Survival and recovery after pediatric hypothermic immersion injury achieved through coordinated multidisciplinary approach

Our purpose is to illustrate how this Level 1 Trauma Center coordinated multiple disciplines to facilitate the care of two pediatric hypothermic immersions. The clinical services involved in the stabilization and care of these children included Prehospital EMS, Emergency Services, Operating Room, Cardiac Surgery, Trauma, Pediatric Surgery, and Pediatric Critical Care

Three children ages 5, 7 and 12, fell through the ice on a pond December 23, 1998. The oldest child was able to pull himself to safety and call for help. The water temperature was 32°F. The first responders were city police followed by EMS. A call was placed to the Trauma Team by prehospital personnel shortly after their arrival at the scene. The Trauma Attending notified the Operating Room and the Cardiac Surgery Attending to prepare for cardiopulmonary bypass. The 7-year-old was finally rescued 45 min after initial immersion and was intubated at the scene. He arrived in the Trauma Room at 12 noon, asystolic with a temperature of 81°F. He was taken directly to the OR for rewarming via cardiopulmonary bypass. He was on bypass for approximately 4 hours and was successfully resuscitated. He was admitted to the Pediatric Intensive Care Unit for 34 days and then discharged to inpatient rehabilitation. He has made a full functional and neurological recovery. A similar treatment was pursued for the 5 year old child when recovered but resuscitation of vital signs could not be achieved.

This institution experienced many 'firsts' with these cases. We had not previously used cardiopulmonary bypass in children. For future cases of hypothermic immersion injury, we needed a method to assure adequate communication and a systematic way of mobilizing appropriate personnel in a timely manner. Pediatric cardiopulmonary bypass equipment needed to be available and ready. When literature search did not yield specific guidelines for hypothermia, a multi-departmental task force was formed and a new hypothermia management protocol was created. This protocol insured maintenance of necessary equipment, availability of specialty personnel and rapid sequential mobilization and coordination of staff from many disciplines.

Development of a multi-departmental protocol is the key to successful coordination of multiple departments toward a favorable outcome in such time-critical cases as hypothermic immersion injury. Institutional education and the publicizing of favorable outcomes will help to motivate staff in maintaining preparedness for these cases.