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Master Thesis

Facteurs associés à la survie des patients présentant une hypothermie sévère

Abstract : Introduction: Accidental hypothermia, defined an involuntary drop in core body temperature under 35°C, is a condition associated with significant morbidity and mortality. The aim of the study was to identify factors associated with survival in hypothermic stage III or IV with and without cardiac arrest. Method: The charts of all patients with accidental hypothermia who were admitted to the trauma center of a single academic hospital during a 10 year period were retrospectively retrieved. Results: Of 164 charts, 48 patients were admitted with a temperature < 28°C, Median 26°C and interquartile range [24-27,2]. The etiology of hypothermia was exposure to cold environment in 56%, avalanche in 27% of these patients and immersion or submersion in cold water in 17%. Their average age was 47 ± 22 years, and 58% were males. Thirty-two patients (67%) had a cardiac arrest (CA): 15 presented an initial cardiac arrest before arrival of rescue (ICA) (31%), 17 presented a rescue collapse (RC) (36%). Twenty three patients (47%) had an Extracorporeal Life support (ECLS) including 21 with a cardiac arrest (8 ICA, 13 RC) and 2 patients with hemodynamic instability. Overall mortality was 50%, in subgroup with ICA 80% (OR 4; CI 95% [1,3-12,4]),in subgroup with a rescue collapse 53% (OR 1,12 [0,52-2,4]). Cerebral performance category score was 4 [4-4] for survivors of ICA and 1 [1-2] for survivors of rescue collapse. In univariate analysis, factors associated with a poor prognosis were an ICA, a decrease in PH or TP, an increase serum potassium, serum sodium, lactates, creatinine or TCA. We find two cases of survival in exceptional circumstances: a prolonged cardiopulmonary resuscitation >5h, T=16,9°C, and a prolonged burial of 7h, T=22°C. Discussion: Our Study shows that initial cardiac arrest before arrival of rescue is associated with an unfavorable prognostic, the three only survivors were in a vegetative state. The implementation of ECLS in this situation is questionable. A rescue collapse is not a poor prognostic factor. In this case resuscitation should be extended even if the Cardiopulmonary resuscitation is extremely prolonged. The orientation of patients with severe hypothermia must always be to a specialized center with ECLS.
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Master Thesis
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Submitted on : Tuesday, March 5, 2013 - 8:53:32 AM
Last modification on : Tuesday, May 11, 2021 - 11:36:17 AM
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  • HAL Id : dumas-00796478, version 1
  • PPN : 167811320


Ibrahim Imoustapha@chu-Grenoble.Fr Moustapha. Facteurs associés à la survie des patients présentant une hypothermie sévère. Médecine humaine et pathologie. 2013. ⟨dumas-00796478⟩



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