# Survival from cardiac arrest at a core temperature of 14.0 °C on hospital arrival caused by cold exposure hypothermia treated with extracorporeal cardiopulmonary resuscitation: a case report

## TL;DR

A 70-year-old woman survived cardiac arrest with a core temperature of 14°C thanks to extracorporeal cardiopulmonary resuscitation and had a good neurological outcome.

## Contribution

This case report presents survival at an exceptionally low core temperature using ECPR in accidental hypothermic cardiac arrest.

## Key findings

- The patient survived with favorable neurological outcome after ECPR at a core temperature of 14°C.
- Profound hypothermia may protect the brain during prolonged circulatory arrest.
- ECPR is clinically important for selected hypothermic cardiac arrest patients.

## Abstract

•A patient with accidental hypothermic cardiac arrest arrived with a core temperature of 14.0 °C.•Extracorporeal cardiopulmonary resuscitation allowed survival with favorable neurological outcome.•Profound hypothermia may confer cerebral protection despite prolonged circulatory arrest.•This case highlights the clinical importance of ECPR in carefully chosen hypothermic cardiac arrest patients.

A patient with accidental hypothermic cardiac arrest arrived with a core temperature of 14.0 °C.

Extracorporeal cardiopulmonary resuscitation allowed survival with favorable neurological outcome.

Profound hypothermia may confer cerebral protection despite prolonged circulatory arrest.

This case highlights the clinical importance of ECPR in carefully chosen hypothermic cardiac arrest patients.

Accidental hypothermia complicated by cardiac arrest remains a challenging clinical condition, in which extracorporeal cardiopulmonary resuscitation (ECPR) may provide favorable outcomes in selected patients (Ruttmann et al., 2007; Walpoth et al., 1990).

A 70-year-old woman was found collapsed on a street near her home and was in cardiac arrest when emergency medical services arrived. On hospital arrival, her rectal temperature was 14.0 °C, and serum potassium measured from arterial blood was 8.68 mmol/L. Accidental cold exposure hypothermia was presumed, and ECPR using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated (Ruttmann et al., 2007; Walpoth et al., 1990). Ventricular fibrillation occurred shortly after initiation of ECPR, and defibrillation was performed when the core body temperature reached 25.6 °C, resulting in return of spontaneous circulation and a favorable neurological outcome. The predicted survival probability according to the HOPE score was 40% (Pasquier et al., 2018).

This case represents survival at one of the lowest core body temperatures reported on hospital arrival in an adult and highlights the established neuroprotective effects of profound hypothermia in accidental hypothermic cardiac arrest (Brown et al., 2012; McCullough and Arora, 2004; Gilbert et al., 2000; Sessler, 1997).