II. Indications
-
Invasive Active Core Rewarming in Severe Hypothermia (core Temperature <28 to 30 C)
- Consider in hypothermic, pulseless arrest if extracorporeal warming not available within 6 hours
III. Contraindications
- Extracorporeal blood warming (ECMO) is available
- Preferred method of Invasive Active Core Rewarming in Severe Hypothermia
- Significant Coagulopathy
- Lung pleura adhesions
- Infection overlying Chest Tube insertion sites
IV. Efficacy
- Raises core temp by 5.4 to 10.8 F (3 to 6 C) per hour
V. Technique: Chest Tube Placement
- Typical Configuration: Two Chest Tubes
- In (anterior superior)
- Midclavicular Thoracostomy tube (second to third intercostal space)
- Out (posterior inferior)
- Midaxillary Thoracostomy tube (fourth to fith intercostal space)
- In (anterior superior)
- Alternative Configuration
- Single Chest Tube used to infuse, leave fluid in place and then suction fluid out
- Repeat on opposite side as needed
- Typically started on the right side
- Left sided lavage may increase risk for Dysrhythmia and decreased chest compression efficacy
VI. Technique: Saline Infusion
- Prepare Heated Sterile Normal Saline to 100.4 to 113 F (38 to 45 C, some guidelines limit to <42 C)
- Use commercial emergency department saline warmers (if available) OR
- Microwave (650 W) Normal Saline 1 liter bag
- Warm bag for 60 seconds and shake to agitate and distribute heat
- Warm bag again for another 60 seconds and shake to agitate
- Confirm bag Temperature at target 38 to 45 C
- Infuse warmed saline into anterior superior Chest Tube, and drain via posterior inferior Chest Tube
- Monitor Ins and Outs
VII. Technique: Completion of Thoracic Lavage
- Remove anterior superior Chest Tube and close the surgical wound site
- Leave the posterior inferior Chest Tube to allow saline to further drain
VIII. Complications
- Acute Respiratory Distress Syndrome
- Pneumonia
- Renal Failure
- Dysrhythmia (left sided lavage)
- Decreased chest compression efficacy (left sided lavage)
IX. References
- Warrington (2022) Crit Dec Emerg Med 36(2): 18