Accidental Hypothermia: 2021 Update

Abstract

Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.

Treatment of Cardiovascular Dysfunction with PDE3-Inhibitors in Moderate and Severe Hypothermia—Effects on Cellular Elimination of Cyclic Adenosine Monophosphate and Cyclic Guanosine Monophosphate

“…Patients with signs of cardiovascular instability, cardiac arrest, or core temperatures <30 °C, are transported directly to a hospital with stand-by extracorporeal life support (ECLS) for active rewarming. Remaining patients are triaged to the nearest, appropriate hospital for passive and/or minimally invasive active rewarming (Lott et al, 2021;Paal et al, 2022). In accidental hypothermic patients, one pharmacological strategy to prevent or treat HCD is to elevate cardiac contractility (Dietrichs, Sager and Tveita, 2016).…”

Prevention of Hypothermia in the Aftermath of Natural Disasters in Areas at Risk of Avalanches, Earthquakes, Tsunamis and Floods

“…Chemical or battery-powered heat packs that do not require an external source of electricity or hot water bottles should be stockpiled for active external rewarming. A review of the diagnosis and treatment of accidental hypothermia can be found in this special issue [79].…”

Editorial on the Research Topic the 2nd Edition of Mountain Sports Activities: Injuries and Prevention

“…The development of effective strategies for the prevention of accidents/emergencies in mountain sports requires, beside updated knowledge derived from observational (epidemiological) studies, the inclusion of up-to-date findings from basic research. For example, information on cardiovascular and musculo-skeletal strain during hiking, climbing, skiing, cycling, etc., under different ambient conditions (e.g., altitude, cold, heat) is extremely helpful to advise healthy and in particular diseased individuals on the selection of and how to prepare for mountain sports activities [ 10 , 11 , 12 , 13 , 14 ]. Furthermore, knowledge on pathophysiological mechanisms triggering high-altitude illnesses (e.g., acute mountain sickness, high-altitude cerebral and pulmonary edema) is a prerequisite for the prevention and appropriate treatment of those illnesses as well [ 15 , 16 , 17 ].…”