Out-of-hospital cardiac arrest secondary to accidental hypothermia in a patient with myelodysplastic syndrome: A case report

Abstract

An 86-year-old man with a history of myelodysplastic syndrome was discovered in an unresponsive state in a cold environment. Immediately after the arrival of the ambulance attendants at the scene, the patient developed cardiopulmonary arrest (CPA) with pulseless electrical activity. He received prompt cardiopulmonary resuscitation (CPR) and was transferred to our hospital. Upon arrival at our emergency department, the cardiac rhythm showed ventricular fibrillation, and his core body temperature was 22.6˚C. He was diagnosed with out-of-hospital cardiac arrest secondary to accidental hypothermia. CPR was continued following electrical defibrillation, and advanced cardiovascular life support including endotracheal intubation was initiated. Simultaneous conventional rewarming using primarily warm fluid infusion was aggressively attempted, and these interventions led to return of spontaneous circulation 72 min after initiation of CPR. Laboratory test results revealed severe anemia. Rewarming was continued with intensive care measures, including mechanical ventilation and red blood cell concentrate transfusion. His core body temperature increased to 35.0˚C 6.5 hours after admission, with recovery of consciousness. Despite disseminated intravascular coagulation, rewarming shock, and congestive heart failure, he eventually recovered and was transferred to the Department of Hematological Internal Medicine on hospital day 7 without any neurological sequelae.

Patients with CPA secondary to accidental hypothermia should undergo sustained CPR with rewarming, even if prolonged therapy is required.