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JouniKurola

Resuscitation in Accidental Hypothermia

Essentials

  • 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.
  • If no signs of life are present, start cardiopulmonary resuscitation (CPR), unless the patient exhibits secondary signs of irrevocable death http://www.dynamed.com/condition/accidental-hypothermia#TOPIC_PRJ_YCJ_GQB.
    • Start bag-mask ventilation with supplemental oxygen.
  • Defibrillate if required, but limit defibrillation attempts to three if the patient's body temperature (tympanic or oesophageal) is below 30 °C.

Further care

  • Resuscitate a hypothermic patient according to the normal CPR guidelines http://www.dynamed.com/condition/accidental-hypothermia#TOPIC_PRJ_YCJ_GQB.
  • 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.