Sunday, 3 December 2017

Never declare a patient dead under conditions of hypothermia

Never declare a patient dead under conditions of hypothermia

 Dr KK Aggarwal, Dr R N Tandon
A core body temperature below 95°F is hypothermia. Core temperature 90-95°F is mild hypothermia, 82 to 90°F is moderate hypothermia and core temperature below 82°F is severe hypothermia.

In conditions of severe hypothermia in children, body metabolism is suspended, which may protect against hypoxia. Patients with core body temperature 82°F have been known to survive anoxia for 12-18 minutes and up to 60 minutes or more at core body temperature 68°F. Sometimes, hypothermic patients can be successfully revived with CPR even with total resuscitation time of 9 hours. Because of dilated pupils, asystole, hypoventilation, absence of shivering, the patient appears dead. Because of failure to recognize this state, the patient may be declared dead.

Successful revival is also possible in adults because of the neuroprotective effects of hypothermia. Several hours of CPR may be required for this. Efforts to revive the patient should be continued till the core body temperature reaches 90-95°F i.e. bring the temperature from severe hypothermia to mild hypothermia or normal. If the patient still cannot be revived with CPR, then he/she can be declared dead.

The recent incident of a premature (22 weeks) newborn, who was alive, but allegedly declared dead at a private hospital in the National capital has captured headlines. The other twin was stillborn. While being taken for the funeral, the newborn was discovered to be alive and is now on life support system.

In light of this incident, IMA has issued an advisory that patients should not be declared dead under conditions of hypothermia. 

It is important to recognize hypothermia so that patient can be timely revived using all resuscitative measures, including rewarming, CPR.

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