| Author | Title | Year | Journal/Proceedings | Reftype | DOI/URL |
|---|---|---|---|---|---|
| [no authors listed] | State of Alaska. Cold injuries guidelines. Alaska multi-level 2003 version (revised 1/2005). [Abstract] |
2005 | electronic | URL | |
| Abstract: [extract] INTRODUCTION. The State of Alaska Cold Injuries Guidelines have been developed for use by prehospital, clinic and hospital personnel dealing with cold injuries in Alaska. The guidelines are not absolute rules, governing the treatment of hypothermia, cold water near drowning, frostbite and avalanche burial. Readers should note that these guidelines are primarily designed to be used in EMS education and as a reference for the treatment of cold injuries and for use in assisting in the development of local standing orders. In the absence of standing orders, they may be used to guide the treatment of cold injuries until ... | |||||
| [no authors listed] | Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Part IV. Special resuscitation situations. | 1992 | JAMA Vol. 268(16), pp. 2242-2250 |
article | |
| [no authors listed] | Intubating the hypothermic patient. | 1983 | Ann Emerg Med Vol. 12(2), pp. 124 |
article | |
| [no authors listed] | Letters to the Editor | 1983 | Ann Surg Vol. 198(5), pp. 667 |
article | URL |
| [no authors listed] | American Academy of Pediatrics. Committee on Pediatric Aspects of Physical Fitness, Recreation, and Sports. Accidental hypothermia. | 1979 | Pediatrics Vol. 63(6), pp. 926-928 |
article | |
| Aibiki, M., Maekawa, S., Nishiyama, T., Seki, K. & Yokono, S. | Activated cytokine production in patients with accidental hypothermia. [Abstract] |
1999 | Resuscitation Vol. 41(3), pp. 263-268 |
article | |
| Abstract: We have demonstrated recently that therapeutic moderate hypothermia of 32-33 degrees C, induced by surface cooling under the administration of narcotics, sedatives and muscle relaxant, suppresses cytokine production after traumatic brain injury. We present here the first documented case report of augmented cytokine production in two accidental hypothermia patients, unconscious 84- (acute immersion) and 87- (non-immersion) year-old women, whose rectal temperatures were below 28 degrees C. The victims were artificially ventilated after sedation with midazolam and buprenorphine in accordance with our protocol. Rewarming at the rate of approximately 1 degrees C/h was done by blowing forced-air with appropriate fluid resuscitation. Plasma interleukin(IL)-6 and/or IL-8 levels were measured using ELISA in the patients. In both patients, plasma IL-6 levels on admission were already elevated and the cytokine levels further increased during and after the rewarming period. In the patient with the poorer prognosis, the plasma IL-8 level on admission was not elevated remarkably but after rewarming the level rose significantly. Augmented IL-6 production in accidental hypothermia was sustained for 6 days in the patient with the poorer prognosis but not in the subject with good recovery, who was treated with anti-thrombin III in the early phase. Since the mechanisms for developing accidental hypothermia were different, simple comparisons between the two cases should be limited. But, these findings may suggest a need for testing a hypothesis whether cytokine modulation could be a therapeutic approach worthy of consideration. The results presented here also suggest that in hypothermia, changes in cytokine release may vary depending on procedures such as the anesthetic drugs used, the duration of the therapy, or the rate of rewarming from hypothermia. | |||||
| Ainslie, P.N. & Reilly, T. | Physiology of accidental hypothermia in the mountains: a forgotten story. [Abstract] |
2003 | Br J Sports Med Vol. 37(6), pp. 548-550 |
article | |
| Abstract: Hypothermia is a serious condition, often with fatal consequences. The physiology and mechanisms of hypothermia in mountainous areas are discussed. It is as important to facilitate heat loss, especially during periods of high exertion, as it is to maintain heat production and preserve insulation. This can be partly achieved by clothing adjustments. | |||||
| Aliukhin, I.S. | [Respiration and blood circulation in the terminal stages of deep hypothermia] [Abstract] |
1994 | Fiziol Zh Im I M Sechenova Vol. 80(5), pp. 46-53 |
article | |
| Abstract: In immersion hypothermia (9 degrees C) the brain temperature was 2 degrees higher on the average than in the heart area and 3-4 degrees C higher than rectal temperature in rats. At the brain temperature below 24-25 degrees C a strong dependence of the respiration rate on the body temperature occurs followed by the same dependence for the heart rate and arterial pressure. Arrest of the respiration occurs at the brain temperature 18 degrees C on the average, heart arrest occurs within 31 min on the average (at the heart temperature 11 degrees C). The main hypothermic pathogenetic factor is a direct effect of the cold on the brain and heart added by hypoxia due to weakening and arrest of respiration. | |||||
| Almeling, M., Böhm, F. & Welslau, W. | Handbuch Tauch- und Hyperbarmedizin. | 1998 | book | URL | |
| Almeling, M., Böhm, F. & Welslau, W. | Spätschäden nach Überdruckexposition. Lungenödem bei Tauchern. | 1998 | Handbuch Tauch- und Hyperbarmedizin., pp. 8-12 | incollection | URL |
| Althaus, U., Aeberhard, P., Schüpbach, P., Nachbur, B.H. & Mühlemann, W. | Management of profound accidental hypothermia with cardiorespiratory arrest. [Abstract] |
1982 | Ann Surg Vol. 195(4), pp. 492-495 |
article | |
| Abstract: Complete recovery following rapid rewarming is described in three tourists who were admitted in a state of profound hypothermia with total cardiorespiratory arrest (rectal temperature ranging from 19 to 24 C). In all three patients, respiration and circulation had ceased during the rescue operation. Rapid core rewarming was achieved by thoracotomy and continuous irrigation of the pericardial cavity with warm fluids in one patient, whereas in the other two patients rewarming was accomplished with extracorporeal circulation using femoro-femoral bypass. In the first patient, the heart could not be defibrillated earlier than 90 minutes following thoracotomy; in the other patients rewarming was attained very rapidly, and within half an hour after institution of bypass, resuscitation of the heart was successful. The patients fully recovered their intellectual and physical abilities, despite the prolonged periods of circulatory arrest lasting from 2 1/2 to 4 hours. We conclude that rapid core rewarming is the adequate therapy for profound accidental hypothermia with circulatory arrest or low cardiac output. If feasible extracorporeal circulation represents the method of choice because it combines the advantage of immediate central rewarming with the benefit of efficient circulatory support, the heart is rewarmed before the shell, thus preventing the "rewarming shock" due to peripheral vasodilatation. Resuscitative efforts should be promptly initiated and vigorously pursued, even in the state of clinical death; in profound hypothermia neurologic examination is inconclusive regarding prognosis. | |||||
| Alty, J.E. & Ford, H.L. | Multi-system complications of hypothermia: a case of recurrent episodic hypothermia with a review of the pathophysiology of hypothermia. [Abstract] |
2008 | Postgrad Med J Vol. 84(992), pp. 282-286 |
article | DOI |
| Abstract: A 61-year-old woman with secondary progressive multiple sclerosis presented on six occasions over a 2-year period with severe hypothermia (31-33.5 degrees C). This resulted in numerous multi-system complications comprising acute pancreatitis, hepatitis, gastrointestinal haemorrhage, psychiatric disturbance, bradycardia, paradoxical sweating, thrombocytopenia, anaemia and raised inflammatory markers. Septic screens were consistently normal. On each occasion she was successfully treated with passive external rewarming and made a complete recovery. This is the first reported case of such extensive sequelae in a single patient with recurrent hypothermic episodes. This unusual patient provides an invaluable insight into the natural history and pathophysiology of hypothermia. The case report is followed by a review of dysfunctional thermoregulation and pathophysiology of hypothermia-induced multi-system complications. A key learning point is to recognise that the clinical manifestations of hypothermia may be widespread and serious but are nonetheless reversible. In addition, one should consider the differential diagnosis of covert hypothermia in those patients with episodic confusion, as hypothermia is under-recognised, particularly in older people, who are prone to accidental hypothermia, and in those with common neurological conditions, such as stroke, head injury and multiple sclerosis, that may have suboptimal thermoregulation. | |||||
| Anderson, S., Herbring, B.G. & Widman, B. | Accidental profound hypothermia. | 1970 | Br J Anaesth Vol. 42(7), pp. 653-655 |
article | |
| Antretter, H., Dapunt, O.E. & Mueller, L.C. | Portable cardiopulmonary bypass: resuscitation from prolonged ice-water submersion and asystole. | 1994 | Ann Thorac Surg Vol. 58(6), pp. 1786-1787 |
article | |
| Antretter, H., Müller, L.C., Cottogni, M. & Dapunt, O.E. | [Successful resuscitation in severe hypothermia following near-drowning] [Abstract] |
1994 | Dtsch Med Wochenschr Vol. 119(23), pp. 837-840 |
article | |
| Abstract: A six-year-old boy fell into an ice-cold mountain stream and was immediately washed away. He was rescued 65 min later, 6 1/2 km downstream, seemingly lifeless with a rectal temperature of 16.4 degrees C. He was flown by helicopter to the surgical clinic of Innsbruck University, while resuscitation measures were undertaken by an accompanying doctor. After cannulation of the femoral artery and vein, extracorporeal circulation (ECC) with a child-size oxygenator was started and the blood rewarmed over 96 min in steps of 3 degrees C. Once circulatory stability and adequate cardiac output had been achieved ECC was gradually discontinued while the patient was still slightly hypothermic. Ten months after the accident the boy is restored to health, except for minimal residual neurological signs. There is a high chance for full neurological recovery. | |||||
| Arnaoutoglou, H., Petrou, A., Tefa, L., Drossos, G., Matsagas, M. & Papadopoulos, G. | Successful cardiac and cerebral resuscitation with extracorporeal circulation and mild hypothermia. [Abstract] |
2006 | Minerva Anestesiol Vol. 72(9), pp. 763-766 |
article | |
| Abstract: Extracorporeal circulation could be effective for cardiac resuscitation in patients who do not respond to ''Advanced cardiac life support'' (ACLS), but cannot guarantee brain survival. A case of successful cardiac and cerebral resuscitation with extracorporeal circulation and mild hypothermia, in a 48 year-old man with cardiac arrest due to cardiac tamponade, is reported. The good long term neurologic outcome of the patient is also described. | |||||
| Aslan, S., Erdem, A.F., Uzkeser, M., Cakir, Z., Cakir, M. & Akoz, A. | The Osborn wave in accidental hypothermia. [Abstract] |
2007 | J Emerg Med Vol. 32(3), pp. 271-273 |
article | DOI |
| Abstract: Hypothermia is generally defined as a core body temperature less than 35 degrees C (95 degrees F), and is one of the most common environmental emergencies encountered by emergency physicians. A 32-year-old male hunter was admitted to the hospital with altered mental status. He remained unconscious, Glasgow Coma Scale (GCS) score was recorded as 5/15, and pupils were dilated and unreactive. His vital signs showed a heart rate of 48 beats/min, respiratory rate of 10 breaths/min, blood pressure of 95/50 mm Hg, and rectal temperature of 31 degrees C. An electrocardiogram (ECG) was obtained and showed marked sinus bradycardia and J waves. His finger-stick glucose was 85. He was intubated. After 3 h of active rewarming, his temperature was 34 degrees C, and the repeat ECG showed near-complete resolution of the J waves and acceleration of the sinus rate to 68 beats/min. At the same time, emergency head computed tomography (CT) scan showed subarachnoid hemorrhage (SAH) and subdural hemorrhage. The patient died on the third day of admission. In this case we want to indicate that J waves and obtunded state could be due to either SAH or hypothermia, and SAH could have been missed if initial obvious hypothermia had been believed to cause all symptoms. | |||||
| Aznar, R., Ziad, F., Serrano, R. & Lacasa, J. | [Severe hypothermia induced by hypoglycemia. A manifestation of dysautonomic neuropathy?] | 1991 | Rev Clin Esp Vol. 188(7), pp. 385 |
article | |
| Babbs, C.F. | Simplified meta-analysis of clinical trials in resuscitation. [Abstract] |
2003 | Resuscitation Vol. 57(3), pp. 245-255 |
article | |
