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Treatment of hypothermia in children

INTRODUCTION

Although generally harmful, severe hypothermia may also provide cerebral protection against anoxia, allowing cases of remarkable survival after cardiac arrest [1-5]. Successful resuscitation of the hypothermic child requires rapid attention to supportive care (airway, breathing, circulation), assessment and treatment of injury or medical conditions, and rewarming interventions directed by the severity of hypothermia and the presence or absence of circulation (table 1).

This article discusses the treatment of unintentional hypothermia in children. The clinical manifestation of hypothermia in children, neonatal hypothermia, and frostbite are discussed separately. (See "Clinical manifestations of hypothermia in children" and "Short-term complications of the premature infant", section on 'Hypothermia' and "Frostbite".)

DEFINITION OF HYPOTHERMIA

Hypothermia is defined as a core body temperature below 35ºC (95ºF). 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 [6-8]:

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

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

                                      

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Literature review current through: Sep 2014. | This topic last updated: Oct 28, 2014.
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References
Top
  1. Danzl DF, Pozos RS, Auerbach PS, et al. Multicenter hypothermia survey. Ann Emerg Med 1987; 16:1042.
  2. Bolte RG, Black PG, Bowers RS, et al. The use of extracorporeal rewarming in a child submerged for 66 minutes. JAMA 1988; 260:377.
  3. Hughes A, Riou P, Day C. Full neurological recovery from profound (18.0 degrees C) acute accidental hypothermia: successful resuscitation using active invasive rewarming techniques. Emerg Med J 2007; 24:511.
  4. Fisher JD, Schaefer C, Reeves JJ. Successful resuscitation from cardiopulmonary arrest due to profound hypothermia using noninvasive techniques. Pediatr Emerg Care 2011; 27:215.
  5. 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.
  6. Danzl DF, Pozos RS. Accidental hypothermia. N Engl J Med 1994; 331:1756.
  7. Giesbrecht GG. Cold stress, near drowning and accidental hypothermia: a review. Aviat Space Environ Med 2000; 71:733.
  8. Jolly BT, Ghezzi KT. Accidental hypothermia. Emerg Med Clin North Am 1992; 10:311.
  9. 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.
  10. Brown DJ, Brugger H, Boyd J, Paal P. Accidental hypothermia. N Engl J Med 2012; 367:1930.
  11. Corneli HM. Accidental hypothermia. J Pediatr 1992; 120:671.
  12. Boyd J, Brugger H, Shuster M. Prognostic factors in avalanche resuscitation: a systematic review. Resuscitation 2010; 81:645.
  13. Brugger H, Paal P, Boyd J. Prehospital resuscitation of the buried avalanche victim. High Alt Med Biol 2011; 12:199.
  14. Gentilello LM, Cobean RA, Offner PJ, et al. Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill patients. J Trauma 1992; 32:316.
  15. Hultzer MV, Xu X, Marrao C, et al. Pre-hospital torso-warming modalities for severe hypothermia: a comparative study using a human model. CJEM 2005; 7:378.
  16. Lundgren JP, Henriksson O, Pretorius T, et al. Field torso-warming modalities: a comparative study using a human model. Prehosp Emerg Care 2009; 13:371.
  17. Harnett RM, O'Brien EM, Sias FR, Pruitt JR. Initial treatment of profound accidental hypothermia. Aviat Space Environ Med 1980; 51:680.
  18. Scaife ER, Connors RC, Morris SE, et al. An established extracorporeal membrane oxygenation protocol promotes survival in extreme hypothermia. J Pediatr Surg 2007; 42:2012.
  19. 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.
  20. 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.
  21. Silfvast T, Pettilä V. Outcome from severe accidental hypothermia in Southern Finland--a 10-year review. Resuscitation 2003; 59:285.
  22. Wollenek G, Honarwar N, Golej J, Marx M. Cold water submersion and cardiac arrest in treatment of severe hypothermia with cardiopulmonary bypass. Resuscitation 2002; 52:255.
