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Home | Articles | Emergencies | Hypothermia

Hypothermia

Last updated 26th February 2024

Accidental Hypothermia

  1. Assess core temperature with a low reading thermometer; tympanic in the unintubated, oesophageal (distal) in patients with a tracheal tube in place
  2. Check for the presence of vital signs / signs of life for up to one minute (do not give CPR if signs of life present even if minimal)
  3. Prehospital insulation, triage, fast transfer to a hospital and rewarming are key interventions
  4. Type of hypothermia (exposure, immersion, submersion and avalanche) with on-scene airway patency, initial cardiac rhythm and time of CPR should be actively sought from prehospital teams as key elements in determining prognosis.
  5. Be careful with patient handling, in particular those who are less than fully alert – increasing risk of arrest with decreasing conscious level
  6. Hypothermic patients with risk factors for imminent cardiac arrest (i.e. core temperature <30°C, ventricular arrhythmia, systolic blood pressure <90 mmHg) and those in cardiac arrest should ideally be transferred to an ExtraCorporeal Life Support (ECLS) Centre (Aberdeen in Scotland) direct from scene for rewarming where possible
  7. Hypothermic cardiac arrest patients should receive continuous CPR during transfers
  8. Chest compression and ventilation rate should be the same as in normothermic patients
  9. Consider the use of a mechanical chest compression device if prolonged CPR is needed
  10. If ventricular fibrillation (VF) persists after three shocks, delay further attempts until core temperature >30°C
  11. Withhold adrenaline until the core temperature is >30°C
  12. Increase administration intervals for adrenaline to 6-10minutes if the core temperature is 30-34°C
  13. If prolonged transport is required or the terrain is difficult, use of a mechanical CPR device is recommended
  14. In hypothermic cardiac arrest, rewarming should be performed with ECLS, preferably with extra-corporeal membrane oxygenation (ECMO) over cardiopulmonary bypass (CPB).
  15. SAS Critical Care Desk should be the point of contact to determine transfer options to ECLS.
  16. Non-ECLS rewarming should be initiated locally if an ECLS centre cannot be reached and good neurological recovery is possible (eg from scores such as the HOPE score).
  17. Utilise all means of rewarming simultaneously (details within algorithms / full guidance below)

Severity of Hypothermia

Stage 1Stage 2Stage 3Stage 4
Clinical FindingsAlert" from AVPU"Verbal" from AVPU"Painful" or "Unconscious" from AVPU
AND
VItal signs present		"Unconscious" from AVPU
AND
No detectable vital signs
Risk of Cardiac ArrestLowModerateHighHypothermic Cardiac Arrest

from Musi et al. Clinical Staging of accidental Hypothermia – the Revised Swiss System. Resuscitation 2021 (162 182-187) https://doi.org/10.1016/j.resuscitation.2021.02.038

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Content by Alex McDonald