Survival after 5-h resuscitation attempt for hypothermic cardiac arrest using CVVH for extracorporeal rewarming

Hypothermic cardiac arrest is associated with a high mortality despite advances in pre-hospital rescue, rewarming techniques and intensive care management. Prolonged resuscitation is justified and full neurological recovery has been described using various methods of extracorporeal rewarming (Vretenar DF, Urschel JD, Parrott JCW et al. Ann Thorac Surg 1994; 58: 895-898; Hughes A, Riou P, Day C. Emerg Med J 2007; 24: 511-512). Extracorporeal rewarming is usually required at temperatures below 32 degrees C or in the presence of cardiovascular instability or neurological dysfunction (Wilkey SA. Am J Clin Med 2004; 1: 4-11). Resuscitation guidelines suggest cardiopulmonary bypass (CPB) as the method of choice in cardiac arrest, but in practice availability is restricted (Soar J, Deakin CD, Nolan JP et al. Resuscitation 2005; 67: S135-S170). Continuous veno-venous haemofiltration (CVVH) is an alternative, but underutilized approach which warrants further consideration given its ease and wider availability.