  23. Eich C, Bräuer A, Kettler D. Recovery of a hypothermic drowned child after resuscitation with cardiopulmonary bypass followed by prolonged extracorporeal membrane oxygenation. Resuscitation 2005; 67:145.
  24. Gill BS, Cox CS Jr. Thermodynamic and logistic considerations for treatment of hypothermia. Mil Med 2008; 173:743.
  25. Feldman KW, Morray JP, Schaller RT. Thermal injury caused by hot pack application in hypothermic children. Am J Emerg Med 1985; 3:38.
  26. Truell KD, Bakerman PR, Teodori MF, Maze A. Third-degree burns due to intraoperative use of a Bair Hugger warming device. Ann Thorac Surg 2000; 69:1933.
  27. Koller R, Schnider TW, Neidhart P. Deep accidental hypothermia and cardiac arrest--rewarming with forced air. Acta Anaesthesiol Scand 1997; 41:1359.
  28. Steele MT, Nelson MJ, Sessler DI, et al. Forced air speeds rewarming in accidental hypothermia. Ann Emerg Med 1996; 27:479.
  29. Kornberger E, Schwarz B, Lindner KH, Mair P. Forced air surface rewarming in patients with severe accidental hypothermia. Resuscitation 1999; 41:105.
  30. 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.
  31. Graham CA, McNaughton GW, Wyatt JP. The electrocardiogram in hypothermia. Wilderness Environ Med 2001; 12:232.
  32. Gilbert M, Busund R, Skagseth A, et al. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet 2000; 355:375.
  33. Hall KN, Syverud SA. Closed thoracic cavity lavage in the treatment of severe hypothermia in human beings. Ann Emerg Med 1990; 19:204.
  34. Lexow K. Severe accidental hypothermia: survival after 6 hours 30 minutes of cardiopulmonary resuscitation. Arctic Med Res 1991; 50 Suppl 6:112.
  35. Quan L, Wentz KR, Gore EJ, Copass MK. Outcome and predictors of outcome in pediatric submersion victims receiving prehospital care in King County, Washington. Pediatrics 1990; 86:586.
  36. Orlowski JP. Drowning, near-drowning, and ice-water drowning. JAMA 1988; 260:390.
  37. 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.
  38. Schaller MD, Fischer AP, Perret CH. Hyperkalemia. A prognostic factor during acute severe hypothermia. JAMA 1990; 264:1842.
  39. Mair P, Kornberger E, Furtwaengler W, et al. Prognostic markers in patients with severe accidental hypothermia and cardiocirculatory arrest. Resuscitation 1994; 27:47.
  40. Dobson JA, Burgess JJ. Resuscitation of severe hypothermia by extracorporeal rewarming in a child. J Trauma 1996; 40:483.
  41. Kjaergaard B, Bach P. Warming of patients with accidental hypothermia using warm water pleural lavage. Resuscitation 2006; 68:203.
  42. Plaisier BR. Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature. Resuscitation 2005; 66:99.
  43. Brunette DD, Sterner S, Robinson EP, Ruiz E. Comparison of gastric lavage and thoracic cavity lavage in the treatment of severe hypothermia in dogs. Ann Emerg Med 1987; 16:1222.
  44. Otto RJ, Metzler MH. Rewarming from experimental hypothermia: comparison of heated aerosol inhalation, peritoneal lavage, and pleural lavage. Crit Care Med 1988; 16:869.
  45. Winegard C. Successful treatment of severe hypothermia and prolonged cardiac arrest with closed thoracic cavity lavage. J Emerg Med 1997; 15:629.
  46. de Caen A. Management of profound hypothermia in children without the use of extracorporeal life support therapy. Lancet 2002; 360:1394.
  47. Coskun KO, Popov AF, Schmitto JD, et al. Extracorporeal circulation for rewarming in drowning and near-drowning pediatric patients. Artif Organs 2010; 34:1026.
  48. Althaus U, Aeberhard P, Schüpbach P, et al. Management of profound accidental hypothermia with cardiorespiratory arrest. Ann Surg 1982; 195:492.
  49. DelRossi AJ, Cernaianu AC, Vertrees RA, et al. Heparinless extracorporeal bypass for treatment of hypothermia. J Trauma 1990; 30:79.
  50. Bräuer A, Wrigge H, Kersten J, et al. Severe accidental hypothermia: rewarming strategy using a veno-venous bypass system and a convective air warmer. Intensive Care Med 1999; 25:520.
  51. Laniewicz M, Lyn-Kew K, Silbergleit R. Rapid endovascular warming for profound hypothermia. Ann Emerg Med 2008; 51:160.
  52. Fox JB, Thomas F, Clemmer TP, Grossman M. A retrospective analysis of air-evacuated hypothermia patients. Aviat Space Environ Med 1988; 59:1070.