| Abstract: OBJECTIVE: To present and demonstrate a new simplified method for synthesizing results of multiple clinical trials in resuscitation research. METHODS: The mean difference across studies in the proportion of favorable outcomes between experimental and control groups is calculated. This difference is shown to have a t-distribution. Its significance can be ascertained with a simple t-test. The analysis can be implemented in a one-page computer spreadsheet. RESULTS: Simplified meta-analysis provides high sensitivity and can be extended to include weighting of studies according to size or quality, comparison of subgroups of studies, tests for outliers, and calculation of the power of the meta-analysis. Sample analyses are presented for two experimental forms of cardiopulmonary resuscitation (CPR): interposed abdominal compression (IAC) CPR and active compression-decompression (ACD) CPR. CONCLUSIONS: Traditional narrative reviews, taking note of the proportion of individual studies with statistically significant results, can lead to erroneous conclusions and unnecessary delays in the clinical use of research findings. Simplified meta-analysis can provide rapid, quantitative, and accurate estimates of the amount of benefit or harm from an experimental intervention and can further empower physicians to practice evidence-based medicine. | |||||
| Bacher, A. & Spiss, C.K. | [The two sides of mild hypothermia] | 1998 | Anasthesiol Intensivmed Notfallmed Schmerzther Vol. 33(6), pp. 349-351 |
article | |
| Bahlmann, L., Klaus, S., Baumeier, W., Schmucker, P., Raedler, C., Schmittinger, C.A., Wenzel, V., Voelckel, W. & Lindner, K.H. | Brain metabolism during cardiopulmonary resuscitation assessed with microdialysis. [Abstract] |
2003 | Resuscitation Vol. 59(2), pp. 255-260 |
article | |
| Abstract: BACKGROUND AND PURPOSE: Microdialysis is an established tool to analyse tissue biochemistry, but the value of this technique to monitor cardiopulmonary resuscitation (CPR) effects on cerebral metabolism is unknown. The purpose of this study was to assess the effects of active-compression-decompression (ACD) CPR in combination with an inspiratory threshold valve (ITV) (=experimental CPR) vs. standard CPR on cerebral metabolism measured with microdialysis. METHODS: Fourteen domestic pigs were surfaced-cooled to a body core temperature of 26 degrees C and ventricular fibrillation was induced, followed by 10 min of untreated cardiac arrest; and subsequently, standard (n=7) CPR vs. experimental (n=7) CPR. After 8 min of CPR, all animals received 0.4 U/kg vasopressin IV, and CPR was maintained for an additional 10 min in each group; defibrillation was attempted after a total of 28 min of cardiac arrest, including 18 min of CPR. RESULTS: In the standard CPR group, microdialysis measurements showed a 13-fold increase of the lactate-pyruvate ratio from 7.2+/-1.3 to 95.5+/-15.4 until the end of CPR (P<0.01), followed by a further increase up to 138+/-32 during the postresuscitation period. The experimental group developed a sixfold increase of the lactate-pyruvate ratio from 7.1+/-2.0 to 51.1+/-8.7 (P<0.05), and a continuous decrease after vasopressin. In the standard resuscitated group, but not during experimental CPR, a significant increase of cerebral glucose levels from 0.6+/-0.1 to 2.6+/-0.5 mM was measured (P<0.01). CONCLUSION: Using the technique of microdialysis we were able to measure changes of brain biochemistry during and after the very special situation of hypothermic cardiopulmonary arrest. Experimental CPR improved the lactate-pyruvate ratio, and glucose metabolism. | |||||
| Baile, E.M., Dahlby, R.W., Wiggs, B.R. & Paré, P.D. | Role of tracheal and bronchial circulation in respiratory heat exchange. [Abstract] |
1985 | J Appl Physiol Vol. 58(1), pp. 217-222 |
article | |
| Abstract: Due to their anatomic configuration, the vessels supplying the central airways may be ideally suited for regulation of respiratory heat loss. We have measured blood flow to the trachea, bronchi, and lung parenchyma in 10 anesthetized supine open-chest dogs. They were hyperventilated (frequency, 40; tidal volume 30-35 ml/kg) for 30 min or 1) warm humidified air, 2) cold (-20 degrees C dry air, and 3) warm humidified air. End-tidal CO2 was kept constant by adding CO2 to the inspired ventilator line. Five minutes before the end of each period of hyperventilation, measurements of vascular pressures (pulmonary arterial, left atrial, and systemic), cardiac output (CO), arterial blood gases, and inspired, expired, and tracheal gas temperatures were made. Then, using a modification of the reference flow technique, 113Sn-, 153Gd-, and 103Ru-labeled microspheres were injected into the left atrium to make separate measurements of airway blood flow at each intervention. After the last measurements had been made, the dogs were killed and the lungs, including the trachea, were excised. Blood flow to the trachea, bronchi, and lung parenchyma was calculated. Results showed that there was no change in parenchymal blood flow, but there was an increase in tracheal and bronchial blood flow in all dogs (P less than 0.01) from 4.48 +/- 0.69 ml/min (0.22 +/- 0.01% CO) during warm air hyperventilation to 7.06 +/- 0.97 ml/min (0.37 +/- 0.05% CO) during cold air hyperventilation. | |||||
| Baudet, E.M. | Profound hypothermia and circulatory arrest. | 1992 | Ann Thorac Surg Vol. 54(3), pp. 596 |
article | |
| Baumeier, W. | Intensivtransport: Besonderheiten bei schwerer Hypothermie. | 1999 | Intensivtransport. Symposium zum 25jährigen Bestehen der Luftrettung im Kreis Aachen., pp. 108 | incollection | URL |
| Baumeier, W. | [Severe accidental hypothermia. Rescue and treatment procedures at sea] [Abstract] |
2008 | Notfall Rettungsmed Vol. 11(7), pp. 463-468 |
article | DOI |
| Abstract: Cardiac arrest not responding to any treatment is the most dangerous difficulty of severe accidental hypothermia at sea. The cooling down of brain tissue correlates with a remarkable increase of cerebral oxygen deficiency tolerance. Within the SARRRAH project (Search and Rescue, Resuscitation and Rewarming in Accidental Hypothermia) procedures and equipment for sea rescue purposes have been developed to enable seamen to perform a sufficient mechanical long-term resuscitation, even under rough conditions and limited manpower. A specially modified combitube is being used as a safe artificial airway device. The use of active compression- decompression cardiopulmonary resuscitation (ACD-CPR) in combination with an inspiratory impedance threshold device and an oxygen demand valve causes a sufficient blood circulation to keep the inner organ tissues vital. Ships' crew members and maritime rescue staff need a simple additional advanced First Aid training to be enabled to start life-saving procedures by themselves, without professional help.; Zusammenfassung; Der präklinische therapierefraktäre Kreislaufstillstand ist die gefährlichste Komplikation der schweren Unterkühlung. Mit der Abkühlung des Gehirngewebes korreliert eine deutliche Zunahme der zerebralen Sauerstoffmangeltoleranz. Im vorliegenden Beitrag werden Verfahren und Materialien beschrieben, die im Rahmen des Projekts SARRRAH (Search and Rescue, Resuscitation and Rewarming in Accidental Hypothermia) für die Seerettung vor der deutschen Küste entwickelt wurden. Diese sollen auch unter den schwierigen Umgebungsbedingungen und mit den eingeschränkten personellen Möglichkeiten auf See eine wirkungsvolle und auf mechanische Maßnahmen reduzierte Sauerstoffversorgung der lebenswichtigen Organe bei einer länger dauernden Reanimation sicherstellen. Ein speziell konfektionierter Kombitubus als sicheres Atemwegshilfsmittel in Verbindung mit einer Wechseldruck- Herzdruckmassage, der Anwendung eines Impedanzventils und eines Sauerstoff-Demand-Ventils bieten die Voraussetzungen dafür, dass auch Schiffsbesatzungen, die als medizinische Laien im Rahmen einer erweiterten Erste-Hilfe-Ausbildung geschult wurden, am Beginn einer Rettungskette auf sich allein gestellt lebensrettend tätig werden können. | |||||
| Baumeier, W. | The SARRRAH Project. | 2006 | Handbook on Drowning. Prevention, Rescue, Treatment. World Congress on Drowning 26-28 June 2002, Amsterdam, congress book., pp. 524-526 | incollection | URL |
| Baumeier, W. | The registration system SARRRAH. | 2002 | Book of abstracts. World Congress on Drowning 2002. held in Amsterdam on 26-28 June 2002., pp. 70 | incollection | |
| Baumeier, W. | Akzidentelle Hypothermie: präklinisches und klinisches Management. | 2000 | J Anaesth Intensivbehand Vol. 1, pp. 12-14 |
article | |
| Baumeier, W. | Projekt 'SARRRAH' : Primärrettung und aufbau der Rettungskette bei ausgeprägter Unterkühlung. Medizinische und logistische Aspekte nach der Rettung aus dem Wasser. | 2000 | Unterkühlung im Rettungsdienst. Prä- und innerklinische Therapie der akzidentellen Hypothermie., pp. 9-16 | incollection | URL |
| Baumeier, W., Bahlmann, L. & Schmucker, P. | Accidental Hypothermia and the Project 'SARRRAH'. First Experiences with a Multicenter Study. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 129-140 | incollection | URL |
| Baumeier, W. & Schmucker, P. | Hypothermia in Cardiac Surgery. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 243-250 | incollection | URL |
| Baumeier, W. & Schwindt, M. | Horizontal and Other Rescue Techniques: Practical Aspects. | 2006 | Handbook on Drowning. Prevention, Rescue, Treatment. World Congress on Drowning 26-28 June 2002, Amsterdam, congress book., pp. 242-249 | incollection | URL |
| Baumgartner, F.J., Janusz, M.T., Jamieson, W.R., Winkler, T., Burr, L.H. & Vestrup, J.A. | Cardiopulmonary bypass for resuscitation of patients with accidental hypothermia and cardiac arrest. [Abstract] |
1992 | Can J Surg Vol. 35(2), pp. 184-187 |
article | |
| Abstract: Hypothermic patients have been successfully rewarmed by a number of methods. However, when cardiac arrest occurs, as it frequently does at core temperatures of less than 27 degrees C, prolonged cardiopulmonary resuscitation (CPR) is required, because defibrillation can rarely be achieved until the patient has been rewarmed to 30 degrees to 34 degrees C. Five cases of accidental hypothermia with cardiac arrest treated with cardiopulmonary bypass are discussed. The first patient died as a result of inadequate low-flow cardiopulmonary bypass by the femorofemoral route. The second patient had prolonged CPR by closed-chest cardiac massage and warm peritoneal lavage followed by transthoracic cardiopulmonary bypass. This patient regained consciousness but was found to be paraplegic and died from bowel infarction related to peritoneal rewarming without adequate perfusion. In the last three patients, high-flow cardiopulmonary bypass was rapidly achieved using a no. 28 French chest tube for femoral venous cannulation, and they recovered completely. In cases of accidental hypothermia with cardiac arrest, rapid institution of full cardiopulmonary bypass provides excellent circulatory support and rapid rewarming. This avoids the complications of prolonged inadequate circulation that occur when closed-chest cardiac massage and external rewarming are used. | |||||
| Beck, E., Langer, M., Mauro, P.D. & Prato, P. | Efficacy of intraoperative heat administration by ventilation with warm humidified gases and an oesophageal warming system. [Abstract] |
1996 | Br J Anaesth Vol. 77(4), pp. 530-533 |
article | |
| Abstract: We measured changes in body temperature in 12 hypothermic (mean aural temperature 34.4 (SD 1.0) degrees C) pigs during general anaesthesia with an open abdominal cavity and the effect of two warming systems: heating of inspired gases to 39 degrees C (intratracheal temperature) and oesophageal warming to 39 degrees C by a water perfused oesophageal heat exchanger. Each animal underwent both treatments and the control period in random sequence. Each condition was studied over 1 h. No additional protection against heat loss (drapes, blankets, i.v. fluids warming, etc.) was used. Anaesthesia, room temperature and relative humidity, amount and temperature of infusions and extension of exposed visceral surfaces were standardized. Mean decrease in body temperature was 1.0 (0.7) degree C (P < 0.005) without warming and 0.6 (0.2) degree C (P < 0.005) with heated inspired gases: this difference was not statistically significant. Oesophageal warming was very efficient as mean body temperature did not change significantly (-0.1 (0.2) degree C; ns). | |||||
| Bedi, N. & Hardy, P. | Pacing in hypothermia: does it work? [Abstract] |
2006 | Emerg Med J Vol. 23(7), pp. 585 |
article | DOI |
| Abstract: [extract] Hypothermia is a relatively common clinical problem in the emergency department. It requires a informed response as regards the physiological changes that occur when there is a significant drop in core body temperature. We describe the case of an elderly man who appeared particularly resistant. An 87 year old man was found collapsed outdoors in his coal shed having been there most of the night. On presentation to the emergency department he did not have an oral airway adjunct, oxygen saturations were 82% on 100% oxygen, BP was 65/50, and pulse rate was 64 bpm. In addition, the patient ... | |||||
| Beier, U. | Großgewässer-Gefahr Nr. 1: Unterkühlung. [PDF] |
2003 | Deutscher Kanu-Verband e.V. Vol. 11, pp. 1-19 |
