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Resuscitation of a Pediatric Cold Water Drowning with Prolonged Cardiac Arrest

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Resuscitation of a Pediatric Cold Water Drowning with Prolonged Cardiac Arrest
Eric Melnychuk, DO, Kathryn Gibbons, MD, Filip Moshkovsky, DO, Brendan Dragann DO, Christopher Wilson, MD, Alfred Kennedy, MD, Richard Lambert, MD and Frank Maffei, MD, Geisinger Medical Center, Danville PA

Objective: A 22 month old male was found submerged in an icy 1.1oC creek approximately 30 minutes after he was reported missing. EMS arrived and began CPR with bag valve mask ventilation; initial cardiac rhythm was pulseless electrical activity (PEA). Resuscitation per pediatric advanced life support protocol was initiated. At the initial community hospital, he remained in PEA and CPR was continued. Initial rectal temperature was 25oC. Endotracheal intubation was performed and active external rewarming initiated. He was transported by air to our institution with ongoing CPR for continued resuscitation and possible extracorporeal rewarming. Upon arrival, CPR was continued and central access obtained. Active internal rewarming measures were then initiated. Initial examination revealed an unresponsive child with fixed and dilated pupils, no cough or gag, no spontaneous movement, and rectal temperature of 26oC. Initial blood gas analysis demonstrated a pH of 6.504 and a lactate of 13.2. Repeat blood gas demonstrated a pH of 6.7. Prior to extracorporeal rewarming cannulation, return of spontaneous circulation was documented by palpable pulses and blood pressure of 68/32mmHg. The patient received a total of 101 minutes of CPR; rectal temperature was 28oC at ROSC. Rewarming continued with the goal to rewarm to 32oC for 24 hours followed by rewarming to 37oC. The patient was discharged on hospital day 4 after full neurological recovery.
Objective: Describe the prolonged resuscitation of a child in hypothermic cardiac arrest.Objective Content: Highlight the importance of continuing CPR while rewarming victims of hypothermia-induced cardiac arrest. Describe a successful case of a pediatric patient air transported in full cardiac arrest.


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