Severe hypothermia and cardiac arrest successfully treated without external mechanic circulatory support.

A 65-year-old man developed profound hypothermia after environmental exposure. On arrival, he was unresponsive, with a core body temperature of 19.6 degrees C (67.3 degrees F), no discernable pulse or blood pressure, and no cardiac activity present on bedside cardiac echocardiography. Given the patient's extreme cold temperature, mechanical chest compression was not initiated nor was it used at any point during the resuscitation process or hospital stay. Attempts to warm him with traditional surface warming methods and intravascular heating were initiated but were felt unlikely to be successful due to lack of any cardiac output and perfusion. Thoracic lavage with warm saline was performed and resulted in initially minimal cardiac contraction seen on echocardiography. Once circulation was established by directly warming the myocardia with thoracic lavage, intravascular and external warming methods proved effective in raising the patient's body temperature at a target rate of approximately 1.0 degrees C (1.8 degrees F) per hour and restoring hemodynamic stability and neurologic function. This is, to our knowledge, the first case report of successful resuscitation and neurological intact survival in a severely hypothermic patient presenting with no cardiac activity in which neither chest compressions nor invasive circulatory support were utilized.