UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Accidental hypothermia in adults

Authors
Ken Zafren, MD, FAAEM, FACEP, FAWM
C Crawford Mechem, MD, FACEP
Section Editor
Daniel F Danzl, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Death from exposure and accidental hypothermia occurs throughout the world and can present significant management problems [1-5]. While typically associated with regions of the world with severe winters, hypothermia is also seen in areas with milder climates, such as the southern United States [6]. Cases of hypothermia occur during the summer months and in hospitalized patients [7]. Even with modern supportive care, the in-hospital mortality of patients with moderate or severe accidental hypothermia approaches 40 percent [8].

The definition, pathophysiology, and management of accidental hypothermia will be discussed here. A table outlining the emergency management of hypothermia in adults is provided (table 1). Drowning, which is often complicated by hypothermia, is discussed separately, as are external injuries from cold and accidental hypothermia in children. (See "Drowning (submersion injuries)" and "Frostbite" and "Hypothermia in children: Clinical manifestations and diagnosis" and "Hypothermia in children: Management".)

DEFINITIONS

Hypothermia is defined as a core temperature below 35°C (95°F). The stage of hypothermia, defined by core temperature, has a large impact on both recognition and treatment. The most commonly used definitions found in the literature are as follows [9,10]:

Mild hypothermia – Core temperature 32 to 35°C (90 to 95°F)

Moderate hypothermia – Core temperature 28 to 32°C (82 to 90°F)

