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.