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CS436
Turn on the Heat: Surviving the Trauma Hypothermia Ice Age with Intravascular Core Rewarming
By: C. Mastropieri & M. Foreman; Baylor University Medical Center; Dallas, TX
For further information, please contact: cjmastropieri@aol.com
Purpose: Trauma hypothermia frequently occurs in the severely injured patient and leads to increased morbidity and mortality. Current warming measures are inadequate to treat hypothermia. A trauma program initiative was undertaken to implement and evaluate intravascular core rewarming for hypothermia.
Description: Maintaining normothermia during resuscitation plays a vital role in overall care and outcomes. After review of evidence base guidelines, a trauma hypothermia protocol was developed for intravascular core rewarming with CoolGard 3000®. Two systems were purchased from a foundation grant and training was initiated. Case analysis revealed a 52 year old male with history of depression found unresponsive in a swimming pool with self inflicted SW to the throat, abdomen and wrists. EMS care included intubation and IV fluid resuscitation. The patient was transported to a Level I trauma center. The initial Bp was 65/25, HR 114, oxygen saturation 100%, GCS 3 and a rectal temperature 86.9º F. The patient received 3 units of warm PRBC, bladder temperature monitoring and warm blankets. Initial pH was 6.9 and base excess -20. The patient was taken to the OR where an ICY® catheter was placed in the femoral vein and core rewarming initiated using CoolGard 3000®. The patient received 7 units of PRBC, 20 units of cryoprecipitate and 1 single donor platelets. Injuries included a neck laceration with tracheal injury, open transverse colon injury, median nerve transection, tendon laceration and bilateral ulna artery transection.
Evaluation and Outcomes: The patient was warmed to 94.8º F with a pH 7.33 and base excess -6 in the OR within 3 hours. The patient was taken to the ICU and the temperature reached 98.6º F in 1.5 hours. The ICY® catheter was removed in 24 hours with no complications. The ISS was 12, RTS 2.63 and RPS .6416. The LOS was 13 days. The use of intravascular core rewarming during trauma resuscitation was instrumental to decrease morbidity-mortality and improve outcomes.
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