{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T05:40:49Z","timestamp":1761198049645,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T00:00:00Z","timestamp":1648512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The aim of our study is to investigate successful pre-rewarming resuscitation after hypothermic cardiac arrest (HCA). The hypothermic heart may be insensitive to defibrillation when core temperature is below 30 \u00b0C and after successful defibrillation, sinus rhythm often returns into ventricular fibrillation. Recurrent defibrillation attempts may induce myocardial injury. Discrepancy exists concerning pre-rewarming defibrillation between the guidelines of the European Resuscitation Council and American Heart Association. The International Hypothermia Registry (IHR) gathers hypothermia cases. The primary outcome was survival. Secondary outcomes were the characteristics of defibrillation, the effect of Adrenaline administration under 30 \u00b0C, and the duration of CPR. Of the 239 patients, eighty-eight were in cardiac arrest at arrival of the rescue team. Successful pre-rewarming resuscitation was obtained in 14 patients. The outcome showed: seven deaths, one vegetative state, two patients with reversible damage, and four patients with full recovery. A total of five patients had a shockable rhythm, and defibrillation was successful in four patients. The response rate to Adrenaline was reported as normal in six patients. There were no statistically significant differences in the presence of a shockable rhythm, the success of defibrillation, and the effect on Adrenaline administration between the survivors and non-survivors. Successful resuscitation in severe hypothermia is possible before active rewarming and arrival in the hospital, thus improving the chance of survival.<\/jats:p>","DOI":"10.3390\/ijerph19074059","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T21:44:52Z","timestamp":1648590292000},"page":"4059","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Successful Pre-Rewarming Resuscitation after Cardiac Arrest in Severe Hypothermia: A Retrospective Cohort Study from the International Hypothermia Registry"],"prefix":"10.3390","volume":"19","author":[{"given":"Evelien","family":"Cools","sequence":"first","affiliation":[{"name":"Department of Acute Medicine, Division of Anaesthesiology, University Hospitals Geneva, 1205 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Centre Hospitalier University Vaudois, 1011 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delphine","family":"Courvoisier","sequence":"additional","affiliation":[{"name":"Quality of Care Unit, University Hospitals of Geneva, 1205 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beat","family":"Walpoth","sequence":"additional","affiliation":[{"name":"Emeritus, Department of Cardiovascular Surgery, University Hospitals of Geneva, 1205 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1056\/NEJM199711203372103","article-title":"Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming","volume":"337","author":"Walpoth","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s11739-009-0228-5","article-title":"Hypothermia: An under-estimated risk","volume":"4","author":"Caroselli","year":"2009","journal-title":"Intern. Emerg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s13049-016-0303-7","article-title":"Accidental hypothermia-an update","volume":"24","author":"Paal","year":"2016","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1007\/s12024-010-9142-4","article-title":"Hypothermia","volume":"6","author":"Turk","year":"2010","journal-title":"Forensic Sci. Med. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.jtcvs.2007.05.028","article-title":"No one is dead until warm and dead","volume":"134","author":"Iyer","year":"2007","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.resuscitation.2021.08.016","article-title":"Hypothermic Cardiac Arrest\u2014Retrospective cohort study from the International Hypothermia Registry","volume":"167","author":"Walpoth","year":"2021","journal-title":"Resuscitation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.resuscitation.2021.02.011","article-title":"European Resuscitation Council Guidelines for Cardiac Arrest in Special Circumstances","volume":"161","author":"Lott","year":"2021","journal-title":"Resuscitation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S366","DOI":"10.1161\/CIR.0000000000000916","article-title":"Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"142","author":"Panchal","year":"2020","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1186\/s13256-019-2282-6","article-title":"Successful resuscitation from prolonged hypothermic cardiac arrest without extracorporeal life support: A case report","volume":"13","author":"Kuhnke","year":"2019","journal-title":"J. Med. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1097\/00003246-200206000-00027","article-title":"Vasopressin improves survival in a pig model of hypothermic cardiopulmonary resuscitation","volume":"30","author":"Schwarz","year":"2002","journal-title":"Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S135","DOI":"10.1016\/j.resuscitation.2005.10.004","article-title":"European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances","volume":"67","author":"Soar","year":"2005","journal-title":"Resuscitation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1016\/j.resuscitation.2010.08.015","article-title":"European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution","volume":"81","author":"Soar","year":"2010","journal-title":"Resuscitation"},{"key":"ref_13","first-page":"148","article-title":"Cardiac arrest in special circumstances section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances","volume":"95","author":"Deakin","year":"2015","journal-title":"Resuscitation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1016\/j.wem.2014.10.010","article-title":"Wilderness Medical Society. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update","volume":"25","author":"Zafren","year":"2014","journal-title":"Wilderness Environ. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.wem.2019.10.002","article-title":"Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update","volume":"30","author":"Dow","year":"2019","journal-title":"Wilderness Environ. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.resuscitation.2018.10.018","article-title":"Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm","volume":"133","author":"Schmidbauer","year":"2018","journal-title":"Resuscitation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.resuscitation.2007.07.023","article-title":"Who survives from out-of-hospital pulseless electrical activity?","volume":"76","author":"Kuisma","year":"2008","journal-title":"Resuscitation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1089\/ham.2018.0084","article-title":"Successful Defibrillation of Four Hypothermic Patients with Witnessed Cardiac Arrest","volume":"20","author":"Mair","year":"2019","journal-title":"High Alt. Med. Biol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e006472","DOI":"10.1161\/JAHA.117.006472","article-title":"Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest","volume":"6","author":"Piktel","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/MEJ.0000000000000213","article-title":"Severe Accidental Hypothermia Center","volume":"22","author":"Darocha","year":"2015","journal-title":"Eur. J. Emerg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1097\/MAT.0000000000000422","article-title":"Profound Accidental Hypothermia: Systematic Approach to Active Recognition and Treatment","volume":"63","author":"Jarosz","year":"2017","journal-title":"ASAIO J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.resuscitation.2018.02.026","article-title":"Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score","volume":"126","author":"Pasquier","year":"2018","journal-title":"Resuscitation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1056\/NEJMra1114208","article-title":"Accidental Hypothermia","volume":"367","author":"Brown","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13049-020-00723-y","article-title":"Therapeutic management of severe hypothermia with veno-arterial ECMO: Where do we stand? Case report and review of the current literature","volume":"28","author":"LeDoux","year":"2020","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/S0300-9572(00)00254-9","article-title":"Successful defibrillation in profound hypothermia (core body temperature 25.6 \u00b0C)","volume":"47","author":"Thomas","year":"2000","journal-title":"Resuscitation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.wem.2020.01.003","article-title":"Successful Defibrillation at a Core Temperature of 18.2 Degrees Celsius","volume":"31","author":"Drzewiecka","year":"2020","journal-title":"Wilderness Environ. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4103\/0019-5049.111882","article-title":"Successful defibrillation\/resuscitation in accidental profound hypothermia","volume":"57","author":"Marimuthu","year":"2013","journal-title":"Indian J. Anaesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S0196-0644(80)80339-8","article-title":"Extreme hypothermia and ventricular fibrillation","volume":"9","author":"DaVee","year":"1980","journal-title":"Ann. Emerg. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1136\/emj.2006.044404","article-title":"Best evidence topic report. Is defibrillation effective in accidental severe hypothermia in adults?","volume":"24","author":"Clift","year":"2007","journal-title":"Emerg. Med. 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