Comparison of Cadaveric Warming Rates in Accidental Hypothermia Between Continuous and Dwell Thoracic Lavage

Accidental hypothermia is the unintentional decrease in core body temperature below 35°C due to environmental exposure. Severe hypothermia, defined as a core body temperature less than 28°C, can cause hemodynamic instability, cardiac arrest, and death; therefore, rapid rewarming is indicated. In centers without extracorporeal membrane oxygenation or cardiopulmonary bypass capabilities, invasive rewarming can be performed via thoracic lavage. Thoracic lavage is performed by placing two thoracostomy tubes and continuously infusing warm fluids through the thoracic cavity or using intermittent dwells. There is no evidence as to whether continuous infusion or dwells are more efficacious for rewarming.

We aimed to provide experimental data to determine which thoracic lavage method more rapidly increases core body temperature.

A total of five continuous trials and five dwell trials were performed utilizing five fresh cadavers. Warm fluid infusion at 36°C was performed using a Belmont Rapid infuser RI-2 at a rate of 200 mL/min for continuous lavage and a 500 mL dwell of at least 15 minutes. Core and infusion fluid temperature measurements were recorded, and the rewarming rate across each trial was calculated.

The median continuous and dwell rewarming rate was 1.37°C/h (interquartile range (IQR) 1.31-2.18) and 1.33°C/h (IQR 0.74-1.43), respectively. A paired Wilcoxon signed-rank test was performed, indicating no significant difference in rewarming rate between the two techniques (p = 0.63).

These results suggest that the thoracic lavage technique does not significantly impact the rewarming rate. Therefore, physicians should consider additional factors, such as resource availability, when choosing the appropriate thoracic lavage rewarming method.