3 group included patient age, rewarming rate, and blood BE; while in the RC group, patient age and lactate concentration.


      The occurrence of rescue collapse is linked to a doubling of the risk of death in severely hypothermic patients. Procedures which are known as potential triggers of rescue collapse should be performed with special attention, including in conscious patients.


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        • Pasquier M.
        • Cools E.
        • Zafren K.
        • Carron P.-N.
        • Frochaux V.
        • Rousson V.
        Vitals signs in accidental hypothermia.
        High Alt Med Biol. 2020; : 2-3
        • Durrer B.
        • Brugger H.
        • Syme D.
        The medical on-site treatment of hypothermia: ICAR-MEDCOM recommendation.
        High Alt Med Biol. 2003; 4: 99-103
        • Musi M.E.
        • Sheets A.
        • Zafren K.
        • et al.
        Clinical staging of accidental hypothermia: the revised Swiss system: recommendation of the International Commission for Mountain Emergency Medicine (ICAR MedCom).
        Resuscitation. 2021; 162: 182-187
        • Mallet M.L.
        Pathophysiology of accidental hypothermia.
        QJM. 2002; 95: 775-785
        • Frei C.
        • Darocha T.
        • Debaty G.
        • et al.
        Clinical characteristics and outcomes of witnessed hypothermic cardiac arrest: a systematic review on rescue collapse.
        Resuscitation. 2019; 137: 41-48
        • Pasquier M.
        • Carron P.N.
        • Rodrigues A.
        • et al.
        An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature.
        Scand J Trauma Resusc Emerg Med. 2019; 27: 60
        • Podsiadło P.
        • Darocha T.
        • Kosiński S.
        • Sanak T.
        • Cebula G.
        • Gałązkowski R.
        Implementation of European Resuscitation Council guidelines: measurement of core body temperature in emergency medical services in Europe.
        Med Stud. 2020; 36: 14-17
        • Podsiadło P.
        • Darocha T.
        • Kosiński S.
        • Sanak T.
        • Gałazkowski R.
        Body temperature measurement in ambulance: a challenge of 21-st century?.
        BMC Emerg Med. 2019; 19: 1-5
        • Debaty G.
        • Moustapha I.
        • Bouzat P.
        • et al.
        Outcome after severe accidental hypothermia in the French Alps: a 10-year review.
        Resuscitation. 2015; 93: 118-123
        • Morita S.
        • Inokuchi S.
        • Yamagiwa T.
        • et al.
        Efficacy of portable and percutaneous cardiopulmonary bypass rewarming versus that of conventional internal rewarming for patients with accidental deep hypothermia.
        Crit Care Med. 2011; 39: 1064-1068
        • Safar P.
        Resuscitation after Brain Ischemia.
        in: Grenvik A. Safar P. Brain failure and resuscitation. Churchill Livingstone, New York1981: 155-184
        • Darocha T.
        • Podsiadło P.
        • Polak M.
        • et al.
        Prognostic factors for nonasphyxia-related cardiac arrest patients undergoing extracorporeal rewarming— HELP Registry study.
        J Cardiothorac Vasc Anesth. 2020; 34: 365-371
        • Saczkowski R.
        • Kuzak N.
        • Grunau B.
        • Schulze C.
        Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia.
        Eur J Cardiothorac Surg. 2021; 56: 593-600
        • Pasquier M.
        • Hugli O.
        • Paal P.
        • et al.
        Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: the HOPE score.
        Resuscitation. 2018; 126: 58-64
        • Kosiński S.
        • Darocha T.
        • Jarosz A.
        • et al.
        Clinical course and prognostic factors of patients in severe accidental hypothermia with circulatory instability rewarmed with veno-arterial ECMO—an observational case series study.
        Scand J Trauma Resusc Emerg Med. 2017; 25: 46
        • Balik M.
        • Porizka M.
        • Matousek V.
        • et al.
        Management of accidental hypothermia: an established extracorporeal membrane oxygenation centre experience.
        Perfusion. 2019; 34: 74-81
        • Gordon L.
        • Paal P.
        • Ellerton J.A.
        • Brugger H.
        • Peek G.J.
        • Zafren K.
        Delayed and intermittent CPR for severe accidental hypothermia.
        Resuscitation. 2015; 90: 46-49
        • Ohbe H.
        • Isogai S.
        • Jo T.
        • Matsui H.
        • Fushimi K.
        • Yasunaga H.
        Extracorporeal membrane oxygenation improves outcomes of accidental hypothermia without vital signs: a nationwide observational study.
        Resuscitation. 2019; 144: 27-32
        • Truhlář A.
        • Deakin C.D.
        • Soar J.
        • et al.
        European Resuscitation Council guidelines for resuscitation 2015: section 4. Cardiac arrest in special circumstances.
        Resuscitation. 2015; 95: 148-201
        • Mair P.
        • Ruttmann E.
        ECMO for severe accidental hypothermia.
        in: Sangalli F. Patroniti N. Pesenti A. ECMO-extracorporeal life support adults. Springer-Verlag, Italia2014: 163-170
        • Brown D.
        in: Tintinalli J. Stapczynski J. Ma O. Yealy D. Meckler G. Cline D. Tintinalli's emergency medicine: a comprehensive study guide. 8th ed. McGraw-Hill Education, New York2016: 1357-1365
        • Giesbrecht G.G.
        Prehospital treatment of hypothermia.
        Wilderness Environ Med. 2001; 12: 24-31
        • Lloyd E.L.
        Accidental hypothermia.
        Resuscitation. 1996; 32: 111-124
        • Golden F.S.
        • Hervey G.R.
        • Tipton M.J.
        Circum-rescue collapse: collapse, sometimes fatal, associated with rescue of immersion victims.
        J R Nav Med Serv. 1991; 77: 139-149
        • Osborne L.
        • Kamal El-Din A.S.
        • Smith J.E.
        Survival after prolonged cardiac arrest and accidental hypothermia.
        Br Med J (Clin Res Ed). 1984; 289: 881-882
        • Dow J.
        • Giesbrecht G.G.
        • Danzl D.F.
        • et al.
        Wilderness Medical Society clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2019 update.
        Wilderness Environ Med. 2019; 30: S47-69
        • Lloyd E.L.
        • Mitchell B.
        Factors affecting the onset of ventricular fibrillation in hypothermia.
        Lancet (London, England). 1974; 2: 1294-1296