Hypothermia in Trauma

Abstract

Hypothermia in trauma patients is a common condition. It is aggravated by traumatic hemorrhage, which leads to hypovolemic shock. This hypovolemic shock results in a lethal triad of hypothermia, coagulopathy, and acidosis, leading to ongoing bleeding. Additionally, hypothermia in trauma patients can deepen through environmental exposure on the scene or during transport and medical procedures such as infusions and airway management. This vicious circle has a detrimental effect on the outcome of major trauma patients. This narrative review describes the main factors to consider in the co-existing condition of trauma and hypothermia from a prehospital and emergency medical perspective. Early prehospital recognition and staging of hypothermia are crucial to triage to proper care to improve survival. Treatment of hypothermia should start in an early stage, especially the prevention of further cooling in the prehospital setting and during the primary assessment. On the one hand, active rewarming is the treatment of choice of hypothermia-induced coagulation disorder in trauma patients; on the other hand, accidental or clinically induced hypothermia might improve outcomes by protecting against the effects of hypoperfusion and hypoxic injury in selected cases such as patients suffering from traumatic brain injury (TBI) or traumatic cardiac arrest.

Effects of Different Types of Early Restrictive Fluid Resuscitation on Immune Function and Multiorgan Damage on Hemorrhagic Shock Rat Model in a Hypothermic Environment

“…As tissue oxygen consumption is limited by shock, hypothermia is further exacerbated by insufficient heat production. Early hypothermia increases the cardiac output and oxygen consumption, while later hypothermia can inhibit myocardial contractility and decrease the cardiac output [ 6 ]. It demonstrated that shock can trigger hypothermia and that spontaneous hypothermia due to hypothermic exposure can exacerbate hemorrhagic shock [ 7 ].…”

Pulmonary inflammatory response and immunomodulation to multiple trauma and hemorrhagic shock in pigs

“…While numerous experimental studies in animal models reported promising results (e.g., a decrease in TNF-α release and a delay in IL-1 and IL-6 release, increased concentrations of interleukin-10, and increased survival after hemorrhagic shock were shown after intervention with hypothermia) [46,48,49], the mechanisms by which hypothermia influences the posttraumatic immune response after multiple trauma proofed difficult to unravel. Additionally, hypothermia can affect trauma-induced coagulopathy by impaired clotting factor activity and platelet function [50][51][52]. However, data from a study of 310 multiple-trauma patients found that accidental hypothermia was not an independent risk factor for post-traumatic complications (e.g.…”

Analysis of tourniquet pressure over military winter clothing and a short review of combat casualty care in cold weather warfare

“…In the Ukraine war, for example, cold exposure is a relevant medical problem causing cold injuries [ 4 ]. It is well documented that hypothermia worsens coagulation and deteriorates traumatic bleeding [ 5 ]. To our knowledge, no systematic review data exists on preventable causes of traumatic death in cold climates.…”