Vital Signs in Accidental Hypothermia

Pasquier, Mathieu; Cools, Evelien; Zafren, Ken; Carron, Pierre‐Nicolas; Frochaux, Vincent; Rousson, Valentin

doi:10.1089/ham.2020.0179

Cited by 22 publications

(12 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…If core temperature measurement is not available, clinical diagnosis can be made by evaluating the vital signs ( Table 2 ). Vital signs generally decrease linearly as core temperature decreases [ 43 ]. Shivering is not a consistent symptom.…”

Section: Diagnosis Of Hypothermiamentioning

confidence: 99%

“…The vital signs may be minimal and extremely difficult to detect. Rescuers should attempt to find vital signs for 60 s [ 34 , 36 , 43 ]. The use of electrocardiography, ETCO 2 (any detectable expiratory CO 2 correlates with the presence of vital signs) or point-of-care ultrasound (POCUS) may help detect organised cardiac activity and significant cardiac output.…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Diagnosis Of Hypothermiamentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

Self Cite

View full text Add to dashboard Cite

show abstract

“… 16 Moreover, although some reports have addressed the validity of the Swiss staging system, 7 , 18 only one study directly analyzed the association between the level of impaired consciousness and core BT among AH patients, with the important limitation that it did not adjust the potential confounding factors. 19 Second, we evaluated patients who developed AH in urban areas, whereas previous studies have typically evaluated AH occurring in cold climates, such as the Alps. 16 , 17 In contrast, we evaluated a predominantly urban sample that included a large number of elderly people with underlying diseases, which suggests that our results could be generalizable to urban areas with aging populations.…”

Section: Discussionmentioning

confidence: 99%

“…First, we undertook a multicenter study with a large sample of patients, whereas most previous studies have examined a small sample of patients at a single center 16 . Moreover, although some reports have addressed the validity of the Swiss staging system, 7,18 only one study directly analyzed the association between the level of impaired consciousness and core BT among AH patients, with the important limitation that it did not adjust the potential confounding factors 19 . Second, we evaluated patients who developed AH in urban areas, whereas previous studies have typically evaluated AH occurring in cold climates, such as the Alps 16,17 .…”

Section: Discussionmentioning

confidence: 99%

Clinical relevance of impaired consciousness in accidental hypothermia: a Japanese multicenter retrospective study

Fukuda

Nozawa

Okada

et al. 2022

Acute Medicine & Surgery

View full text Add to dashboard Cite

Aim This study aimed to investigate the association between level of impaired consciousness and severe hypothermia (<28°C) and to evaluate the association between level of impaired consciousness and inhospital mortality among accidental hypothermia patients. Methods This was a multicenter retrospective study using the J‐Point registry database, which includes data regarding patients whose core body temperature was 35.0°C or less and who were treated as accidental hypothermia in emergency departments between April 1, 2011 and March 31, 2016. We estimated adjusted odds ratios of the level of impaired consciousness for severe hypothermia less than 28°C and inhospital mortality using a logistic regression model. Results The study included 505 of 572 patients in the J‐Point registry. Relative to mildly impaired consciousness (Glasgow Coma Scale [GCS] 13–15), the adjusted odds ratios for severe hypothermia less than 28°C were: moderate (GCS 9–12), 3.26 (95% confidence interval [CI], 1.69–6.25); and severe (GCS < 9), 4.68 (95% CI, 2.40–9.14). Relative to mildly impaired consciousness (GCS 13–15), the adjusted odds ratios for inhospital mortality were: moderate (GCS9–12), 1.65 (95% CI, 0.95–2.88); and severe (GCS < 9), 2.10 (95% CI, 1.17–3.78). Conclusion The level of impaired consciousness in patients with accidental hypothermia was associated with severe hypothermia and inhospital mortality.

show abstract

“…This system applies a three point ordinal scale of ‘low’, ‘medium’, and ‘high’ risk of cardiac arrest based on conscious level as the primary element for staging, without attempt to quantify this risk further. The indirect argument presented is based on Pasquier et al’s study which demonstrates that haemodynamic and conscious level parameters correlate with core temperature, the latter showing the highest correlation (Spearman’s rho = 0.78) [ 35 ]. It is worth noting that this correlation is not the strongest, with a GCS of 5 being associated with a core temperature between 20 and 31 °C and a GCS as high as 14 being associated with a core temperature from 25 to 34 °C.…”

Section: Introductionmentioning

confidence: 99%

Accidental hypothermia: direct evidence for consciousness as a marker of cardiac arrest risk in the acute assessment of cold patients

Barrow¹,

Ives

2022

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background Rapid stratification of the risk of cardiac arrest is essential in the assessment of patients with isolated accidental hypothermia. Traditional methods based on measurement of core temperature are unreliable in the field. Behavioural observations have been used as predictors of core temperature and thus indirect predictors of cardiac arrest. This study aims to quantify the direct relationship between observed conscious level and cardiac arrest. Methods Retrospective case report analysis identified 114 cases of isolated accidental hypothermia meeting inclusion criteria. Level of consciousness in the acute assessment and management phase was classified using the AVPU system with an additional category of “Alert with confusion”; statistical analysis then related level of consciousness to incidence of cardiac arrest. Results All patients who subsequently suffered cardiac arrest showed some impairment of consciousness (p < < .0001), and the risk of arrest increased directly with the level of impairment; none of the 33 fully alert patients arrested. In the lowest impairment category, Alert confused, a quarter of the 12 patients went on to arrest, while in the highest Unresponsive category, two thirds of the 43 patients arrested. Where core temperature was available (62 cases), prediction of arrest by consciousness level was at least as good as prediction from core temperature. Conclusions This study provides retrospective analytical evidence that consciousness level is a valid predictor of cardiac arrest risk in isolated accidental hypothermia; the importance of including confusion as a criterion is a new finding. This study suggests the use of consciousness alone may be at least as good as core temperature in cardiac arrest risk prediction. These results are likely to be of particular relevance to the management of accidental hypothermia in the pre-hospital and mass casualty environment, allowing for rapid and accurate triage of hypothermic patients.

show abstract

Vital Signs in Accidental Hypothermia

Cited by 22 publications

References 29 publications

Accidental Hypothermia: 2021 Update

Accidental Hypothermia: 2021 Update

Clinical relevance of impaired consciousness in accidental hypothermia: a Japanese multicenter retrospective study

Accidental hypothermia: direct evidence for consciousness as a marker of cardiac arrest risk in the acute assessment of cold patients

Contact Info

Product

Resources

About