article | |
| Beran, A.V., Shinto, R.A., Proctor, K.G. & Sperling, D.R. | Effect of inhalate thermal conductivity and high O2 in producing hypothermia. [Abstract] |
1979 | J Appl Physiol Vol. 47(1), pp. 228-232 |
article | |
| Abstract: The effect of an increase in inhalate thermal conductivity and the fraction of inspiratory O2 (FIO2) on the rate of cooling and rewarming using a surface-inhalate heat exchange method was evaluated. Male New Zealand White rabbits were divided into three groups: those ventilated with air, those with 20% O2 + 80% He, and those with 100% O2. All animals were cooled to an esophageal temperature of 22.5 degrees C (or for 180 min maximum). Following a 15-min exposure to room air, the animals were connected to the humidifying and warming system. He-O2 had the highest thermal conductivity and the animals ventilated with it had the fastest cooling rate. One hundred percent O2 and room air had similar thermal conductivities, but the animals ventilated with 100% O2 had significantly lower cooling rates. These data indicate that, while maintaining a constant surface heart exchange, the rate of heat exchange across the lung can be modified by altering the thermal conductivity of the inhalate gas mixture. Total heat exchange can also be modified by hyperoxemia-induced hemodynamic changes. | |||||
| Berger, R.L. | Nazi science--the Dachau hypothermia experiments. | 1990 | N. Engl. J. Med. Vol. 322(20), pp. 1435-1440 |
article | |
| Bes, S., Roussel, P., Laubriet, A., Vandroux, D., Tissier, C., Rochette, L. & Athias, P. | Influence of deep hypothermia on the tolerance of the isolated cardiomyocyte to ischemia-reperfusion. [Abstract] |
2001 | J. Mol. Cell. Cardiol. Vol. 33(11), pp. 1973-1988 |
article | DOI |
| Abstract: The influence of deep hypothermia (4 degrees C) during a substrate-free, hypoxia-reoxygenation treatment was investigated on cardiomyocytes (CM) prepared from newborn rat heart in culture in an in vitro, substrate-free model of ischemia-reperfusion. The transmembranous potentials were recorded with standard microelectrodes. The contractions were monitored photometrically. The RNA messenger (mRNA) and protein expression for protein (HSP70) were analysed by RT-PCR (reverse transcriptase-polymerase chain reaction) and Western blotting, respectively. Simulated ischemia (SI) caused a gradual decrease and then a cessation of the spontaneous electromechanical activity. During the reoxygenation, the CM recovered normal function, provided that SI did not exceed 2.5 h. When SI duration was increased up to 4 h, reoxygenation failed to restore the spontaneous electromechanical activity. Conversely, the exposure of the CM to SI together with deep hypothermia decreased the functional alterations observed, and provided a complete electromechanical recovery after 2.5 h as well as after 4 h of SI. Deep hypothermia alone failed to induce HSP70 mRNA and protein production. On the contrary, HSP70 mRNA production increased after 2.5 and 4 h of deep hypothermia followed by 1 h of rewarming, proportionally to the duration of the cooling period. This augmentation in mRNA was associated with a rise in HSP70 protein content. In summary, it appeared that deep hypothermia exerts a strong cytoprotective action during SI only, whereas cooling CM before SI has no beneficial effect on subsequent SI. Moreover, these results suggested the persistence of a signaling system and/or transduction in deeply cooled, functionally depressed cells. Finally, CM in culture appeared to be a model of interest for studying heart graft protection against ischemia-reperfusion and contributed to clarifying the molecular and cellular mechanisms of deep hypothermia on myocardium. | |||||
| Bicego, K.C., Barros, R.C.H. & Branco, L.G.S. | Physiology of temperature regulation: comparative aspects. [Abstract] |
2007 | Comparative biochemistry and physiology. Part A, Molecular & integrative physiology Vol. 147(3), pp. 616-639 |
article | DOI |
| Abstract: Few environmental factors have a larger influence on animal energetics than temperature, a fact that makes thermoregulation a very important process for survival. In general, endothermic species, i.e., mammals and birds, maintain a constant body temperature (Tb) in fluctuating environmental temperatures using autonomic and behavioural mechanisms. Most of the knowledge on thermoregulatory physiology has emerged from studies using mammalian species, particularly rats. However, studies with all vertebrate groups are essential for a more complete understanding of the mechanisms involved in the regulation of Tb. Ectothermic vertebrates-fish, amphibians and reptiles-thermoregulate essentially by behavioural mechanisms. With few exceptions, both endotherms and ectotherms develop fever (a regulated increase in Tb) in response to exogenous pyrogens, and regulated hypothermia (anapyrexia) in response to hypoxia. This review focuses on the mechanisms, particularly neuromediators and regions in the central nervous system, involved in thermoregulation in vertebrates, in conditions of euthermia, fever and anapyrexia. | |||||
| Bierens, J.J. & Bierens, J.J.L.M. | Handbook on Drowning. Prevention, Rescue, Treatment. World Congress on Drowning 26-28 June 2002, Amsterdam, congress book. [Abstract] |
2006 | , pp. 714 | book | DOI URL |
| Abstract: World-wide at least half a million people die from drowning each year. To address this global issue, experts from around the world, ranging from rescuers to clinicians and researchers, share their knowledge and expertise to focus on the major areas of need and strategies for success.The Handbook on Drowning is the "must have" for anyone who desires a satellite view of existing knowledge about prevention, rescue, and treatment of drowning. The book is not only a rich source of focused information, but also a stimulant for initiatives on how best to reduce the annual number of drownings, in individual cases and during disasters, and how to improve the outcome of drowning victims.This book is of great importance for those involved in the pre-hospital, emergency and intensive care treatment of drowned victims and also a rich source of information for public health officials involved in drowning prevention and for professionals involved in water rescue. | |||||
| Bierens, J.J., Uitslager, R., van Ingen, M.M.S., van Stiphout, W.A. & Knape, J.T. | Accidental hypothermia: incidence, risk factors and clinical course of patients admitted to hospital. [Abstract] |
1995 | Eur J Emerg Med Vol. 2(1), pp. 38-46 |
article | |
| Abstract: This study was initiated to identify the incidence, risk factors and outcome predictors of patients admitted to hospital in the Netherlands because of accidental hypothermia. Information about these patients was available for study through the National Health Care Data Bank. Between 1987 and 1990, 612 accidental hypothermic patients were admitted: 185 hypothermic patients also suffered from submersion (HYPSUBS), but this was not the case in the remaining 427 patients (HYPNOTSUBS). Patients in the HYPNOTSUBS group were older (average age 55.2 years versus 38.9 years; p < 0.001), remained longer in hospital (average 20.8 days versus 9.2 days; p < 0.001) and had a higher death rate than those in the HYPSUBS group (16.9% versus 5.9 p < 0.001). In HYPNOTSUBS, increasing age correlated with increases in the length of hospital stay and death rate. This relationship was not found in HYPSUBS. Trauma was the major associated problem in both groups; these patients had the highest death rate (22.8% versus 16.7 not significant). Death occurred within 2 days in 54% of HYPNOTSUBS non-survivors and 73% of HYPSUB non-survivors. HYPNOTSUBS admitted to university hospitals showed a lower death rate (5.9 compared with HYPNOTSUBS admitted to non-university hospitals with less than 400 beds (13.4 or more than 400 beds (21.7. In contrast, the death rate in HYPSUB was higher in university hospitals (14.3 than in non-university hospitals with less than 400 beds (5.2 or more than 400 beds (3.6. We observed that the incidence of accidental hypothermia is low at 1.1 per 100,000 inhabitants per year. We concluded that HYPNOTSUBS and HYPSUB are different groups of patients with respect to demographic data, risk factors and prognostic factors. Old age is an important unfavourable prognostic factor in HYPNOTSUB but not in HYPSUB. Hypothermia with trauma is an unfavourable combination in both groups. Almost half of the HYPNOTSUBS non-survivors died after more than 2 days. Because body temperature will have returned to normal by then, this must be the result of late complications. Most HYPSUB non-survivors died during the first 2 days, probably as a direct result of the submersion injury. | |||||
| Bierens, J.J.L.M. | Incidence, risk factors and clinical course of patients admitted with immersion or submersion hypothermia. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 119-128 | incollection | |
| Biggart, M.J. & Bohn, D.J. | Effect of hypothermia and cardiac arrest on outcome of near-drowning accidents in children. [Abstract] |
1990 | J Pediatr Vol. 117(2 Pt 1), pp. 179-183 |
article | |
| Abstract: We conducted a retrospective review of 55 near-drowning victims (mean age 4.75 years) admitted to the intensive care unit during a 5-year period, to determine the factors that may influence survival both before and after hospital admission. All patients who remained comatose after resuscitation received ventilation for an initial 24 hour period, after which an assessment of central nervous system injury was made. Intracranial pressure was not monitored, and barbiturate therapy was used only for seizure control. Thirty-seven children survived and 18 died; five survivors had profound neurologic damage resulting in a persistent vegetative state: the remaining 32 (58 survived intact. The major factors that separated intact survivors from those who died and from survivors in a persistent vegetative state were the presence of a detectable heartbeat and hypothermia (less than 33 degrees C) on examination in the emergency department. Thirteen patients with absent vital signs and a temperature of greater than 33 degrees C either died or survived in a persistent vegetative state. Fourteen patients had a combination of absent vital signs and hypothermia and were resuscitated; eight died, two survived in a persistent vegetative state, and four survived intact. All intact survivors had been submerged in cold water for prolonged periods, and all underwent prolonged cardiopulmonary resuscitation. All patients with a detectable pulse, regardless of temperature, survived without neurologic sequelae. The 58% intact survival rate in this series compares favorably with the 50% we reported previously when high-dose barbiturate therapy and hypothermia were used to control intracranial pressure; at the same time, the number of survivors with a persistent vegetative state has been reduced by 50 We conclude that prolonged in-hospital resuscitation and aggressive treatment of near-drowning victims who initially have absence of vital signs and are not hypothermic either results in eventual death or increases the number of survivors with a persistent vegetative state. | |||||
| Binnema, R., van der Wal, A., Visser, C., Schepp, R., Jekel, L. & Schröder, P. | Treatment of accidental hypothermia with cardiopulmonary bypass: a case report. [Abstract] |
2008 | Perfusion Vol. 23(3), pp. 193-196 |
article | DOI |
| Abstract: This case report describes the successful treatment of severe accidental hypothermia of a 40-year-old woman. At arrival in the operating theatre her rectal temperature was 23 degrees C, her nasal temperature 21 degrees C and her periferal temperature 14 degrees C. The patient presented with a severe respiratory and metabolic acidosis which was corrected during cardiopulmonary bypass (CPB). She was rewarmed to obtain a rectal and nasal temperature of 34 degrees C. After 272 minutes, the patient was weaned successfully from CPB. The patient remained at mild hypothermia (34 degrees C) for 24 hours in the intensive care unit (ICU). The chest X-ray showed some signs of acute respiratory distress syndrome (ARDS) in spite of normal blood gas values. This improved within a few days and, after five days, she was transferred to the nursing department. On the seventh day, the patient was discharged from hospital without physical or neurological complaints. | |||||
| Bjørnstad, H., Tande, P.M. & Refsum, H. | Cardiac electrophysiology during hypothermia. Implications for medical treatment. [Abstract] |
1991 | Arctic Med Res Vol. 50 Suppl 6, pp. 71-75 |
article | |