                         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Jul 05 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Näyhä S. Environmental temperature and mortality. Int J Circumpolar Health 2005; 64:451.
  2. Centers for Disease Control and Prevention (CDC). Hypothermia-related deaths--United States, 2003-2004. MMWR Morb Mortal Wkly Rep 2005; 54:173.
  3. Mulcahy AR, Watts MR. Accidental hypothermia: An evidence-based approach. Emergency Medicine Practice EBMedicine.net 2009; 11:1. http://www.cmua.nl/content/SEHLiteratuur/SEH%20literatuurbestanden/Accidental%20Hypothermia%200109.pdf (Accessed on March 06, 2012).
  4. Headdon WG, Wilson PM, Dalton HR. The management of accidental hypothermia. BMJ 2009; 338:b2085.
  5. Stares J, Kosatsky T. Hypothermia as a cause of death in British Columbia, 1998-2012: a descriptive assessment. CMAJ Open 2015; 3:E352.
  6. Burke WP. A case report of warm weather accidental hypothermia. J Miss State Med Assoc 2004; 45:263.
  7. MacDonell JE, Wrenn K. Hypothermia in the summer. South Med J 1991; 84:804.
  8. Vassal T, Benoit-Gonin B, Carrat F, et al. Severe accidental hypothermia treated in an ICU: prognosis and outcome. Chest 2001; 120:1998.
  9. Giesbrecht GG. Cold stress, near drowning and accidental hypothermia: a review. Aviat Space Environ Med 2000; 71:733.
  10. Truhlář A, Deakin CD, Soar J, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148.
  11. Durrer B, Brugger H, Syme D, International Commission for Mountain Emergency Medicine. The medical on-site treatment of hypothermia: ICAR-MEDCOM recommendation. High Alt Med Biol 2003; 4:99.
  12. Danzl D. Accidental hypothermia. In: Wilderness Medicine, 6th ed, Auerbach PS. (Ed), Elsevier, Philadelphia 2012. p.115.
  13. Pasquier M, Zurron N, Weith B, et al. Deep accidental hypothermia with core temperature below 24°c presenting with vital signs. High Alt Med Biol 2014; 15:58.
  14. Deslarzes T, Rousson V, Yersin B, et al. An evaluation of the Swiss staging model for hypothermia using case reports from the literature. Scand J Trauma Resusc Emerg Med 2016; 24:16.
  15. Hanania NA, Zimmerman JL. Accidental hypothermia. Crit Care Clin 1999; 15:235.
  16. Jolly BT, Ghezzi KT. Accidental hypothermia. Emerg Med Clin North Am 1992; 10:311.
  17. Lee-Chiong TL Jr, Stitt JT. Disorders of temperature regulation. Compr Ther 1995; 21:697.
  18. Danzl DF, Pozos RS. Accidental hypothermia. N Engl J Med 1994; 331:1756.
  19. Brown DJ, Brugger H, Boyd J, Paal P. Accidental hypothermia. N Engl J Med 2012; 367:1930.
  20. Delaney KA, Vassallo SU, Larkin GL, Goldfrank LR. Rewarming rates in urban patients with hypothermia: prediction of underlying infection. Acad Emerg Med 2006; 13:913.
  21. Ranhoff AH. Accidental hypothermia in the elderly. Int J Circumpolar Health 2000; 59:255.
  22. Ballester JM, Harchelroad FP. Hypothermia: an easy-to-miss, dangerous disorder in winter weather. Geriatrics 1999; 54:51.
  23. Hector MG. Treatment of accidental hypothermia. Am Fam Physician 1992; 45:785.
  24. Kempainen RR, Brunette DD. The evaluation and management of accidental hypothermia. Respir Care 2004; 49:192.
  25. Mallet ML. Pathophysiology of accidental hypothermia. QJM 2002; 95:775.
  26. Harchelroad F. Acute thermoregulatory disorders. Clin Geriatr Med 1993; 9:621.
  27. Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med 1992; 20:1402.
  28. Gentilello LM. Advances in the management of hypothermia. Surg Clin North Am 1995; 75:243.
  29. MacLeod DB, Cortinez LI, Keifer JC, et al. The desaturation response time of finger pulse oximeters during mild hypothermia. Anaesthesia 2005; 60:65.
  30. Shapiro BA. Temperature correction of blood gas values. Respir Care Clin N Am 1995; 1:69.
  31. Hansen JE. Arterial blood gases. Clin Chest Med 1989; 10:227.
  32. Doshi HH, Giudici MC. The EKG in hypothermia and hyperthermia. J Electrocardiol 2015; 48:203.
  33. Nolan J, Soar J. Images in resuscitation: the ECG in hypothermia. Resuscitation 2005; 64:133.
  34. Graham CA, McNaughton GW, Wyatt JP. The electrocardiogram in hypothermia. Wilderness Environ Med 2001; 12:232.
  35. Alsafwah S. Electrocardiographic changes in hypothermia. Heart Lung 2001; 30:161.
  36. Salinski EP, Worrilow CC. ST-segment elevation myocardial infarction vs. hypothermia-induced electrocardiographic changes: a case report and brief review of the literature. J Emerg Med 2014; 46:e107.
  37. Jurkovich GJ. Environmental cold-induced injury. Surg Clin North Am 2007; 87:247.
  38. Kloos RT. Spontaneous periodic hypothermia. Medicine (Baltimore) 1995; 74:268.
  39. Rescorl D. Environmental emergencies. Crit Care Nurs Clin North Am 1995; 7:445.
  40. Varon J, Sadovnikoff N, Sternbach GL. Hypothermia. Saving patients from the big chill. Postgrad Med 1992; 92:47.
  41. Biem J, Koehncke N, Classen D, Dosman J. Out of the cold: management of hypothermia and frostbite. CMAJ 2003; 168:305.
  42. Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010; 81:1400.
  43. Zafren K, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update. Wilderness Environ Med 2014; 25:S66.
  44. Gordon L, Paal P, Ellerton JA, et al. Delayed and intermittent CPR for severe accidental hypothermia. Resuscitation 2015; 90:46.
  45. Oung CM, English M, Chiu RC, Hinchey EJ. Effects of hypothermia on hemodynamic responses to dopamine and dobutamine. J Trauma 1992; 33:671.
  46. Schröder T, Hering JP, Heidelmeyer CF, et al. Dopamine-dependent diastolic dysfunction in moderate hypothermia. J Cardiovasc Pharmacol 1994; 23:698.
  47. Gilbert M, Busund R, Skagseth A, et al. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet 2000; 355:375.
