Accidental hypothermia–an update

Abstract

BackgroundThis paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest.MethodsThe authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review.ResultsThe hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature <28 °C, ventricular arrhythmia, systolic blood pressure <90 mmHg), and those who have already arrested, should be transferred directly to an ECLS-centre. Cardiac arrest patients should receive continuous cardiopulmonary resuscitation (CPR) during transfer. If prolonged transport is required or terrain is difficult, mechanical CPR can be helpful. Delayed or intermittent CPR may be appropriate in hypothermic arrest when continuous CPR is impossible. Modern post-resuscitation care should be implemented following hypothermic arrest. Structured protocols should be in place to optimise pre-hospital triage, transport and treatment as well as in-hospital management, including detailed criteria and protocols for the use of ECLS and post-resuscitation care.ConclusionsBased on new evidence, additional clinical experience and clearer management guidelines and documentation, the treatment of accidental hypothermia has been refined. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.

Accidental hypothermia in recreational activities in the mountains: A narrative review

“…The gold standard involves measuring core temperature (eg, in the pulmonary artery or lower third of the esophagus). The advantages and disadvantages of measuring temperature at different sites in the body have been reviewed elsewhere . Less invasive techniques as well as other systems of staging that rely on clinical signs instead of temperature measurement are often used in the field because they are more practical, though not necessarily accurate.…”

“…The advantages and disadvantages of measuring temperature at different sites in the body have been reviewed elsewhere. 18,19 Less invasive techniques as well as other systems of staging 20 that rely on clinical signs instead of temperature measurement are often used in the field because they are more practical, though not necessarily accurate. Current international recommendations suggest the use of esophageal or thermistor-based tympanic measurement to determine core temperature in hypothermic patients.…”

“…Current international recommendations suggest the use of esophageal or thermistor-based tympanic measurement to determine core temperature in hypothermic patients. 17,18,21 3 | PHYSIOLOGICAL RESPONSE…”

Warming the head of hypothermic patient – is it always safe?

“…The publication “Accidental hypothermia – an update” is a valuable, comprehensive review of current knowledge of hypothermic patients’ management, especially in prehospital settings [1]. It contains clear and useful guidelines, which are very important in the mountain rescue.…”

“…For this reason, keeping the low gradient between a brain temperature and a core temperature during rewarming, can be essential for neuronal survival. Sometimes, shielding the head from the heat source can be beneficial, which is mentioned by the authors in further part of their paper [1]. …”