| Abstract: Reduction in body temperature induces characteristic electrophysiological and mechanical alterations of the heart. The heart rate is markedly reduced. Myocardial conduction is slowed, partly due to reduced rate of depolarization of the action potential, and is reflected by widening of the QRS-complex in the ECG. There is also a fall in resting membrane potential. Action potential duration and refractory period are markedly lengthened during hypothermia, attributed to delayed repolarization. This is reflected by increased QT-time in the ECG. Since action potential duration changes significantly even after as small temperature changes as 1 to 2 degrees C, nonuniform cooling or rewarming of the heart may cause significant dispersion of conduction, action potential duration and refractoriness in the myocardium. This dispersion may cause unidirectional block, hence creating a substrate for reentry atrial and ventricular arrhythmias, and may be an important mechanism for explaining the hypothermia-associated arrhythmias. Class III antiarrhythmic drugs such as d-sotalol lengthen long action potentials at low temperatures to a greater extent than the shorter action potentials at higher temperatures. This may further increase dispersion and thereby the tendency towards arrhythmias. Sotalol as an example, shows that some antiarrhythmic drugs may have increased arrhythmogenic effect and should probably be contraindicated during hypothermia. | |||||
| Bolte, R.G., Black, P.G., Bowers, R.S., Thorne, J.K. & Corneli, H.M. | The use of extracorporeal rewarming in a child submerged for 66 minutes. [Abstract] |
1988 | JAMA Vol. 260(3), pp. 377-379 |
article | |
| Abstract: A 2 1/2-year-old girl had a good neurologic recovery after submersion in cold water for at least 66 minutes; as far as we know, this is the longest time ever reported. Cardiopulmonary resuscitation was maintained for more than two hours before the initiation of extracorporeal rewarming in this child who had a core temperature of 19 degrees C. To our knowledge, this is the first successful use of extracorporeal rewarming in a child suffering from accidental hypothermia. Extension of this technique to children offers rapid rewarming and cardiovascular support for pediatric victims of severe hypothermia. We emphasize the importance of a coordinated response by the entire emergency medical system integrated with hospital-based personnel. Where it is geographically feasible, regionalization of triage and care for the pediatric victim of severe accidental hypothermia should be considered. | |||||
| Bookallil, M.J. | pH and temperature. | 1999 | pH of the blood: acid-base balance. | incollection | URL |
| Bosacki, C., Hausfater, P., Koenig, M., Serratrice, J., Piette, A.-M. & Cathébras, P. | [Spontaneous hypothermia: a series of ten cases, place of Shapiro's syndrome] [Abstract] |
2005 | Rev Med Interne Vol. 26(8), pp. 615-623 |
article | DOI |
| Abstract: SUBJECT: Hypothermia (defined as a core temperature lower than 35 degrees C) may result from accidental causes (exposure to cold, drug intoxications), from endocrine disorders (hypothyroidism), or from central or peripheral neurological disease. Among the causes of spontaneous hypothermia, the place of spontaneous periodic hypothermia or Shapiro's syndrome, of which less than 50 cases in children or adults have been reported, remains unclear. METHODS: Case series of spontaneous hypothermia in adults, from a register of the French Society of Internal Medicine (SNFMI). RESULTS: The ten collected cases of spontaneous hypothermia are heterogeneous. In half of the cases, an often ill-labeled psychiatric illness and/or epilepsy and/or anti-psychotic medication were found contributive. Only 5 cases at best seem to conform to the pattern of spontaneous periodic hypothermia or Shapiro's syndrome (in which agenesis of corpus callosum is typically found). In such cases, the episodes of hypothermia start with profuse hyperhidrosis suggesting a paroxystic reset of the hypothalamic thermostat with a lower temperature set point. In none of the cases was found a significant encephalic lesion. None of the treatment trials with anti-epileptics or cyproheptadine were found useful. Spontaneous hypothermia, whether periodic or not, seems to have an unpredictable course, with long periods of remission, and a benign long-term outcome. CONCLUSIONS: Spontaneous hypothermia is a symptom of likely multifactorial etiology. Even in cases conforming to the definition of Shapiro's syndrome, central nervous system anomalies are not unequivocal. No specific treatment for spontaneous hypothermia, whether periodic or not, can be recommended in the current state of knowledge. | |||||
| Bravo, L.J.B. | Thermodynamic modelling of hypothermia. [Abstract] |
1999 | Eur J Emerg Med Vol. 6(2), pp. 123-127 |
article | |
| Abstract: Hypothermia is an important threat in trauma patients. The prevention of accidental hypothermia requires a thermal steady state. A simple mathematical model describing thermal steady state is introduced. When applied to trauma patients the model seems sensitive to changes in temperature of intravenous fluids. To simulate possible strategies to prevent hypothermia in the trauma patient the mathematical solution needs to be extended to describe situations where steady state does not exist. From these simulations it can be concluded that infusion heating devices are mandatory in patients with high fluid requirements. | |||||
| Brieva, J., McFadyen, B. & Rowley, M. | Severe hypothermia: challenging normal physiology. [Abstract] |
2005 | Anaesth Intensive Care Vol. 33(5), pp. 662-664 |
article | |
| Abstract: Accidental hypothermia is not a frequent cause of death in Australia. Moreover it is rare to have an admission to hospital with a core temperature below 32 degrees C. Among the cases described in the literature, it is clear that temperature and prognosis are related. Our patient presented with severe accidental hypothermia and even though the admission core temperature was below 26 degrees she was successfully discharged from hospital after active re-warming with three different devices. She had laboratory and ECG findings associated with severe hypothermia. | |||||
| Bristow, G. | Accidental hypothermia. | 1984 | Can Anaesth Soc J Vol. 31(3 Pt 2), pp. S52-S55 |
article | |
| Bristow, G.K., Sessler, D.I. & Giesbrecht, G.G. | Leg temperature and heat content in humans during immersion hypothermia and rewarming. [Abstract] |
1994 | Aviat Space Environ Med Vol. 65(3), pp. 220-226 |
article | |
| Abstract: Core temperature afterdrop following cold water immersion has previously been shown to be greater during treadmill exercise than shivering (J. Appl. Physiol. 1987; 63:2375-9). To test the hypothesis that this results from increased transfer of heat from the core to exercising muscles, we quantified the changes in leg temperature and heat content during cooling and exercise/shivering protocols. Upper and lower leg muscle temperatures were measured at multiple depths in five thin healthy male subjects immersed in 8 degrees C water until core temperatures reached 32.8-34.9 degrees C. In these thin subjects there was a significant but small difference between exercise and shivering afterdrop (approximately 0.2 degrees C), and total leg heat content was unchanged during this period with both protocols. Subsequent heat gain was similar in both treatments but, in the lower leg, was greater during exercise than shivering, suggesting that shivering is less effective than exercise in increasing lower leg heat content. | |||||
| Britt, L.D., Dascombe, W.H. & Rodriguez, A. | New horizons in management of hypothermia and frostbite injury. [Abstract] |
1991 | Surg Clin North Am Vol. 71(2), pp. 345-370 |
article | |
| Abstract: Diagnosing hypothermia requires a high index of suspicion. Restoring lost heat with careful attention to hemodynamics usually results in complete recovery. Frostbite is best treated by physicians who are cognizant of the pathophysiology of cold injury. Although alternative methods of intervention are being tested, rapid rewarming and anti-inflammatory agents are integral to treatment protocols. | |||||
| Brooks, C.J. | Survival in cold waters. staying alive. | 2003 | , pp. 85 | book | |
| Brugger, H. & Falk, M. | [New perspectives of avalanche disasters. Phase classification using pathophysiologic considerations] [Abstract] |
1992 | Wien Klin Wochenschr Vol. 104(6), pp. 167-173 |
article | |
| Abstract: This study comprises an analysis of the data on 332 persons totally buried by avalanches in Switzerland between 1981 and 1989. The survival rate was calculated with the aid of a computer-assisted estimation procedure according to Turnbull. The curve pattern was interpreted according to pathophysiological considerations, on the basis of which the time course of the battle for survival was divided into 4 phases: 1) Survival phase: until 15 minutes after burial under the snow masses. The survival probability amounts to 93% and is, thus, higher than so far assumed. Almost all those buried survived this period of the time provided they were not fatally injured and received first aid. 2) Asphyxia phase: duration of burial under the avalanche from 15 to 45 minutes. The probability of survival sank dramatically during this period from 93% to about 25% (fatal kink of the survival probability curve). Those buried under the snow without an air pocket die of acute asphyxia (the point of no return) and the mortality rate reaches its maximum in this phase. 3) Latent phase: the period as from 45 minutes following the avalanche until the time of rescue. This phase is survived only in the presence of an air pocket. With sufficient oxygen reserves and freedom of thoracic movement a "phase of relative safety" occurs, whereby the survival probability diminishes further only slowly. The first deaths due to hypothermia arise after 90 minutes. 4) Rescue phase: from the time of extrication from the snow until arrival in hospital. There is an increased risk of a fatal outcome during the rescue procedure and immediately afterwards through augmented hypothermia.(ABSTRACT TRUNCATED AT 250 WORDS) | |||||
| Brugger, H., Falk, M. & Adler-Kastner, L. | [Avalanche emergency. New aspects of the pathophysiology and therapy of buried avalanche victims] [Abstract] |
1997 | Wien Klin Wochenschr Vol. 109(5), pp. 145-159 |
article | |
| Abstract: A series of investigations on the pathophysiology and management of persons buried in an avalanche has been undertaken over the past few years in response to increased awareness of the importance of emergency medical treatment of avalanche victims and the fact that the high mortality rate has not decreased in spite of the improvement in rescue techniques. This paper is the very first review of the problems encountered in avalanche disasters. The developments over the past 20 years, in particular, are summarized and discussed. Furthermore, current opinions and recommendations on optimal rescue procedure, as well as the prevention of such emergencies are presented. Precise assessment of the survival probability after burial under an avalanche and recognition of the prognostic importance of an air pocket, but only limited role of hypothermia, provide the basis for new concepts governing therapy and triage by the emergency doctor. Resulting guidelines have been endorsed by the Emergency Medicine Subdivision of the International Commission of the Alpine Rescue Services (ICAR) and these recommendations are intended for implementation by organised rescue teams in order to reduce secondary deaths following successful extrication of victims from the avalanche masses. However, the chance of being rescued alive depends primarily on the rapidity of extrication, i.e. how quickly the rescue teams are alerted and transported to the disaster area in the first instance, then how quickly the victims are located and extricated. In order to reduce the mortality additional preventive measures must be introduced to avoid complete burial if possible, or appreciably hasten the rescue procedure. The very steep drop ("fatal kink") in survival probability as from 15 minutes after burial underlines the absolute necessity of the mastery of efficient rescue procedure by uninjured companions. Improvement of the technical developments for the avoidance of total burial (avalanche air bag) and optimization of the electronic location (transceiver) of buried skiers by uninjured companions are essential future requirements. Nonetheless, primary prevention remains of paramount importance in governing decision making by offpiste skiers. Correct assessment of the inherent risks according to the prevailing circumstances and strict adherence to safety rules take precedence over all other considerations. | |||||
| Brugger, H., Sumann, G., Meister, R., Adler-Kastner, L., Mair, P., Gunga, H.C., Schobersberger, W. & Falk, M. | Hypoxia and hypercapnia during respiration into an artificial air pocket in snow: implications for avalanche survival. [Abstract] |
2003 | Resuscitation Vol. 58(1), pp. 81-88 |
article | |