  48. Walpoth BH, Walpoth-Aslan BN, Mattle HP, et al. Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 1997; 337:1500.
  49. Wanscher M, Agersnap L, Ravn J, et al. Outcome of accidental hypothermia with or without circulatory arrest: experience from the Danish Præstø Fjord boating accident. Resuscitation 2012; 83:1078.
  50. Hilmo J, Naesheim T, Gilbert M. "Nobody is dead until warm and dead": prolonged resuscitation is warranted in arrested hypothermic victims also in remote areas--a retrospective study from northern Norway. Resuscitation 2014; 85:1204.
  51. ECC Committee, Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112:IV1.
  52. Monika BM, Martin D, Balthasar E, et al. The Bernese Hypothermia Algorithm: a consensus paper on in-hospital decision-making and treatment of patients in hypothermic cardiac arrest at an alpine level 1 trauma centre. Injury 2011; 42:539.
  53. Hauty MG, Esrig BC, Hill JG, Long WB. Prognostic factors in severe accidental hypothermia: experience from the Mt. Hood tragedy. J Trauma 1987; 27:1107.
  54. Romlin BS, Winberg H, Janson M, et al. Excellent Outcome With Extracorporeal Membrane Oxygenation After Accidental Profound Hypothermia (13.8°C) and Drowning. Crit Care Med 2015; 43:e521.
  55. Debaty G, Moustapha I, Bouzat P, et al. Outcome after severe accidental hypothermia in the French Alps: A 10-year review. Resuscitation 2015; 93:118.
  56. Epstein E, Anna K. Accidental hypothermia. BMJ 2006; 332:706.
  57. Harnett RM, O'Brien EM, Sias FR, Pruitt JR. Initial treatment of profound accidental hypothermia. Aviat Space Environ Med 1980; 51:680.
  58. Sterba JA. Efficacy and safety of prehospital rewarming techniques to treat accidental hypothermia. Ann Emerg Med 1991; 20:896.
  59. Golden FS, Hervey GR, Tipton MJ. Circum-rescue collapse: collapse, sometimes fatal, associated with rescue of immersion victims. J R Nav Med Serv 1991; 77:139.
  60. Steele MT, Nelson MJ, Sessler DI, et al. Forced air speeds rewarming in accidental hypothermia. Ann Emerg Med 1996; 27:479.
  61. Delaney KA, Vassallo SU, Goldfrank LR. Thermoregulatory principles. In: Toxicologic Emergencies, 5th, Goldfrank LR, Flomenbaum NE, Lewin NA, et al. (Eds), Appleton and Lange, Norwalk 1994. p.151.
  62. Kjaergaard B, Bach P. Warming of patients with accidental hypothermia using warm water pleural lavage. Resuscitation 2006; 68:203.
  63. Plaisier BR. Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature. Resuscitation 2005; 66:99.
  64. Laniewicz M, Lyn-Kew K, Silbergleit R. Rapid endovascular warming for profound hypothermia. Ann Emerg Med 2008; 51:160.
  65. Rollstin AD, Seifert SA. Acetaminophen/diphenhydramine overdose in profound hypothermia. Clin Toxicol (Phila) 2013; 51:50.
  66. Hernandez E, Praga M, Alcazar JM, et al. Hemodialysis for treatment of accidental hypothermia. Nephron 1993; 63:214.
  67. Gentilello LM, Cobean RA, Offner PJ, et al. Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill patients. J Trauma 1992; 32:316.
  68. Vretenar DF, Urschel JD, Parrott JC, Unruh HW. Cardiopulmonary bypass resuscitation for accidental hypothermia. Ann Thorac Surg 1994; 58:895.
  69. Letsou GV, Kopf GS, Elefteriades JA, et al. Is cardiopulmonary bypass effective for treatment of hypothermic arrest due to drowning or exposure? Arch Surg 1992; 127:525.
  70. Mulpur AK, Mirsadraee S, Hassan TB, et al. Refractory ventricular fibrillation in accidental hypothermia: salvage with cardiopulmonary bypass. Perfusion 2004; 19:311.
  71. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Hypothermia. Circulation 2005; 112(24 Suppl):IV (136).
  72. Britt LD, Dascombe WH, Rodriguez A. New horizons in management of hypothermia and frostbite injury. Surg Clin North Am 1991; 71:345.
  73. Ruttmann E, Weissenbacher A, Ulmer H, et al. Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. J Thorac Cardiovasc Surg 2007; 134:594.
  74. Caluwé R, Vanholder R, Dhondt A. Hemodialysis as a treatment of severe accidental hypothermia. Artif Organs 2010; 34:237.
  75. Morita S, Inokuchi S, Inoue S, et al. The efficacy of rewarming with a portable and percutaneous cardiopulmonary bypass system in accidental deep hypothermia patients with hemodynamic instability. J Trauma 2008; 65:1391.
  76. Ho JD, Heegaard WG, Brunette DD. Successful transcutaneous pacing in 2 severely hypothermic patients. Ann Emerg Med 2007; 49:678.
  77. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S829.
  78. Koller R, Schnider TW, Neidhart P. Deep accidental hypothermia and cardiac arrest--rewarming with forced air. Acta Anaesthesiol Scand 1997; 41:1359.
  79. Thomas R, Cahill CJ. Successful defibrillation in profound hypothermia (core body temperature 25.6 degrees C). Resuscitation 2000; 47:317.
  80. Wira CR, Becker JU, Martin G, Donnino MW. Anti-arrhythmic and vasopressor medications for the treatment of ventricular fibrillation in severe hypothermia: a systematic review of the literature. Resuscitation 2008; 78:21.
  81. Danzl DF, Hedges JR, Pozos RS. Hypothermia outcome score: development and implications. Crit Care Med 1989; 17:227.
  82. Farstad M, Andersen KS, Koller ME, et al. Rewarming from accidental hypothermia by extracorporeal circulation. A retrospective study. Eur J Cardiothorac Surg 2001; 20:58.
  83. Kornberger E, Schwarz B, Lindner KH, Mair P. Forced air surface rewarming in patients with severe accidental hypothermia. Resuscitation 1999; 41:105.
  84. Lexow K. Severe accidental hypothermia: survival after 6 hours 30 minutes of cardiopulmonary resuscitation. Arctic Med Res 1991; 50 Suppl 6:112.
  85. Gruber E, Beikircher W, Pizzinini R, et al. Non-extracorporeal rewarming at a rate of 6.8°C per hour in a deeply hypothermic arrested patient. Resuscitation 2014; 85:e119.