• Shivering-induced increase in oxygen consumption by as much as 400%

• A leftward shift in the oxygen-hemoglobin dissociation curve

• Decreased blood clotting ability (10% reduction in coagulation factor activity for every 1 °C drop in body temperature)

• Increased epinephrine and norepinephrine levels, causing vasoconstriction

• As hypothermia becomes severe, possible decreases in both HR and blood pressure

• Cardiac arrhythmias that can progress to ventricular fibrillation

References

• Lester ELW, Fox EE, Holcomb JB, et al. The impact of hypothermia on outcomes in massively transfused patients. J Trauma Acute Care Surg. 2019;86:458-463.
• Petrosoniak A, Pavenski K, da Luz LT, et al. Massive hemorrhage protocol: a practical approach to the bleeding trauma patient. Emerg Med Clin North Am. 2023;41:51-69.
• Sihler KC, Napolitano LM. Complications of massive transfusion. Chest. 2010;137:209-220.