Book contents
- Frontmatter
- Contents
- Introduction
- 1 Hypothermia as a Disorder
- 2 Epidemiology and Estimating Preventable Deaths in Accidental Hypothermia
- 3 Facts and Myths about Hypothermia and its Treatment
- 4 Measurement of Patient's Body Temperature
- 5 Prehospital Management of Hypothermia
- 6 Thermal Insulation
- 7 Airway Management in Hypothermic Patients
- 8 ECG in Hypothermia
- 9 Hypothermia as a Reversible Cause of Cardiac Arrest
- 10 The Role and Tasks of Polish Medical Air Rescue
- 11 Trauma and Hypothermia
- 12 Prehospital Management of Avalanche Victims
- 13 Prehospital Rewarming in Hypothermia. Indications, Methods, Problems and Pitfalls
- 14 Coagulopathies in Hypothermic Patient
- 15 Changes of Pharmacokinetics and Pharmacodynamics of Medications in Hypothermic Patients
- 16 Extracorporeal Therapy in Patients in Severe Hypothermia
- 17 Vascular Access for Extracorporeal Circulation
- 18 Problems and Pitfalls of Qualification for Extracorporeal Treatment of Patients in Severe Hypothermia
- 19 Procedure of Extracorporeal Treatment of Hypothermic Patients
- 20 Recommendation of National Consultant in the Field on Emergency Medicine
- 21 Accidental Hypothermia: the Need for the International Hypothermia Registry
- 22 Qualification for Extracorporeal Rewarming Medical Report
18 - Problems and Pitfalls of Qualification for Extracorporeal Treatment of Patients in Severe Hypothermia
Published online by Cambridge University Press: 03 January 2018
- Frontmatter
- Contents
- Introduction
- 1 Hypothermia as a Disorder
- 2 Epidemiology and Estimating Preventable Deaths in Accidental Hypothermia
- 3 Facts and Myths about Hypothermia and its Treatment
- 4 Measurement of Patient's Body Temperature
- 5 Prehospital Management of Hypothermia
- 6 Thermal Insulation
- 7 Airway Management in Hypothermic Patients
- 8 ECG in Hypothermia
- 9 Hypothermia as a Reversible Cause of Cardiac Arrest
- 10 The Role and Tasks of Polish Medical Air Rescue
- 11 Trauma and Hypothermia
- 12 Prehospital Management of Avalanche Victims
- 13 Prehospital Rewarming in Hypothermia. Indications, Methods, Problems and Pitfalls
- 14 Coagulopathies in Hypothermic Patient
- 15 Changes of Pharmacokinetics and Pharmacodynamics of Medications in Hypothermic Patients
- 16 Extracorporeal Therapy in Patients in Severe Hypothermia
- 17 Vascular Access for Extracorporeal Circulation
- 18 Problems and Pitfalls of Qualification for Extracorporeal Treatment of Patients in Severe Hypothermia
- 19 Procedure of Extracorporeal Treatment of Hypothermic Patients
- 20 Recommendation of National Consultant in the Field on Emergency Medicine
- 21 Accidental Hypothermia: the Need for the International Hypothermia Registry
- 22 Qualification for Extracorporeal Rewarming Medical Report
Summary
If indications for extracorporeal rewarming in hypothermia are clearly defined, the problems one might encounter in practice have not been, as yet, delineated. Isolated reports on “qualification pitfalls” appear in certain case studies, but majority of these constitute only relative contraindications. In patients with instability of cardiovascular system, and cardiac arrest in particular, decision to qualify for extracorporeal rewarming must be immediate. At the same time, diagnostic possibilities are significantly limited (incoming reports from emergency medical teams or mountain rescue services, patients undergoing resuscitation or extremely unstable). In such instances not qualification, but denial of extracorporeal treatment may present the greatest challenge on both clinical as well as ethical planes.
The compilation of problems and pitfalls experienced during qualification procedure is based upon several months of work of Severe Hypothermia Treatment Centre coordinators in Kraków. It is until now the only centre specialising in extracorporeal rewarming in Poland, and the only one operating according to proprietary, uniform algorithm. This has allowed to observe recurrence of certain conditions, assess their importance and draw appropriate conclusions. ECMO therapy carries a risk of grave complications, but majority of these can be avoided by means of proper qualification procedure and avoidance of factors which affect the very treatment. As emphasised before, the problems described below constitute merely relative contraindications, and thanks to good long term outcomes of extracorporeal rewarming, they should be considered in relation to a complete disorder evaluation and discussed by the team involved in the treatment.
Thrombocytopenia and/or clinically important anaemia
These disorders are present in patients belonging to so called “underclass”, but also in the elderly, neglected and malnutrition stricken victims of “urban hypothermia.” The values of haemoglobin seen in our patients reached even 3.6 mg/dL and thrombocyte count 18,000/mL. It should be stressed that even such low parameters do not constitute a contraindication for extracorporeal rewarming, yet require intervention.
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- Chapter
- Information
- Hypothermia: Clinical Aspects Of Body CoolingAnalysis Of Dangers Directions Of Modern Treatment, pp. 161 - 168Publisher: Jagiellonian University PressPrint publication year: 2016