Active Measures: Alternatives to Cardiopulmonary Bypass

CPB simply will not be available to a lot of departments. If it is not an option (or while you are waiting for CPB) you should:

Start forced-air warming ‘blanket’ (e.g. Bair Hugger®)

Warm IV fluids

Warmed IV fluids will not do too much to increase core temperature but they will certainly prevent any further drop that might result from using room temperature infusions. Large volumes of fluid may be required.

Warm inspired air to 40-46°C

This requires a heater humidifier which if not available in the ED, should be obtained from the ICU. If unavailable, ensure that a heat and moisture exchange filter is in place.

Try gastric, bladder, peritoneal and/or pleural lavage

Use warmed Hartmann’s solution for gastric lavage via an NG tube or bladder lavage with a three-way catheter. Use warmed peritoneal dialysate (4L) via a peritoneal catheter. Leave the fluid in place for 10-15 minutes to allow heat exchange before draining out and replacing with fresh warm fluid. Pleural lavage requires an apical and basal chest drain on each side. 2L of warmed Hartmann’s is infused into each hemithorax via the apical drain and then removed through the basal drain about 10-15 minutes later.

Use a high volume renal haemofilter

A high volume renal haemofilter may be a readily available tool in smaller hospitals as most intensive care units have the facility for renal support. It may be technically difficult in a patient with no blood pressure but if flow can be established the machine will generally allow heating of the blood as it flows through the circuit. The kit is also fairly easily moved to the patient.

Intravascular temperature management devices exist too and some case reports have highlighted there use in re-warming hypothermic patients. The rate at which they achieve re-warming in severe hypothermia is unclear.