Accidental hypothermia-an update : The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

Peter Paal,Gabriel Putzer,Gregor Broessner,Michael Holzer,Michael Wanscher,Hermann Brugger,Beat Walpoth,Les Gordon,Giacomo Strapazzon,Doug Brown,Monika Brodmann Maeder

doi:10.1186/s13049-016-0303-7

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.

Highlights

The management of accidental hypothermia has made substantial progress over the last two decades and hypothermic cardiac arrest (CA) patients who often do not survive with traditional rewarming methods have become increasingly salvageable with extracorporeal life support (ECLS) [1,2,3,4,5,6,7,8]
Some pathophysiological mechanisms are similar, accidental hypothermia should neither be compared to induced hypothermia (as used in deep hypothermic circulatory arrest (DHCA) for cardiovascular surgery) nor to therapeutic hypothermia: i) accidental hypothermia happens unexpectedly and is uncontrolled; ii) it is often associated with exposure to cold environments and/or secondary to impaired thermoregulation e.g. alcohol, drug ingestion, trauma, extremes of age or co-morbid illness [10]
Delayed or intermittent cardiopulmonary resuscitation (CPR) may be appropriate in hypothermic arrest when continuous CPR is impossible

Summary

Introduction

The management of accidental hypothermia has made substantial progress over the last two decades and hypothermic CA patients who often do not survive with traditional rewarming methods (e.g. dialysis, pleural lavage) have become increasingly salvageable with extracorporeal life support (ECLS) [1,2,3,4,5,6,7,8]. This paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest. The management of accidental hypothermia has made substantial progress over the last two decades and hypothermic cardiac arrest (CA) patients who often do not survive with traditional rewarming methods (e.g. dialysis, pleural lavage) have become increasingly salvageable with extracorporeal life support (ECLS). ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or CA.

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