Wiederbelebung bei Hypothermie und Ertrinken

Circulatory arrest in accidental hypothermia is a special challenge for the emergency physician, starting with the difficulty of diagnosis because of bradycardia and hypotonia. Extracorporal circulation is the standard method of rewarming in deep hypothermia with circulatory arrest. When not available, conservative rewarming with forced air, warmed infusions and ventilator gas, dialysis, peritoneal and pleural lavage are alternatives that have been successful. These conservative methods are also effective in cases of hypothermia with sustained perfusion although there is no accordance about the optimal method of rewarming these patients. In hospital the decision whom to take on extracorporal circulation or to terminate resuscitative efforts must remain individualized. Elevated serum potassium levels and prolonged activated clotted time indicate patients in whom deleterious hypoxia has preceded the protective effects of hypothermia. A submersion time of victims in icewater up to 66 min has been survived. In asystolic avalanche victims, a time of >45 min in absence of an air pocket is a good triage criteria for preclinical declaration of death.