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Severe exposure hypothermia: a resuscitation protocol.

S C Zell, K J Kurtz

    Annals of Emergency Medicine
    |April 1, 1985
    PubMed
    Summary
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    Severe hypothermia requires aggressive rewarming, often with cardiopulmonary bypass, balancing interventions to prevent cardiac arrest. Successful resuscitation hinges on carefully managing aggressive and gentle approaches for profound hypothermia victims.

    Area of Science:

    • Emergency Medicine
    • Cardiology
    • Critical Care Medicine

    Background:

    • Severe hypothermia presents a critical medical emergency.
    • Cardiac instability is a major concern below 28°C core temperature.
    • Current resuscitation protocols for hypothermia involve complex management decisions.

    Purpose of the Study:

    • To discuss the appropriate interventions for severe hypothermia.
    • To highlight the balance between aggressive and gentle rewarming techniques.
    • To address controversies in the initial management of profound hypothermia.

    Main Methods:

    • Review of existing literature on hypothermia management.
    • Discussion of invasive rewarming techniques like femoro-femoral partial bypass.

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  • Analysis of risks associated with different rewarming strategies.

    • Main Results:

    • Aggressive invasive rewarming is often ideal for cardiac instability below 28°C.
    • Gentle therapeutic maneuvers are crucial to prevent ventricular fibrillation (VF) in non-arrested patients.
    • Successful resuscitation requires a careful balance of aggressive and gentle interventions.

    Conclusions:

    • The diagnosis of death in hypothermia is defined by unresponsiveness to resuscitation and rewarming.
    • Management strategies must carefully balance aggressive and gentle interventions.
    • Further prospective data are needed to resolve controversies in profound hypothermia management, considering legal and medical aspects of CPR protocols.