Accidental hypothermic cardiac arrest and extracorporeal membrane oxygenation: a case report

BACKGROUND: Accidental hypothermic cardiac arrest, an involuntary drop in core body temperature resulting in cardiopulmonary arrest, is linked to 1500 deaths annually. We highlight the challenges with the treatment of accidental hypothermic cardiac arrest and describe improved preparations necessary for an integrated health system to care for similar patients. CASE REPORT: Emergency medical services (EMS) were dispatched to a 34‐year‐old female who had been missing for several hours during a January snowfall. The patient was found unconscious over an embankment. The patient was found with a weak carotid pulse and two empty bottles of clozapine, an atypical antipsychotic. The EMS crew extricated the patient, performed a rapid trauma assessment, passive rewarming, and airway management. During transport, the patient suffered a ventricular fibrillation cardiac arrest, received defibrillation, and advanced life support measures. Resuscitative efforts continued in the emergency department while the treatment team addressed environmental exposure, assessed for traumatic injury and toxicologic exposure. On emergency department (ED) arrival, the patient's core temperature was 24°C, and despite aggressive resuscitation, the patient remained in cardiac arrest. The ED care team used extracorporeal membrane oxygenator (ECMO) and successfully resuscitated the patient with extracorporeal cardiopulmonary resuscitation. The patient achieved full neurologic recovery 15 days post‐ED arrival. CONCLUSION: This case highlights the importance of early recognition of accidental hypothermic cardiac arrest by EMS clinicians, rapid transport to a tertiary facility, and the timely application of active rewarming and in‐hospital ECMO. Accidental hypothermic cardiac arrest is a reversible state; prompt and correct treatment allows for a high probability of a favorable neurologic outcome.