| Abstract: Snow avalanche case reports have documented the survival of skiers apparently without permanent hypoxic sequelae, after prolonged complete burial despite there being only a small air pocket on extrication. We investigated the underlying pathophysiological changes in a prospective, randomised 2 x 2 crossover study in 12 volunteers (28 tests) breathing into an artificial air pocket (1- or 2-l volume) in snow. Peripheral SpO(2), ETCO(2), arterialised capillary blood variables, air pocket O(2) and CO(2), snow density, and snow conditions at the inner surface of the air pocket were determined. SpO(2) decreased from a median of 99% (93-100 to 88% (71-94 P<0.001) within 4 min of breathing into the air pocket; the reduction was greater at 1 l, than 2 l, volume air pocket (P=0.013, intention to treat P=0.003) and correlated to snow density (r=0.50, P=0.021, partial correlation coefficient). ETCO(2) rose simultaneously from median 5.07 kPa (3.47-6.93 kPa) to 6.8 kPa (5.87-8.27 kPa; P<0.001), with consequent respiratory acidosis. Despite premature interruption due to hypoxia (SpO(2) | |||||
| Brunette, D.D., Biros, M., Mlinek, E.J., Erlandson, C. & Ruiz, E. | Internal cardiac massage and mediastinal irrigation in hypothermic cardiac arrest. [Abstract] |
1992 | Am J Emerg Med Vol. 10(1), pp. 32-34 |
article | |
| Abstract: Two unconscious patients with unknown past medical histories were found to be severely hypothermic, with core temperatures of 80.2 degrees F and 86.7 degrees F, respectively. During the course of active internal rewarming, both patients sustained a cardiac arrest. Emergency thoracotomies were immediately done, and internal cardiac massage with warmed mediastinal irrigation was performed. Spontaneous cardiac activity developed in both patients. Within 24 hours after resuscitation, both patients were responsive and following commands. | |||||
| Brunette, D.D., Sterner, S. & Ruiz, E. | Rewarming in severe hypothermia. | 1990 | Ann Emerg Med Vol. 19(9), pp. 1076-1077 |
article | |
| Brunson, C.E., Abbud, E., Osman, K., Skelton, T.N. & Markov, A.K. | Osborn (J) wave appearance on the electrocardiogram in relation to potassium transfer and myocardial metabolism during hypothermia. [Abstract] |
2005 | J Investig Med Vol. 53(8), pp. 434-437 |
article | |
| Abstract: The genesis of the J wave during hypothermia has been attributed to injury current, delayed ventricular depolarization and early repolarization, tissue anoxia, and acidosis. To our knowledge, no studies have addressed the appearance of the J wave in relation to the myocardial K+ transfer and metabolism during hypothermia. Dogs (n = 9) were progressively cooled, blood samples were taken from the aorta and coronary sinus, and myocardial tissue samples were obtained for adenosine triphosphate (ATP), creatine phosphate (CP), and glycolytic intermediate determination. In every instance, the appearance of the J wave was preceded by a net loss of K+ from the myocardium. In one dog, there was no myocardial K+ loss and the J wave was absent. The J wave appeared when the esophageal temperature was between 27 degrees and 24 degrees C (26.6 +/- 0.73 degrees C). At that temperature, the animals were hypotensive and bradycardic, but arterial oxygen partial pressure, carbon dioxide partial pressure, and pH were within the physiologic range at that temperature. The myocardial ATP and CP from the hypothermic dogs was lower compared with the value obtained from dogs at 37 degrees C (p < .025 and p < .005, respectively). The levels of the glycolytic intermediates, fructose-1,6-diphosphate, dihydroxyacetone phosphate, and pyruvate, were lower and the level of lactate was higher compared with those from the normothermic dogs (not significant; p < .007, p < .02, p < .001, respectively). These findings suggest that the appearance of the J wave on electrocardiography during cooling is a result of depression of the metabolic process concerned with maintenance of the partition of ions across the cell membrane, as evidenced by decreased myocardial energy content and K+ loss during the hypothermic state. | |||||
| Brát, R., Skorpil, J., Bárta, J., Suk, M. & Schichel, T. | Rewarming from severe accidental hypothermia with circulatory arrest. [Abstract] |
2004 | Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub Vol. 148(1), pp. 51-53 |
article | |
| Abstract: This case report demonstrates successful cardiopulmonary and cerebral resuscitation (CPCR) of a young male explored 15 hours following a suicide attempt (carbamazepine intoxication) in deep hypothermia (19 degrees C) with circulatory arrest. An extracorporeal circuit was used to rewarm the patient's blood. Weaning from extracorporeal circulation (ECC) was successful and without complications as was recovery from multiorgan dysfunction, severe rhabdomyolysis and carbamazepine intoxication. An excellent outcome was achieved without any neurological deficit at the time of discharge from the hospital. | |||||
| Bundesärztekammer | Mitteilungen. Aus der UAW-Datenbank Hypothermie als reversible Nebenwirkung der Valproinsäure. | 2003 | Dtsch Arztebl Ausg A Vol. 100(13), pp. A-871 |
article | URL |
| Abstract: Arzneimittelkommission der deutschen Ärzteschaft Aus der UAW- Datenbank Hypothermie als reversible Nebenwirkung der Valproinsäure Zu den Aufgaben der AkdÄ gehören die Erfassung, Dokumentation und Bewertung von unerwünschten Arzneimittelwirkungen (UAW). Die AkdÄ möchte Sie regelmäßig über aktuelle Themen aus der Arbeit ihres UAW-Ausschusses informieren und hofft, Ihnen damit wertvolle Hinweise für den Praxisalltag geben zu können. Valproinsäure ist Mittel der ersten Wahl zur Behandlung generalisierter und fokaler Epilepsien (1). Obwohl diese Substanz seit mehr als 30 Jahren in Europa zugelassen ist, wurde erst in den letzten Jahren über Fälle berichtet, bei denen die Körpertemperatur unter 35 °C fiel. Diese Hypothermie war nach Absetzen des Arzneimittels reversibel. Da das Auftreten einer Hypothermie in den Fachinformationen nicht aufgeführt wird, soll die Ärzteschaft über die vorliegenden Meldungen aus dem deutschen Spontanerfassungssystem für unerwünschte Arzneimittelwirkungen (gemeins... | |||||
| Burke, W.P. | A case report of warm weather accidental hypothermia. [Abstract] |
2004 | J Miss State Med Assoc Vol. 45(9), pp. 263-266 |
article | |
| Abstract: A case of hypothermia is presented as a reminder to "Deep South" physicians that our warm weather is not prophylaxis against this syndrome; and many common situations, diseases and medications contribute to and worsen the condition. Diagnosis is made by obtaining a true core body temperature and effective treatment modalities can be easily applied. With appropriate rewarming, a search for complications and monitoring of patient progress a gratifying outcome should result for both patient and physician. | |||||
| Cahill, C.J., Balmi, P.J. & Tipton, M.J. | An evaluation of hand immersion for rewarming individuals cooled by immersion in cold water. [Abstract] |
1995 | Aviat Space Environ Med Vol. 66(5), pp. 418-423 |
article | |
| Abstract: The hypothesis that hypothermic individuals can be actively rewarmed in the field by immersion of the extremities in hot water was investigated. Three techniques for rewarming subjects with lowered deep body temperatures were compared: a) whole body immersion to the neck in water at 40 degrees C; b) immersion of two hands plus forearms only in water at 42 degrees C; and c) passive rewarming. The suggestion that the fall in deep body temperature resulting from immersion to the neck in water at 15 degrees C could be arrested by immersing both arms in water at 42 degrees C was also investigated. Results indicated that immersion to the neck in hot water was clearly the most effective rewarming technique. No significant difference (p > 0.05) was observed in the deep body temperature response during passive rewarming or during immersion of both hands and forearms in water at 42 degrees C. In the later condition some increase in peripheral blood flow to the hands may have occurred and resulted in a heat input of approximately 12 W, but any benefit from this was negated by an associated significant decrease (p > 0.05) in intrinsic heat production. Immersing the arms in hot water during immersion to the neck in cold water appeared to accelerate rather than decelerate the rate of fall of deep body temperature. We concluded that hand rewarming, although theoretically attractive, is ineffective in practice and could be detrimental in some circumstances, by suppressing intrinsic heat production or precipitating rewarming collapse. | |||||
| Canivet, J.L., Larbuisson, R. & Lamy, M. | Interest of face mask--CPAP in one case of severe accidental hypothermia. [Abstract] |
1989 | Acta Anaesthesiol Belg Vol. 40(4), pp. 281-283 |
article | |
| Abstract: We report one case of severe accidental hypothermia; rectal temperature was 25 degrees C. Hypoxemia unmodified by 100 O2 inhalation in an ordinary face-mask was easily corrected using a face-mask CPAP; a ventilation-perfusion mismatching could be implicated in the cold induced hypoxemia. Active rewarming (1.5 degrees C/h) was pursued from 25 to 37 degrees C, using non aggressive methods: warming blankets and a Bennett heated humidifier inserted in the CPAP system. Even in severe hypothermia successful results may be obtained without resort to sophisticated methods. | |||||
| Caputa, M. & Cabanac, M. | Bradycardia during face cooling in man may be produced by selective brain cooling. [Abstract] |
1979 | J Appl Physiol Vol. 46(5), pp. 905-907 |
article | |
| Abstract: In human subjects, bradycardia was produced by immersing the subjects' faces in water at 15 degrees C when they were hyperthermic. When they were hypothermic, the same face cooling produced tachycardia. It is suggested that the difference in cardiac response originates in selective brain cooling during hyperthermia, by venous return from the face to the brain, via ophthalmic veins. | |||||
| Carden, D.L. & Novak, R.M. | Disseminated intravascular coagulation in hypothermia. | 1982 | JAMA Vol. 247(15), pp. 2099 |
article | |
| Carlson, C.J., Emilson, B. & Rapaport, E. | Creatine phosphokinase MB isoenzyme in hypothermia: case reports and experimental studies. [Abstract] |
1978 | Am Heart J Vol. 95(3), pp. 352-358 |
article | |
| Abstract: Six patients with severe medical disorders and profound hypothermia are presented who had elevated total serum creatine phosphokinase (CPK) and CPK-MB isoenzyme activity without clinical or postmortem evidence of acute myocardial infarction. Experiments in dogs indicate that hypothermia reduces total CPK activity in both striated and myocardial muscle resulting in increased serum enzyme activity. These data suggest that profound hypothermia may result in diffuse striated and cardiac muscle cellular injury without evidence of discrete infarction with consequent release of CPK-MB isoenzyme into serum. | |||||
| Carr, M.E. & Wolfert, A.I. | Rewarming by hemodialysis for hypothermia: failure of heparin to prevent DIC. [Abstract] |
1988 | J Emerg Med Vol. 6(4), pp. 277-280 |
article | |
| Abstract: Disseminated intravascular coagulation (DIC) is an infrequent but known complication of hypothermic injury. Previous work with a dog model had indicated that DIC could be prevented if the animals were treated with heparin prior to rewarming. We report here the case of a young man treated with core rewarming by hemodialysis who developed DIC despite the use of heparin during dialysis. | |||||
| Clayton, D.G., Webb, R.K., Ralston, A.C., Duthie, D. & Runciman, W.B. | A comparison of the performance of 20 pulse oximeters under conditions of poor perfusion. [Abstract] |
1991 | Anaesthesia Vol. 46(1), pp. 3-10 |
article | |
| Abstract: The performance of 20 pulse oximeters with finger probes was evaluated by comparison of their readings with directly measured arterial blood oxygen saturations. The samples were taken from patients who had undergone cardiac surgery under hypothermic cardiopulmonary bypass and had poor peripheral perfusion. The mean difference (bias, accuracy), standard deviation (precision) and drop-out rate for each pulse oximeter was determined. An overall ranking of performance of each pulse oximeter was calculated using five criteria (accuracy, precision, number of readings within 3% of standard, percentage of readings given within 3% of standard, expected overread limit in 95% of cases). Two pulse oximeters achieved a combination of accuracy and precision such that 95% of measurements would be expected to be within 4% of the co-oximeter value; these two also had the lowest drop-out rate. | |||||
| Cohen, D.J., Cline, J.R., Lepinski, S.M., Bowman, H.M. & Ireland, K. | Resuscitation of the hypothermic patient. [Abstract] |
1988 | Am J Emerg Med Vol. 6(5), pp. 475-478 |
article | |
| Abstract: A case of cardiac arrest following hypothermia due to cold-water immersion is presented. Following rescue and initiation of cardiopulmonary resuscitation, the patient was transported by helicopter to a facility where rewarming using cardiopulmonary bypass was possible. Initial rectal temperature in the emergency department was 28 degrees C. Initial prehospital rhythm was ventricular fibrillation persisting approximately 1.5 hours until the patient was successfully cardioverted after 25 minute of femoral artery/femoral venous partial cardiopulmonary bypass rewarming. Temperature at the time of cardioversion was 30 degrees C (esophageal). Despite extended cardiac arrest and profound metabolic acidosis (pH = 6.41 at 37 degrees C), he recovered uneventfully and is neurologically normal. A protocol for the management of a patient with hypothermic cardiac arrest is included. | |||||
