DROWNING ASPHYXIA AND ACCIDENTAL HYPOTHERMIC CARDIAC ARREST WITH FAVORABLE OUTCOME: A CASE REPORT

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Drowning with accidental hypothermia (AH) and cardiac arrest is a challenging clinical situation—severe core body temperature (CBT) < 28 ˚C by itself life-threatening. The overall mortality ranges from 30-80% increases to 100% in submersion victims who are comatose required prolonged CPR. CASE PRESENTATION: A 22-year-old female was seen bystanders as she intentionally jumped into an ice-covered lake Minnesota on cold December night when the outdoor 20 ˚F (-6 ˚C). She submerged for 25 minutes. On retrieval, asystole, CPR commenced at scene continued along way nearest ER. In ER, remained asystole another minutes before achieving ROSC. immediately intubated GCS of 3 hypoxia. Her initial CBT 27.7 (82 ˚F). Multiple active external internal rewarming techniques were employed. laboratory workup revealed pH 6.8, serum K 2.5 mEq/L LA 10.7 mmol/L. Ongoing care ICU included deep sedation rewarming. chest X-ray showed extensive bilateral pulmonary opacities. oxygenation worsen, PF ratio 65, suggesting severe ARDS. Unfortunately, considered not suitable candidate ECMO based suspected asphyxia subsequent anoxic brain injury. Consequently, managed protective lung ventilation prone positioning. Re-warming (using Arctic Sun™ TTM system), normothermia achieved rate 1 ˚C/hr. Day 2, tolerated SAT SBT. However, developed jerky movements her extremities. diagnosis post-hypoxic myoclonus (Lance-Adams myoclonus) made responded well Levetiracetam. successfully extubated 4 left 5. medical ward, MRI scattered areas acute infarction involving cerebral cortex bilaterally. discharged 14. Levetiracetam discontinued follow-up visit complete neurological recovery. DISCUSSION: outcome has substantially improved ECLS use survival 100%. subgroup hypothermia, submersion, have significant morbidity mortality, despite ECLS. Current guidelines recommend aggressive management all patients, particularly young victims, no methods can reliably predict will likely survive. drowning-related immersion period > min invariably prove fatal. This poor due which leads irreversible damage, usually preceding effects tissue. CONCLUSIONS: Despite known survival, should be contraindication hypothermic arrest, especially victims. REFERENCE #1: Avellanas Chavala, M. L., Ayala Gallardo, M., Soteras Martínez, Í., & Subirats Bayego, E. (2019). Management hypothermia: narrative review. Gestión de la hipotermia accidental: revisión narrativa. Medicina intensiva, 43(9), 556–568. PMID: 30683520. #2: Ledoux, A., Saint Leger, P. (2020). Therapeutic veno-arterial ECMO: where do we stand? report review current literature. Scandinavian journal trauma, resuscitation emergency medicine, 28(1), 30. 32316980. #3: Farstad, Andersen, K. S., Koller, E., Grong, K., Segadal, Husby, (2001). Rewarming extracorporeal circulation. retrospective study. European cardio-thoracic surgery : official Association Cardio-thoracic Surgery, 20(1), 58–64. 11423275. DISCLOSURES: No relevant relationships Sumera Ahmad, source=Web Response Osama Mukhtar,