Given the current weather it seems appropriate to post some guidance for patients suffering significant cold exposure. Below are concise guidelines from OSU medical center  and the Wilderness Medical Society (pre-hospital).  Both have useful information in regards to management along the spectrum of exposure. 

ECMO TRANSFERS

At this time we are referring all all ECMO transfers to Montefiore’s Cardiothoracic Surgical ICU.  Although most ECPR cases are not typically candidates for on-site cannulation and transfer, in some rare hypothermic cases (eg. young patient, short downtime) there may be an exception. 

To initiate possible transfer first call 718-920-ECMO and provide the following: Patient name, Diagnosis and Location.  The transfer center will connect you with a CT surgeon with whom you can discuss the case and decide whether the patient is a candidate for potential transfer.

If ECMO is deemed appropriate, next call the AOD in order to initiate the emergency credentialing process for the surgeon.

EXCLUSIONS to CPR

Appropriate situations in which to terminate efforts for performing CPR in hypothermic patients with cardiac arrest:

• Body is frozen solid (cannot perform chest compressions, no chest recoil)
• Obvious non-survivable injury (eg. Decapitation, truncal transection, incineration/decomposition of whole body)
• Airway obstruction (snow/ice) with downtime greater than 1 hour (more for avalanche victims than urban recoveries)

PROCEDURES

Thoracic lavage should be reserved only for pulseless patients.  A few variations of the procedure are possible including single and dual tube methods.  A good review can be found here THORACIC LAVAGE

Thank you to Neil Dubey and Mark Andreae for their help with this post.