Complete Neurological Recovery after Severe Accidental Hypothermia: Two Cases and a Novel Algorithm Proposal

Khortnal Delvecchio,Ingida Asfaw,Zewditu Asfaw,Thomas Hanna,Susan Seman,Alexander L Marinica,Calvin Williams

doi:10.12691/ajmcr-7-6-2

Abstract

Primary accidental hypothermia results from endogenous thermoregulatory mechanisms being overwhelmed by environmental stressors. Vulnerable populations include the elderly, mentally ill, homeless, and chemically dependent. When core temperatures fall below 35°C, the resulting metabolic derangements provoke cardiopulmonary compromise and dysrhythmia. Due to the human bodyâs innate protective mechanisms there are reports of patients making complete neurologic recovery after exposure to extreme temperatures and prolonged cardiopulmonary arrest. We describe two cases from our institution demonstrating appropriate treatment methods for the two most severe stages of hypothermia. A 57-year-old male with a core temperature of 27°C who was successfully resuscitated with warm bladder and thoracic lavage and a 34-year-old female with a core temperature of 22°C that fully recovered after 5 hours of external cardiopulmonary bypass. From our experience and a review of the literature, we have developed a modified version of the Swiss staging model and incorporated it into a novel treatment algorithm for in-hospital adult accidental hypothermia patients presenting to urban community hospitals. The two example cases described highlight how appropriate utilization of this novel algorithm can lead to positive outcomes in otherwise critical clinical scenarios.

Highlights

Defined as unintentional core temperature below 35°C, accidental hypothermia claims the lives of nearly 1500 individuals in the United States annually [1]
We present two cases from a single urban community institution in which the appropriate treatment allocation resulted in positive outcomes
After 3 hours, the patient reached a temperature of 32°C, was hemodynamically stable without the need for cardiopulmonary resuscitation (CPR) or vasoactive substances, and he was transferred to the intensive care unit (ICU)

Summary

Introduction

Defined as unintentional core temperature below 35°C, accidental hypothermia claims the lives of nearly 1500 individuals in the United States annually [1]. Using the Swiss staging model as a guide, treatment strategies can be devised for different core temperature thresholds based on their clinical implications [1]. We have modified the Swiss staging model to incorporate treatment levels appropriate for each hypothermia stage (Table 1). We applied this modified classification toward a novel algorithm that allocates each hypothermia stage to the corresponding treatment level. We present two cases from a single urban community institution in which the appropriate treatment allocation resulted in positive outcomes. After reviewing these cases and the relevant literature, we propose a treatment algorithm for clinical assistance at similar institutions (Figure 1)

Clinical Findings

Case Reports

Conclusion

EKG Findings