Patients with accidental hypothermia may survive even long periods of apparent lifelessness provided that cardiopulmonary resuscitation procedures are not abandoned.
Suspect hypothermia if the patient is found
outside in the cold
motionless indoors with low ambient temperature
exposed to cold water.
Immediate assessment and measures
Look for signs of life.
Check the patient for a response.
Check breathing.
Check circulation (heart rhythm with a cardiac monitor, breathing, carotid pulse), allow extended time (1 minute).
As far as possible, measure tympanic or oesophageal temperature, if you suspect hypothermia in a lifeless patient.
Hypothermic patients with risk factors for imminent cardiac arrest (body temperature below 30 °C, ventricular arrhythmia, systolic blood pressure below 90 mmHg) or with cardiac arrest should, usually, be transported for rewarming directly to a hospital with a possibililty for extracorporeal resuscitation.
If ventricular fibrillation continues after the third debrillation attempt, refrain from further attempts until body temperature is over 30 °C.
Refrain from administering adrenaline if body temperature is below 30 °C.
Increase adrenaline administration interval to 6-10 minutes if body temperature is over 30 °C in a hypothermic patient.
Transfer to a hospital
Local emergency services should be contacted to arrange the transfer (air ambulance/helicopter rescue when indicated).
The receiving unit must always be informed of the forthcoming admission; it takes time to prime and prepare a heart-lung or ECMO machine for use.
Use a mechanical CPR device (if available) or take turns at regular intervals in delivering external chest compressions.