Active Measures: Cardiopulmonary Bypass

In a hypothermic arrest, the therapeutic manoeuvre of choice is cardiopulmonary bypass (CPB) [4,5]. This may be instituted using femoro-femoral or aortic-right atrial bypass. The former is more suited to the emergency department (ED) environment as it is easier and faster to establish and prevents further heat loss, which will result from opening the chest [5]. If femoro-femoral bypass is established, chest compressions should generally be continued to ensure acceptable flow through the cardio-pulmonary circulation.

Temperature increases of 1-2°C every 5 minutes may be achieved. Bypass should be instituted for patients in cardiac arrest, patients with haemodynamic instability and a core temperature below 32°C, frozen extremities and rhabdomyolysis with hyperkalaemia [5].

Note the size of the cardiopulmonary bypass machine in the image shown. It may be easier to take the patient to theatre than the machine to Resus.