| Cook, D.J., Orszulak, T.A., Daly, R.C. & Buda, D.A. | Cerebral hyperthermia during cardiopulmonary bypass in adults. [Abstract] |
1996 | J Thorac Cardiovasc Surg Vol. 111(1), pp. 268-269 |
article | |
| Abstract: [extract] Accepted for publication June 7, 1995 In this report, we document that cerebral hyperthermia occurs regularly during rewarming from hypothermic cardiopulmonary bypass (CPB). These high brain temperatures are not adequately reflected by nasopharyngeal (NP) temperature and may contribute to neurologic morbidity. Stroke and neurocognitive injury remain significant components of perioperative morbidity associated with cardiac surgery. Hypothermic CPB is used in part for its cerebral protective effects. Recent reports, however, have indicated that the rewarming phase of hypothermic CPB is associated with a significant incidence of decreased cerebral venous oxygen saturation (Sjvo2; <=50%).Go Go 1,2 Sjvo2 is thought to be ... | |||||
| Cooper, K.E. | The circulation in hypothermia. [Abstract] |
1961 | Br Med Bull Vol. 17, pp. 48-51 |
article | |
| Abstract: [extract] Work on the effects of artificially induced hypothermia on the circulation presents considerable difficulties, in that many factors which contribute to regulate the cardiovascular system are independently altered by changing temperatures. An observation on the result of body-cooling on any aspect of the circulation may present insuperable problems in analysis unless all the known mechanisms, which together play a part in the governing of that aspect, are simultaneously recorded. One can regard the behavior of a part of the circulation, whether it be the cardiac output or the muscle blood flow, as the algebraic sum of a considerable number ... | |||||
| Corneli, H.M. | Accidental hypothermia. | 1992 | J Pediatr Vol. 120(5), pp. 671-679 |
article | |
| Curtis, R. | Outdoor action guide to hypothermia and cold weather injuries. [Abstract] |
1995 | electronic | URL | |
| Abstract: Traveling in cold weather conditions can be life threatening. The information provided here is designed for educational use only and is not a substitute for specific training or experience. Princeton University and the author assume no liability for any individual's use of or reliance upon any material contained or referenced herein. Medical research on hypothermia and cold injuries is always changing knowledge and treatment. When going into cold conditions it is your responsibility to learn the latest information. The material contained in this workshop may not be the most current. | |||||
| Danzl, D. | Hypothermia. [Abstract] |
2002 | Semin Respir Crit Care Med Vol. 23(1), pp. 57-68 |
article | DOI |
| Abstract: Accidental hypothermia is defined as an unintentional decline in the core temperature below 35 degrees C. The population of patients at risk is very heterogeneous. Common thermal stressors include both primary exposures and secondary contributory diseases or injuries. As the core temperature progressively declines, the compensatory metabolic, adrenergic, and cardiovascular responses that attempt to maintain thermal homeostasis fail. At this juncture, therapeutic intervention must occur. An understanding of the pathophysiological variables impacting rewarming is critical. For example, the effects of cold on the coagulation system impact both the approach to cardiovascular resuscitation and the choice of rewarming technique. There are no randomized controlled trials that definitively establish the ideal rewarming strategy for each unique presentation. The resuscitative goal is to match the clinical presentation with the threshold temperatures at which various rewarming modalities and pharmacological interventions should occur. Identification of the indications for both noninvasive and invasive active rewarming techniques in patients requiring critical care is key. Poikilothermia, failure to rewarm, endocrinologic insufficiency, cardiovascular instability, traumatic or toxicological induced peripheral vasodilation, or the presence of major predisposing factors mandates active rewarming. The simultaneous or sequential use of the various rewarming techniques permits a versatile approach to therapy. Outcome remains problematic to predict because there may never be a validated prognostic neurological scale. The history, physical examination, and, ironically, the vital signs are routinely misleading. A tachycardia that is not proportionate to the degree of hypothermia suggests hypovolemia, hypoglycemia, or the presence of toxins. Given the decreased carbon dioxide production, persistent hyperventilation implies an underlying organic acidosis or central nervous system abnormality. Finally, toxic or traumatic or infectious impairment of the central nervous system may be obscured by hypothermia. | |||||
| Danzl, D.F., Hedges, J.R. & Pozos, R.S. | Hypothermia outcome score: development and implications. [Abstract] |
1989 | Crit Care Med Vol. 17(3), pp. 227-231 |
article | |
| Abstract: Multiple rewarming methods have been recommended for the treatment of hypothermia in the ED. Because the hypothermic patient population is heterogenous, a method for stratifying mortality risk when comparing therapies is desired. We used univariable and multivariable statistical analyses to identify variables which discriminated between patient death or survival in the 24 h after arrival in the ED. Prehospital cardiac arrest, a low or absent presenting BP, elevated BUN, and the need for either tracheal intubation or NG tube placement in the ED were found to be significant predictors of patient demise in a large database (n = 428). The likelihood ratio was used to develop and validate an empiric hypothermia outcome score that can be used in future hypothermia treatment studies to account for differences of patient presentation. | |||||
| Danzl, D.F. & Pozos, R.S. | Accidental hypothermia. [Abstract] |
1994 | N. Engl. J. Med. Vol. 331(26), pp. 1756-1760 |
article | |
| Abstract: [extract] Accidental hypothermia is defined as an unintentional decline in the core temperature below 35 °C. At this temperature, the coordinated systems responsible for thermoregulation begin to fail, since the compensatory physiologic responses to minimize heat loss through radiation, conduction, convection, respiration, and evaporation are very limited.1,2,3,4 In this article, we shall present an overview of the pertinent pathophysiology and guidelines for resuscitation and rewarming. Nuclei in the preoptic anterior hypothalamus coordinate heat conservation. Activation of these thermostats and the cutaneous cold receptors initiates a cascade of compensatory physiologic events (Table 1). After the initial stimulus, there is progressive ... | |||||
| Danzl, D.F., Pozos, R.S., Auerbach, P.S., Glazer, S., Goetz, W., Johnson, E., Jui, J., Lilja, P., Marx, J.A. & Miller, J. | Multicenter hypothermia survey. [Abstract] |
1987 | Ann Emerg Med Vol. 16(9), pp. 1042-1055 |
article | |
| Abstract: A multicenter survey evaluated the clinical presentation, treatment, and outcome of accidental hypothermia. Data were collected from 13 emergency departments, with 401 of the 428 cases presenting during a two-year study period. Core temperatures ranged from 35 C to 15.6 C (mean, 30.57 C +/- 3.53) with 272 cases (63.6 less than or equal to 32.2 C. There were no significant differences by age in presenting temperature, rewarming strategies, or mortality. The first hour rewarming rate was significantly (P less than .05) faster in the population less than or equal to 59 years (1.08 +/- 1.39 C/hr) than in those greater than or equal to 60 years (0.75 +/- 1.16 C/hr). Male core temperatures averaged 30.27 +/- 3.44 C versus female temperatures of 31.1 +/- 3.61 C. There were no clinically significant differences in male (N = 296) versus female (N = 132) profiles. High ethanol levels (315 to 800 mg did not affect outcome. Nine of 27 (33 patients who received CPR initiated in the field survived, versus six of 14 (43 with CPR begun in the ED. The profile of the CPR versus non-CPR population differed significantly (P less than .05) in location (outdoors), initial temperature (24.8 +/- 3.77 C vs 30.94 +/- 3.12 C), third-hour rewarming rate (2.28 +/- 1.53 C vs 1.17 +/- 1.18 C/hr), and numerous laboratory parameters. Tracheal intubation was performed without incident in 117 cases, of which 97 were less than or equal to 32.2 C. There were 73 fatalities (17.1. Of these, 84.9% (N = 62) were less than or equal to 32.2 C. Predisposing conditions in this group included "serious" illness (30), systemic infection (28), trauma (15), immersion (ten), frostbite (seven), and overdose (two). The initial pulse, hemoglobin, and first-hour rewarming rate was lower in the deceased population, while the potassium, urea nitrogen, creatinine, and phosphorus were elevated. Excluding treatment combinations, outcome with exclusive use of a single rewarming strategy was passive external rewarming, 14 deaths below 32.2 C, 13 above; active external rewarming, six deaths below 32.2 C, two above; active core rewarming, 38 deaths below 32.2 C, none above. Refinements of the American Heart Association's CPR standards in hypothermia and a Hypothermia Survival Index are proposed. | |||||
| Datta, A. & Tipton, M. | Respiratory responses to cold water immersion: neural pathways, interactions, and clinical consequences awake and asleep. [Abstract] |
2006 | J Appl Physiol Vol. 100(6), pp. 2057-2064 |
article | DOI |
| Abstract: The ventilatory responses to immersion and changes in temperature are reviewed. A fall in skin temperature elicits a powerful cardiorespiratory response, termed "cold shock," comprising an initial gasp, hypertension, and hyperventilation despite a profound hypocapnia. The physiology and neural pathways of this are examined with data from original studies. The respiratory responses to skin cooling override both conscious and other autonomic respiratory controls and may act as a precursor to drowning. There is emerging evidence that the combination of the reestablishment of respiratory rhythm following apnea, hypoxemia, and coincident sympathetic nervous and cyclic vagal stimulation appears to be an arrhythmogenic trigger. The potential clinical implications of this during wakefulness and sleep are discussed in relation to sudden death during immersion, underwater birth, and sleep apnea. A drop in deep body temperature leads to a slowing of respiration, which is more profound than the reduced metabolic demand seen with hypothermia, leading to hypercapnia and hypoxia. The control of respiration is abnormal during hypothermia, and correction of the hypoxia by inhalation of oxygen may lead to a further depression of ventilation and even respiratory arrest. The immediate care of patients with hypothermia needs to take these factors into account to maximize the chances of a favorable outcome for the rescued casualty. | |||||
| Davies, D.M., Millar, E.J. & Miller, I.A. | Accidental hypothermia treated by extracorporeal blood warming. | 1967 | Lancet Vol. 1(7498), pp. 1036-1037 |
article | |
| Deakin, C.D. | Forced air surface rewarming in patients with severe accidental hypothermia. | 2000 | Resuscitation Vol. 43(3), pp. 223 |
article | |
| Dean, N.C. | Hypothermia. Lifesaving procedures. [Abstract] |
1987 | Postgrad Med Vol. 82(8), pp. 48-51, 55-8 |
article | |
| Abstract: Hypothermia is a preventable disorder that is being seen with increasing frequency in the United States. Awareness of the process decreases the likelihood of development and also the possibility that its presence will go undetected. Severe hypothermia is a medical emergency, but the patient often recovers fully with careful, aggressive treatment that includes active core rewarming when necessary. | |||||
| Dehn, J., Christensen, A.J. & Schønemann, N.K. | [Treatment of severe, accidental hypothermia with a warm air bed] [Abstract] |
2000 | Ugeskr Laeger Vol. 162(36), pp. 4817-4818 |
article | |
| Abstract: Patients suffering from severe accidental hypothermia are by many authors recommended to be rewarmed by extra-corporal circulation. Some authors argue in favour of other approaches in treatment of severe hypothermia, as long as the patient has a sufficient circulation. One of these is rewarming using forced air warming. We rewarmed a patient with severe hypothermia using forced air warming. The patient arrived with a core temperature of 25.9 degrees C and had sufficient circulation despite of atrial fibrillation. The patient was rewarmed to a core temperature of 36.1 degrees C over seven hours. No other arrhythmias or complications were observed. | |||||
| Deiml, R. & Hess, W. | [Successful therapy of a cardiac arrest during accidental hypothermia using extracorporeal circulation] [Abstract] |
