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Accidental Hypothermia: 2021 Update

Author

Listed:
  • Peter Paal

    (Department of Anesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, 5020 Salzburg, Austria
    International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland)

  • Mathieu Pasquier

    (International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland
    Department of Emergency Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland)

  • Tomasz Darocha

    (Department of Anesthesiology and Intensive Care, Medical University of Silesia, 40-001 Katowice, Poland)

  • Raimund Lechner

    (Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Military Hospital, 89081 Ulm, Germany)

  • Sylweriusz Kosinski

    (Faculty of Health Sciences, Jagiellonian University Medical College, 34-500 Krakow, Poland)

  • Bernd Wallner

    (Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria)

  • Ken Zafren

    (International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland
    Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK 99508, USA
    Department of Emergency Medicine, Stanford University Medical Center, Stanford University, Palo Alto, CA 94304, USA)

  • Hermann Brugger

    (International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland
    Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy
    Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria)

Abstract

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.

Suggested Citation

  • Peter Paal & Mathieu Pasquier & Tomasz Darocha & Raimund Lechner & Sylweriusz Kosinski & Bernd Wallner & Ken Zafren & Hermann Brugger, 2022. "Accidental Hypothermia: 2021 Update," IJERPH, MDPI, vol. 19(1), pages 1-25, January.
  • Handle: RePEc:gam:jijerp:v:19:y:2022:i:1:p:501-:d:716713
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    References listed on IDEAS

    as
    1. Dominique Singer, 2021. "Pediatric Hypothermia: An Ambiguous Issue," IJERPH, MDPI, vol. 18(21), pages 1-14, October.
    2. Panagiotis Kiekkas & Nikolaos Stefanopoulos & Nick Bakalis & Antonios Kefaliakos & Menelaos Karanikolas, 2016. "Agreement of infrared temporal artery thermometry with other thermometry methods in adults: systematic review," Journal of Clinical Nursing, John Wiley & Sons, vol. 25(7-8), pages 894-905, April.
    3. Simon Rauch & Clemens Miller & Anselm Bräuer & Bernd Wallner & Matthias Bock & Peter Paal, 2021. "Perioperative Hypothermia—A Narrative Review," IJERPH, MDPI, vol. 18(16), pages 1-15, August.
    4. Ken Zafren, 2021. "Nonfreezing Cold Injury (Trench Foot)," IJERPH, MDPI, vol. 18(19), pages 1-9, October.
    5. Paige Zhang & Kathryn Wiens & Ri Wang & Linh Luong & Donna Ansara & Stephanie Gower & Kate Bassil & Stephen W. Hwang, 2019. "Cold Weather Conditions and Risk of Hypothermia Among People Experiencing Homelessness: Implications for Prevention Strategies," IJERPH, MDPI, vol. 16(18), pages 1-9, September.
    6. Ivo B. Regli & Giacomo Strapazzon & Marika Falla & Rosmarie Oberhammer & Hermann Brugger, 2021. "Long-Term Sequelae of Frostbite—A Scoping Review," IJERPH, MDPI, vol. 18(18), pages 1-16, September.
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    Cited by:

    1. Katrin Habegger & Simon Brechbühler & Karin Vogt & Jasmin S. Lienert & Bianca M. Engelhardt & Martin Müller & Aristomenis K. Exadaktylos & Monika Brodmann Maeder, 2022. "Accidental Hypothermia in a Swiss Alpine Trauma Centre—Not an Alpine Problem," IJERPH, MDPI, vol. 19(17), pages 1-9, August.

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