Mark et al. International Journal of Emergency Medicine 2012, 5:7 http://www.intjem.com/content/5/1/7 C A S E R E P O R T Open Access Hypothermic cardiac arrest far away from the center providing rewarming with extracorporeal circulation Eckhard Mark1, Olaf Jacobsen2, Astrid Kjerstad2, Torvind Naesheim2, Rolf Busund3, Ramez Bahar3, Jon Kjetil Jensen4, Per Kristian Skorpen5 and Lars J Bjertnaes1,2,6* Abstract A 41-year-old man suffered hypothermic cardiac arrest after water immersion and was transported to our university hospital by ambulance helicopter for rewarming on cardiopulmonary bypass. He resumed spontaneous cardiac activity 6 h 52 min after cardiac arrest and recovered completely. Background In the Northern hemisphere, most victims of accidental hypothermic cardiac arrest have a history of drowning or entombment by avalanches. Consequently, asphyxia and cardiac arrest develop before the body temperature has fallen to a sufficiently low level for oxygen demand to meet the supply. However, some patients have the advantage that they can breathe while being cooled until the heart stops [1-5]. Case report An alcohol-intoxicated man, 41 years of age, fell into a river on the coast of North Norway after leaving a party between 3 and 4 o’clock a.m. on 30 December. Approxi- mately 1 h later, passers by spotted him shouting for help and pulled him out of the water. One of them undressed and attempted to warm him by skin-to-skin contact at the prevailing air temperature of -2°C. The patient lost con- sciousness and stopped breathing as the paramedics lifted him into the ambulance at 04.45 a.m. One of them started cardiopulmonary resuscitation (CPR) and continued it during the drive to the local hospital. Upon arrival at 05.01 a.m., his electro-cardiogram (ECG) was isoelectric, rectal temperature was 27.5°C, and arterial blood gases displayed pH 7.00, PaCO2 10.60 kPa, PaO2 3.60 kPa, HCO3 -18.5 mmol/l, and BE -11.3 mmol/l. He had no * Correspondence: lars.bjertnaes@uit.no 1Department of Emergency Medical Services, University Hospital of North Norway, Trom-sø, Norway Full list of author information is available at the end of the article visible injuries except for a wound in the occipital region. He was endotracheally intubated and received 90 mmol of trimetamol (Tribonat®, Fresenius Kabi AS, Oslo, Norway) intravenously (IV). Following two IV injections of 1 mg epinephrine (Adrenalin®, Nycomed Pharma AS, Asker, Norway), his ECG shifted to ventricular fibrillation (VF), but attempts at defibrillation failed. At 6.00 o’clock, the physician in charge contacted the ambulance dispatch cen- ter of the University Hospital of North Norway (UNN) in Tromsø (latitude: 69°, 40’ North). The anesthesiologist on duty for the helicopter and the thoracic surgical team decided to fly the 260 km (140 NM) to the local hospital and bring the patient to UNN for rewarming by means of extracorporeal circulation. The helicopter that was pre- pared for instrument flights took off at 06.45 a.m. When starting the return flight from the local hospital at 08.00 a. m., the stretcher was turned across the cabin. This facili- tated optimum access for manual ventilation (10 inflations per min, FiO2 1.0) and external cardiac compression (100 compressions per min) carried out alternately by the anesthesiologist and a nurse anesthetist with no hands off time [6]. After landing at UNN at 08.45 a.m., the patient was transferred to the emergency room where his arterial blood gases showed: pH 6.88, PaO2 26.20 kPa, PaCO2 7.62 kPa, and base excess -21 mmol/l. Serum creatine phosphokinase (CPK) and myoglobin were 14,000 μg/l and 3,017 U/l, respectively, K+ 5.9 mmol/l, Ca2+ 1.7 mmol/l, and rectal temperature 25°C. The ECG dis- played a coarse VF. The occipital wound was sutured, © 2012 Mark et al; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.