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Resident PGY 5
Henry Ford Hospital
Objectives: External rewarming often fails to correct the temperature of patients with severe hypothermia. In these cases, various invasive techniques have classically been utilized, including intubation with heated ventilation, heated peritoneal dialysis, thoracic lavage, gastric or colonic lavage, mediastinal irrigation (in arrest), central venous temperature management catheters, and extracorporeal rewarming. All of the invasive procedures above are associated with various procedural complications, and most of the vascular interventions above are limited to regional centers with the necessary equipment and expertise. Esophageal temperature management (ETM) devices present a novel option for rewarming. While their use in cooling as part of post-arrest targeted temperature management has been well-described, we are only aware of one reported case using an ETM device to reverse hypothermia.1 We aim to add to this knowledge base by describing a patient presenting with altered mental status and severe hypothermia of undetermined cause who was successfully rewarmed using an ETM device.Methods: This is a single patient case report.Results: A 69-year-old female (157.5 cm, 57.4 kg) was admitted from a nursing home with a minimum recorded temperature of 26.9 °C (rectal). The patient’s hypothermia was complicated by sinus arrest with junctional bradycardia and hypotension requiring transcutaneous pacing. After warmed intravenous fluids and warming blanket, the patient’s temperature only improved to 28.7 °C (bladder).At this point, an ETM device was inserted to aid warming, and the patient was successfully rewarmed to 37.2 °C. We observed no major adverse effects. Conclusions: Rewarming from severe hypothermia was possible using the ETM device as the sole invasive rewarming method.
Bissonette, Andrew; Miller, Joseph B. MD; and Pflaum-Carlson, Jacqueline, "Rewarming Severe Hypothermia Using Esophageal Temperature Management Device" (2019). Case Reports. 29.