1992 | Anaesthesist Vol. 41(2), pp. 93-98 |
article | |
| Abstract: We report the case of a 59-year-old woman suffering from profound accidental hypothermia promoted by intoxication with codeine, sedatives, and a beta-blocking agent ingested in a suicidal attempt. Treatment was further complicated by ventricular fibrillation and asystole that was refractory to therapeutic interventions. The comatose patient (Glasgow score 3) was found outdoors in rainy weather--environmental temperature approximately 10 degrees C (50 degrees F)--by children. The skin was rosy when the emergency team arrived. The respiratory rate was low and the ECG showed sinus rhythm with a heart rate of 28/min. No arterial pulsations were detectable, even at the carotid and femoral sites. Because catecholamine therapy failed to increase the heart rate, the patient was suspected to be profoundly hypothermic. After confirming core hypothermia with a rectal temperature of 25 degrees C (77 degrees F) at the initial receiving hospital, transfer to an institution with cardiac surgery facilities was initiated. During this transport and after arrival, ventricular fibrillation occurred at decreasing intervals followed by asystole, which was refractory to large doses of epinephrine. The patient was transferred to the operating room under continuous resuscitation maneuvers and cardiopulmonary bypass was instituted via the femoral vessels. After 110 min of extracorporeal circulation (ECC, flow 4.5 l/min) normothermia was achieved and the asystole reverted spontaneously to sinus rhythm. The patient's course was subsequently complicated by worsening pulmonary gas exchange with signs of pulmonary edema on X-ray films and cardiac failure, which was treated successfully with epinephrine and dopamine. No neurological deficits were detectable after consciousness had returned.(ABSTRACT TRUNCATED AT 250 WORDS) | |||||
| DeLapp, T.D. | Accidental hypothermia. | 1983 | Am J Nurs Vol. 83(1), pp. 62-67 |
article | |
| Demaria, R., Frapier, J.M., Valat, J., Albat, B., Aymard, T., Geoffroy, N., Godard, C., Bodino, M., Rouvière, P. & Chaptal, P.A. | [Extracorporeal circulation for warming in severe accidental hypothermia. 3 cases] [Abstract] |
1998 | Presse Med Vol. 27(14), pp. 664-666 |
article | |
| Abstract: BACKGROUND: Severe accidental hypothermia with central temperature below 28 degrees C can result from prolonged cold exposure and lead to a fatal outcome by spontaneous or provoked ventricular fibrillation. CASE REPORT: Three patients were referred for central temperature below 24 degrees C. At admission, the patients had major ventricular rythm disorders (two were in a state of circulatory arrest and the third had auricular fibrillation and circulatory collapse). Emergency care associated internal warning using extracorporeal circulation via the femoro-femoral route with a centrifuge pump. Outcome was favorable in 2 cases. DISCUSSION: Prognosis is very poor in patients who experience severe accidental hypothermia (< 28 degrees C) with circulatory collapse. Death often results from major rhythm disorders. Optimal emergency rewarming and oxygenation using extracorporeal circulatory assistance can be successful. | |||||
| Dexter, W.W. | Hypothermia. Safe and efficient methods of rewarming the patient. [Abstract] |
1990 | Postgrad Med Vol. 88(8), pp. 55-8, 61-4 |
article | |
| Abstract: Hypothermia, a relatively common problem in the winter months, can cause significant morbidity. It presents in a variety of situations and affects a wide age range. Diagnosis requires a high index of suspicion, because the symptoms, which are primarily related to the central nervous system, are not distinctive. Appropriate management requires accurate measurement of core body temperature. Treatment is centered on rewarming the patient safely and efficiently while providing other supportive measures. Care should be taken to avoid arrhythmias. Simple precautions greatly reduce the risk of hypothermia. | |||||
| centers for Disease Control & (CDC), P. | Hypothermia-related deaths--United States, 1999-2002 and 2005. [Abstract] |
2006 | MMWR Morb Mortal Wkly Rep Vol. 55(10), pp. 282-284 |
article | |
| Abstract: Hypothermia, defined as a core body temperature of <95 degrees F (<35 degrees C), is preventable. Excessive exposure to cold temperatures leads to potentially fatal central nervous system depression, arrhythmias, and renal failure. Advanced age, chronic medical conditions, substance abuse, and homelessness are among risk factors for hypothermia-related death. This report describes three hypothermia-related deaths that occurred during 2005 and reviews CDC data on hypothermia-related deaths during 1999-2002 in the United States. Public health strategies should target U.S. populations at increased risk for exposure to excessive cold and recommend behavior modification (e.g., dressing warmly, modifying activity levels, or avoiding alcohol) to help reduce mortality and morbidity from hypothermia. | |||||
| centers for Disease Control & (CDC), P. | Hypothermia-related deaths--Georgia, January 1996-December 1997, and United States, 1979-1995. [Abstract] |
1998 | MMWR Morb Mortal Wkly Rep Vol. 47(48), pp. 1037-1040 |
article | |
| Abstract: Although hypothermia-related deaths are prevalent during the winter in states that have moderately cold (e.g., Illinois, New York, and Pennsylvania) to severely cold (e.g., Alaska and North Dakota) winters and in states with mountainous or desert terrain (e.g., Arizona, Montana, and New Mexico), hypothermia-related deaths also occur in states with milder climates (e.g., Georgia, Mississippi, and South Carolina), where weather systems can cause rapid changes in temperature. This report summarizes three hypothermia-related deaths in Fulton County, Georgia, representing persons in the highest risk groups for hypothermia; and summarizes hypothermia-related deaths in Georgia during January 1996-December 1997 and in the United States during 1979-1995. | |||||
| Douwens, R. | A survey on inhalation rewarming and hypothermia treatment. [Abstract] |
1995 | electronic | URL | |
| Abstract: [extract] It has been stated that there is no longer any excuse for hypothermia deaths; both the knowledge and technology needed to cope with hypothermia exist - it is now a matter of preparedness and application. A reduction in the number of preventable hypothermia-related deaths depends on both treatment and prevention strategies. Better treatment techniques increase the likelihood of resuscitation once the victim is rescued. This suggests that education, prevention and treatment are equally important. It is estimated that 800 recreational boaters, commercial fisherman and merchant mariners die each year in the United States as a result of cold water immersion ... | |||||
| Douwens, R. | Hypothermia and rescue in the field situation. [Abstract] |
1995 | electronic | URL | |
| Abstract: [extract] A reduction in the number of preventable hypothermia-related deaths depends on both treatment and prevention strategies. Better treatment techniques increase the likelihood of resuscitation once the victim is rescued. This suggests that education, prevention and treatment are equally important. Both the knowledge and technology needed to cope with hypothermia exist it is now a matter of preparedness and application. A sampling revealed that the present method of pre-hospital care is to wrapping the cold victim in a blanket. This merely provides insulation, which works well for warm people, but has no benefit to a hypothermic patient as pre-hospital care ... | |||||
| Douwens, R. | Hypothermia recognition and treatment. [Abstract] |
1995 | electronic | URL | |
| Abstract: [extract] The fundamental questions are simple: 1. If effective treatment technology had been available, would an individual have survived ? 2. Are a significant number of people dying because attending personnel are not knowledgeable, or not equipped with current technology? 3. If a hypothermic victim is alive when rescued but dies during recovery, and there is no other significant trauma or disease, does this suggest that death may have resulted from either: i) inappropriate or ineffective treatment, or ii) no treatment at all ? Although no accurate statistics are available, one cannot fail to be concerned by the mortality rate in ... | |||||
| Drenck, N.E. & von Staffeldt, H. | Repeated deep accidental hypothermia. A comparison of active or passive treatment in one patient. [Abstract] |
1986 | Anaesthesia Vol. 41(7), pp. 731-733 |
article | |
| Abstract: Deep accidental hypothermia after self-poisoning with drugs occurred twice in the same patient within 25 days. Initial rectal temperatures were 22.0 degrees C and 23.3 degrees C, respectively; the clinical conditions were otherwise identical. In the first instance, active rewarming by means of peritoneal irrigation was performed, while spontaneous rewarming was allowed on the second occasion. Normothermia was attained within 24 hours in both cases, and the patient was discharged in her habitual state of well-being. The course of these nearly identical cases illustrates the possibility of a passive treatment for deep hypothermia. | |||||
| Ducharme, M.B., Kenny, G.P., Johnston, C.E., Nicolaou, G., Bristow, G.K. & Giesbrecht, G.G. | Efficacy of forced-air and inhalation rewarming in humans during mild (Tco=33.9 dregress celsius) hypothermia. [PDF] |
1996 | Environmental Ergonomics: recent progress and new frontiers (ICEE: 7th : 1996)., pp. 147-150 | incollection | |
| Duguid, H., Simpson, R.G. & Stowers, J.M. | Accidental hypothermia. | 1961 | Lancet Vol. 2(7214), pp. 1213-1219 |
article | |
| Earp, J.K. & Finlayson, D.C. | Relationship between urinary bladder and pulmonary artery temperatures: a preliminary study. [Abstract] |
1991 | Heart Lung Vol. 20(3), pp. 265-270 |
article | |
| Abstract: "Core" temperature and the proper methods for its assessment and management in cardiac surgical patients with hypothermia continues to be a concern for physicians and nurses. In this study we investigated the relationship between pulmonary artery and urinary bladder temperatures over a 6-hour period during rewarming in 14 (adult) patients in the intensive care unit after cardiopulmonary bypass. Bladder temperatures were 0.1 degree C to 0.2 degree C higher than pulmonary artery temperature with correlation coefficients of 0.94 to 0.99. This relationship continued for most of this period with significant mean differences clustering in the early and late period after admission. The significance of these small differences of temperatures and why the two temperatures reversed at certain time periods needs further investigation because the normal thermal gradients may be altered by the hypermetabolic activities consequent to shivering or iatrogenic overheating. | |||||
| ECC Committee, S. & of the American Heart Association, T.F. | 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. [Abstract] |
2005 | Circulation Vol. 112(24 Suppl), pp. IV1-203 |
article | DOI |
| Abstract: [extract] Introduction. This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23–30, 2005. These guidelines supersede the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. As with all versions of the ECC guidelines published since 1974, the 2005 AHA Guidelines for CPR and ECC contain recommendations designed to improve survival from sudden cardiac arrest ... | |||||
| Eckart, W.U. & Vondra, H. | Disregard for Human Life: hypothermia experiments in the Dachau Concentration camp. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 19-31 | incollection | |
| Ehrlich, E. | Wischnewsky's spots. A new sign of death from hypothermia. A preliminary report by the district medical officer, S. M. Wischnewski, administrative district of Tscheboksary, Russia. (translated text of the original russian article from 1885). | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 205-210 | incollection | |
| Elixson, E.M. | Hypothermia. Cold-water drowning. [Abstract] |
1991 | Crit Care Nurs Clin North Am Vol. 3(2), pp. 287-292 |
article | |
| Abstract: Cold-water submersion results in rapidly induced hypothermia. The body's physiologic response to this insult is, in some ways, similar to that of controlled hypothermia employed in the hospital setting, with the time sequencing being greatly enhanced. The application of hypothermic techniques employed with extracorporeal heat exchange on cardiopulmonary bypass to those of cold-water submersion requires careful differentiation, especially during rewarming phases. Conversely, protecting the brain from hypoxic injury (and thus a favorable neurologic recovery) following cold-water submersion can be favorably modified by the co-existence of hypothermia. The protective effects of safe usage of hypothermic without neurologic damage is multifaceted and influenced by age, time, temperature and intracellular pH, metabolic rate, biochemical changes, high-energy storage depots, as well as institution of rewarming techniques. Criteria for brain death established by the President's commission does not apply to the hypothermic patient. According to colleagues, rewarming to between 30 and 34 degrees C is essential before discontinuing resuscitative measures because of the multifactoral influences that the hypothermic state entails. A child who appears asystolic, apneic, and with absence of central nervous system activity after cold-water submersion, requiring intensive resuscitative efforts, may have a favorable outcome. This does not absolutely suggest a devastating outcome as we have seen in those children "frozen alive," who are hypothermic but have been effectively resuscitated, rehabilitated, and allowed to return to normal life activities. Although combined intensive and rehabilitative efforts of the medical team are essential in the care of these children, foremost in our minds should be prevention of these accidents. | |||||
