Hyperkalemia: a prognostic factor during acute severe hypothermia

Article Abstract:

Patients who have succumbed to hypothermia (below normal body temperature) can often be revived with the aid of modern techniques, but deciding which patients will benefit from resuscitation attempts is not easy. To gain insight into prognostic variables, the medical records of hypothermia victims and patients who died in the intensive care unit of one hospital were evaluated. The hypothermia patients were victims of snow avalanches (9, group A), or intoxicated with drugs or alcohol, with or without prolonged exposure to cold (15, group B). On admission to the hospital, the temperatures of group A and group B patients were similar (29.6 degrees Centigrade and 28.8 degrees C, respectively; normal is 37 degrees C). All group A patients had stopped breathing and showed no heart activity (cardiorespiratory arrest), and none responded to resuscitation efforts. All group B patients recovered, but four died within a few days of conditions related to their becoming hypothermic (such as alcoholism, anorexia nervosa). Measurements of blood potassium revealed that group A patients had very high potassium levels (14.5 millimoles of potassium per liter), compared with patients in group B (3.5 millimoles of potassium per liter). Increasingly high levels of potassium (but not as high as those observed in group A patients) were detected among nonhypothermic patients who died in intensive care. It is suggested that the blood potassium level can serve as a valuable aid in deciding how extensively resuscitation should be performed on hypothermic patients in cardiorespiratory arrest and coma. This variable may be particularly helpful when several patients are brought to the emergency ward at the same time. (Consumer Summary produced by Reliance Medical Information, Inc.)

Potassium in the body, Potassium (Nutrient), Hyperkalemia

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Some people are dead when they're cold and dead

Article Abstract:

The medical slogan ''no one is dead until (he is) warm and dead'' is meant to signify that victims of hypothermia (abnormally low body temperatures) can often be resuscitated if dramatic measures are used. However, heroic methods are worthwhile only if they have a reasonable chance of success. The physiological variables associated with a favorable prognosis have not been clearly identified for hypothermic patients. An article in the October 10, 1990 issue of The Journal of the American Medical Association reports that blood potassium levels may used as a guide when considering the advisability of attempting cardiorespiratory resuscitation of hypothermic patients. The study compared potassium levels in avalanche victims in cardiorespiratory arrest (cessation of heart and lung activity) with levels in a group of hypothermic people, most of whom were not in a state of arrest. Additional control groups should have been included. Physiological factors that affect blood potassium levels are discussed. In spite of its weak points, the study shows that a person can be cold and dead. The avalanche victims may have died from trauma and asphyxiation, rather than hypothermia; more data are needed to determine the cause of death. Although potassium levels can be taken into account in some cases, a better-formulated study will have to appear before current resuscitative practice changes. Resuscitation attempts must be instituted when signs of life are present, and not as a consequence of a value on a blood test. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Potassium (Chemical element), Potassium, Medical protocols, Resuscitation, editorial

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Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming

Article Abstract:

The heart-lung bypass machine can successfully rewarm some people whose hearts have stopped and who have become very cold following injury and exposure, with few apparent ill-effects. Blood rewarming using cardiopulmonary bypass saved 15 of 32 patients with hypothermia. Although some suffered early difficulties with speech, movement, memory and other deficits, all reported complete or satisfactory recovery when examined years after their accident. Young, healthy patients and proper medical support during transport in this group in Switzerland may have contributed to the encouraging outcome.

Health aspects, Evaluation, Cardiopulmonary bypass, Hyperthermia treatment systems (Medical care), Hyperthermia treatment equipment

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