Author + information
- Tomasz Darocha, MD, PhD∗ (, )
- Sylweriusz Kosinski, MD, PhD,
- Pawel Podsiadlo, MD,
- Anna Jarosz, MD and
- Rafal Drwila, Prof
- ↵∗Severe Accidental Hypothermia Center, Department of Anesthesiology and Intensive Care, John Paul II Hospital, Medical College of Jagiellonian University, Pradnicka 80, Cracow, Malopolska 31-207, Poland
It was with great interest that we read the article by Aubin et al. (1) published in JACC: Heart Failure. Transport destination for patients (core body temperature <28°C) with unstable circulation or who are in cardiac arrest is a hospital with extracorporeal rewarming (extracorporeal membrane oxygenation [ECMO], cardiopulmonary bypass) capacity (2,3). In southern Poland, we have arranged the severe hypothermia treatment system based on 3 pillars: education, coordination, and equipment (4). The E-learning platform is free and adjusted to different levels of the rescue system: basic life support (fireguards, police, mountain rescuers), advanced life support (ambulance and helicopter emergency medical service [HEMS] staff), and hospital emergency department staff. To date, 25,000 people have successfully completed that learning activity.
Early qualification for extracorporeal rewarming of hypothermic patients with cardiac arrest/hemodynamic instability is necessary to prepare operating room and staff or to haul the equipment. Coordination of transport, treatment, and approval of extracorporeal life support therapy are the tasks of the ECMO coordinator. Dispatch rescue centers have continuous contact with the ECMO coordinator, which allows early notification about victims having suspected or confirmed severe hypothermia. Notepads used in ambulances to enter data in medical records are scanned online for predefined key words describing the cooled patient. Mountain rescuers also inform the ECMO coordinator at the start of their search and rescue missions. Cardiac arrest in severe hypothermia usually requires prolonged chest compression during transport. We use an interactive map of available mechanical chest compression devices, which allows delivery of devices to the rescue team from the nearest location.
All cardiac surgery centers are equipped with ECMO and can admit deeply hypothermic patients with cardiac arrest or hemodynamic instability. We hope to develop a mobile ECMO treatment protocol to be used during transport to the extracorporeal life support center. In our experience, it is a safe and effective method. It is easier and safer to transport a device (with staff) to a remote hospital than to transport a patient requiring continuous chest compressions for 100 or 200 km. Implementation of extracorporeal therapy at the hospital nearest the incident site or even at the site of the incident presents an interesting new mode of treatment. Since November 2013, we have achieved 58% survival among 31 hypothermic patients (cardiac arrest or cardiogenic shock in severe hypothermia). In the cardiac arrest subgroup consisting of 17 patients (duration until implementation of extracorporeal rewarming: 107 to 345 minutes), survival is 47%. All patients were discharged from the hospital with Glasgow Coma Scale 15 and Cerebral Performance Category 1.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2016 American College of Cardiology Foundation