2016Therapeutic Hypothermia and Temperature ManagementRequires access

Burst Suppression in Hypothermia After Cardiac Arrest Because of Drowning Treated with Targeted Temperature Management: A Case Report

Tomoya Okazaki, Toru Hifumi, Satoshi Egawa, Hideyuki Hamaya, Natsuyo Shinohara, Shohei Kawamoto, Takuma Iwaki, Kohei Tsukahara, Kenya Kawakita, Takashi Kusaka, Yasuhiro Kuroda

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Abstract

Outcomes of cardiac arrest (CA) because of drowning in children are generally poor, but some reports show that cases with post-CA hypothermia because of drowning exhibit good recovery when treated with targeted temperature management (TTM). However, because electroencephalogram (EEG) findings are not reported in those cases, a complete examination of brain damage has not been performed during TTM. Here we report a case of a 15-month-old boy with post-CA hypothermia recovery after treating with TTM, along with EEG findings. The initial clinical and laboratory data and resuscitation history in the current case strongly indicated an unfavorable outcome. However, the return of normal EEG findings after 36 hours postadmission may indicate favorable neurological outcomes. Although reliable evidence has not been established, we recommend maintained mild therapeutic hypothermia using TTM, followed by slow rewarming in patients with post-CA hypothermia because of drowning, based on the observations in the current case and in other studies.

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Outcomes of cardiac arrest (CA) because of drowning in children are generally poor, but some reports show that cases with post-CA hypothermia because of drowning exhibit good recovery when treated with targeted temperature management (TTM). However, because electroencephalogram (EEG) findings are not reported in those cases, a complete examination of brain damage has not been performed during TTM. Here we report a case of a 15-month-old boy with post-CA hypothermia recovery after treating with TTM, along with EEG findings. The initial clinical and laboratory data and resuscitation history in the current case strongly indicated an unfavorable outcome. However, the return of normal EEG findings after 36 hours postadmission may indicate favorable neurological outcomes. Although reliable evidence has not been established, we recommend maintained mild therapeutic hypothermia using TTM, followed by slow rewarming in patients with post-CA hypothermia because of drowning, based on the observations in the current case and in other studies.

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Available abstract

Outcomes of cardiac arrest (CA) because of drowning in children are generally poor, but some reports show that cases with post-CA hypothermia because of drowning exhibit good recovery when treated with targeted temperature management (TTM). However, because electroencephalogram (EEG) findings are not reported in those cases, a complete examination of brain damage has not been performed during TTM. Here we report a case of a 15-month-old boy with post-CA hypothermia recovery after treating with TTM, along with EEG findings. The initial clinical and laboratory data and resuscitation history in the current case strongly indicated an unfavorable outcome. However, the return of normal EEG findings after 36 hours postadmission may indicate favorable neurological outcomes. Although reliable evidence has not been established, we recommend maintained mild therapeutic hypothermia using TTM, followed by slow rewarming in patients with post-CA hypothermia because of drowning, based on the observations in the current case and in other studies.

Key concepts: Hypothermia, Medicine, Targeted temperature management, Resuscitation, Anesthesia, Near Drowning, Return of spontaneous circulation, Electroencephalography

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