• Alessandro Forti, Pamela Brugnaro, Simon Rauch, Manuela Crucitti, Hermann Brugger, Giovanni Cipollotti, and Giacomo Strapazzon.
• Department of Anesthesiology and Intensive Care Medicine, Regional Hospital Treviso, Treviso, Italy; Helicopter Emergency Medical Services of SUEM/118 ULSS 1, Pieve di Cadore, Italy.
• Ann Emerg Med. 2019 Jan 1; 73 (1): 52-57.

AbstractWe describe full neurologic recovery from accidental hypothermia with cardiac arrest despite the longest reported duration of mechanical cardiopulmonary resuscitation (CPR) and extracorporeal life support (8 hours, 42 minutes). Clinical data and blood samples were obtained from emergency medical services (EMS) and the intensive care department. A 31-year-old man experienced a witnessed hypothermic cardiac arrest with a core temperature of 26°C (78.8°F) during a summer thunderstorm; he received mechanical CPR for 3 hours and 42 minutes, followed by 5 hours of extracorporeal life support. The use of a standard operating procedure that integrates a technical mountain rescue performed by EMS, optimizes prolonged CPR to the hub hospital, and enables prompt placement of extracorporeal life support is described and discussed. Three months postaccident, the patient had recovered completely (Cerebral Performance Category score of 1) and resumed normal daily life. Neurologically intact survival from hypothermic cardiac arrest is common, suggesting that aggressive resuscitation measures are warranted. There is a need for the establishment of a clear standard operating procedure and multiteam education and training to further optimize the patient survival chain from on-site triage and treatment to inhospital extracorporeal life support and postresuscitation care.Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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