| Farstad, M., Andersen, K.S., Koller, M.E., Grong, K., Segadal, L. & Husby, P. | Rewarming from accidental hypothermia by extracorporeal circulation. A retrospective study. [Abstract] |
2001 | Eur J Cardiothorac Surg Vol. 20(1), pp. 58-64 |
article | |
| Abstract: OBJECTIVE: Twenty-six patients with accidental hypothermia combined with circulatory arrest or severe circulatory failure were rewarmed to normothermia by use of extracorporeal circulation (ECC). The aim of the present study was to evaluate our results. PATIENTS AND METHODS: The treatment of six female and 20 male patients (median age: 26.7 years; range 1.9--76.3 years) rewarmed in the period 1987--2000 was evaluated retrospectively. Hypothermia was related to immersion/submersion in cold water (n=17), avalanche (n=1) or prolonged exposure to cold surroundings (n=8). Prior to admission, the trachea was intubated and cardiopulmonary resuscitation (CPR) initiated in all patients with cardiorespiratory arrest (n=22), whereas in those with respiration/circulation (n=4) only oxygen therapy via a face mask was given. RESULTS: Nineteen of the 26 patients were weaned off ECC whereas seven died because of refractory respiratory and/or cardiac failure. Eight of the 19 successfully weaned patients were discharged from hospital after a median of 10 days. One patient died 3 days after circulatory arrest (complete atrioventricular block) resulting in severe cerebral injury. The remaining ten patients died following 1--2 days due to severe hypoxic brain injury (n=5), cerebral bleeding (n=1) or irreversible cardiopulmonary insufficiency (n=4). Based on the reports from the site of accident, two groups of patients were identified: the asphyxia group (n=15) (submersions (n=14); avalanche accident (n=1)) and the non-asphyxia group (n=11) (patients immersed or exposed to cold environment). Seven intact survivors discharged from hospital belonged to the non-asphyxia group whereas one with a severe neurological deficit was identified within the asphyxia group. CONCLUSION: Patients with non-asphyxiated deep accidental hypothermia have a reasonable prognosis and should be rewarmed before further therapeutic decisions are made. In contrast, drowned patients with secondary hypothermia have a very poor prognosis. The treatment protocol under such conditions should be the subject for further discussion. | |||||
| Feng, Y. & LeBlanc, M.H. | Drug-induced hypothermia begun 5 minutes after injury with a poly(adenosine 5'-diphosphate-ribose) polymerase inhibitor reduces hypoxic brain injury in rat pups. [Abstract] |
2002 | Crit Care Med Vol. 30(11), pp. 2420-2424 |
article | DOI |
| Abstract: OBJECTIVE: Poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors have shown promise in hypoxic ischemic brain damage. We wished to see if GPI-6150 (1,11b-dihydro-[2H]benzopyrano[4,3,2-de]isoquinolin-3-one), a specific PARP inhibitor, would reduce brain injury in a newborn animal model. DESIGN: Randomized controlled trial. SETTING: University laboratory. SUBJECTS: Seven-day-old rat pups. INTERVENTION: Subjects had the right carotid artery ligated and then received either vehicle or 5, 15, or 30 mg/kg GPI-6150 intraperitoneally 5 mins after the hypoxia. Hypoxia was produced by exposing the pups to 8% oxygen for 2.5 hrs. MEASUREMENTS AND MAIN RESULTS: Twenty-two days later, the brains were scored from normal to severely damaged and were weighed by a blinded observer. Twenty-four of 53 (45 vehicle-treated pups, 11 of 22 (50 5 mg/kg treated pups, 22 of 23 (96 15 mg/kg treated pups (p <.01 vs. vehicle), and 16 of 31 (52 30 mg/kg treated pups were scored as normal. Right hemisphere weight was reduced by 15 +/- 2.6% in the vehicle group, 5.9 +/- 2.8% in the 5 mg/kg group, -0.4 +/- 1.7% in the 15 mg/kg group (p <.01 vs. vehicle), and 13.3 +/- 3.1% in the 30 mg/kg group. GPI-6150 decreased rectal temperature from 33 +/- 0.4 to 29 +/- 0.7 degrees C for 3 hrs after dosing, but temperatures returned to normal by 6 hrs. We maintained the body temperature at 35 degrees C for 6 hrs after injury in a group of pups treated with 15 mg/kg. Nine of 25 (41 vehicle-treated and 15 of 26 (58 GPI-6150-treated pups were scored as normal (p = nonsignificant). Right hemisphere weight was reduced by 25 +/- 4% in the vehicle group and 20 +/- 5% in the GPI-6150 group (p = nonsignificant). CONCLUSIONS: GPI-6150 at a dose of 15 mg/kg dramatically decreased the number of pups sustaining brain injury, relative to vehicle, but is dependent on an induced decrease in core temperature to produce the effect. | |||||
| Ferguson, J., Epstein, F. & van de Leuv, J. | Accidental hypothermia. [Abstract] |
1983 | Emerg Med Clin North Am Vol. 1(3), pp. 619-637 |
article | |
| Abstract: The diagnosis of hypothermia rests solely upon a measured core temperature of 35 degrees C or less; a special thermometer calibrated to record low temperatures should be used whenever hypothermia is suspected. Hospital management of the hypothermic patient consists of definitive rewarming therapy. | |||||
| Ferraro, F.J., Spillert, C.R., Swan, K.G. & Lazaro, E.J. | Cold-induced hypercoagulability in vitro: a trauma connection? [Abstract] |
1992 | Am Surg Vol. 58(6), pp. 355-357 |
article | |
| Abstract: Injury severity score and hypothermia can lead to a high level of mortality when combined clinically. In acute trauma, the presence of a coagulopathy is difficult to treat and the aim is prevention. Aliquots of whole blood from healthy human volunteers (n = 9) were added to saline (control) and saline plus endotoxin (activated). The control and activated groups were divided and subjected to 60 minutes of normothermia (24 degrees C) or hypothermia (0 degrees C). The samples were returned to 37 degrees C; then the recalcification times were determined using fibrin formation and the viscous drag as the determining factors. The activated hypothermic group showed a decreased recalcification time of 345 (+/- 48.9) seconds compared to 405 (+/- 60.8) for the activated normothermic group (P less than 0.001). When the normothermic and hypothermic groups were compared without endotoxin added, the differences were not significant. The authors conclude that the effects of endotoxin on clotting time are worsened by hypothermia in vitro and act synergistically to possibly cause the coagulopathy seen in trauma patients. | |||||
| Fitzgerald, F.T. & Jessop, C. | Accidental hypothermia: a report of 22 cases and review of the literature. [Abstract] |
1982 | Adv Intern Med Vol. 27, pp. 128-150 |
article | |
| Abstract: Most of our 22 patients with hypothermia were alcoholics, with a variety of serious complications of their disease. The prevalence of hypoglycemia (41, sepsis (41, and pulmonary complications (36 was surprisingly high in this group of hypothermia victims, and the death rate (36 relatively low. All patients in our series were passively rewarmed and given conservative drug and fluid management under close monitor. | |||||
| Forester, D. | Myoglobinuria and rhabdomyolysis. | 1979 | Am Heart J Vol. 97(6), pp. 814 |
article | |
| Fox, J.B., Thomas, F., Clemmer, T.P. & Grossman, M. | A retrospective analysis of air-evacuated hypothermia patients. [Abstract] |
1988 | Aviat Space Environ Med Vol. 59(11 Pt 1), pp. 1070-1075 |
article | |
| Abstract: This study reviews the outcome of 17 hypothermic patients air evacuated by a civilian helicopter transport service. Age (33 +/- 23), type and duration of exposure, and rewarm methods were examined for each patient. Temperature (T), heart rate (HR), blood pressure (BP), respiratory rate (RR), Glasgow coma score (GCS), trauma score (TS), CRAMS score (CS), and cardiac rhythm in the pre-hospital setting and in the emergency department (ED) were compared to outcome. Eight of the patients had extensive exposure to a cold environment ranging from 4 h to 10 d. The remaining 9 patients were exposed to cold water ranging from 15 min to 4.5 h. By severity of hypothermia as measured in the ED, 6 patients who were hypothermic at the scene were normothermic (t greater than 35 degrees C), 5 patients were classified as mild (t = 35-31.5 degrees C), 3 as moderate (T less than 31.5-25.5 degrees C), and 3 patients were severely hypothermic (T less than 25.5 degrees C). The GCS, TS, and CS were not indicative of outcome. During rewarming, 3 patients had paradoxical temperature drops, and 5 patients had atrial fibrillation. Three patients required cardiopulmonary resuscitation in the field. Two were discharged with resolving disabilities, and 1 expired. No ventricular fibrillation or J waves occurred. All patients were effectively rewarmed without incident. All patient disabilities and the single fatality were not directly related to hypothermia. There were no long-term adverse consequences of helicopter transport in these hypothermic patients. | |||||
| Fox, W.C., Hall, C., Hall, E., Kolkhorst, F. & Lockette, W. | Cardiovascular baroreceptors mediate susceptibility to hypothermia. [Abstract] |
2003 | Aviat Space Environ Med Vol. 74(2), pp. 132-137 |
article | |
| Abstract: BACKGROUND: The maintenance of excessively high peripheral blood flow through dilated blood vessels during immersion in cold water could explain some individuals' predisposition to hypothermia. We hypothesized that interpersonal differences in vascular reactivity could account for contrasting susceptibility to hypothermia. METHOD: Twenty-two highly fit, volume replete subjects undergoing Navy SEAL training were recruited for this study. Vascular reactivity in these trainees was determined in a thermal-neutral environment by measuring changes in forearm blood flow (FBF) while decreasing their BP with the application of lower body negative pressure (LBNP). FBF was also measured during exposure of these subjects to ice cold water. BP, heart rate, stroke volume, and skin temperatures were also recorded. RESULTS: Changes in FBF induced by a fall in BP correlated with an individual's reduction in FBF caused by ice water immersion (n = 17, r = 0.84, p < 0.001). A subject's decrement in BP induced with LBNP correlated inversely with the fall in skin temperature in response to cold water immersion (n = 19, r = 0.70, p < 0.001). Finally, we found that sodium excretion also correlated with cold-induced decrements in peripheral blood flow (n = 7, r = 0.83, p < 0.05). CONCLUSIONS: It is suggested that contrasting cardiovascular baroreceptor sensitivity and vascular responsiveness contribute to individual differences in susceptibility to hypothermia. Furthermore, the trend toward dietary salt restrictions may not be salutary in the Navy SEAL who must frequently operate in cold ambient environments. | |||||
| Fraipont, V., Finianos, L., Albert, F. & D'Orio, V. | [Clinical case of the month. A case of accidental hypothermia] | 1997 | Rev Med Liege Vol. 52(10), pp. 625-630 |
article | |
| Francke, A. & Köpcke, J. | [Accidental hypothermia--a challenge for rescue service and intensive care] [Abstract] |
2002 | Anaesthesiol Reanim Vol. 27(1), pp. 9-15 |
article | |
| Abstract: Accidental hypothermia is a rare clinical picture with different causes. Specific features are shown by patients who have accidents in water, due to rapid cooling. The SARRRAH project (Search and Rescue, Resuscitation and Rewarming in Accidental Hypothermia) was launched to secure fast and professional medical care right up to rewarming by extracorporal circulation. The University of Rostock takes part in this project. Based on the course of accidental hypothermia in fifteen patients, the authors report on the treatment of this life-threatening situation with special regard to the use of extracorporal circulation and present their first results. The core temperature of these patients lay between 16.0 and 34.0 degrees C. Eight of the patients had cardiac arrest at the scene of the accident. Seven of the patients with cardiac arrest were treated with extracorporal circulation in addition to cardiopulmonary resuscitation, which was started pre-clinically and continued in hospital. In one patient, extracorporal circulation was used at an initial temperature of 25.4 degrees C without previous cardiopulmonary resuscitation. Six of these fifteen patients with accidental hypothermia died. Five of the non-survivors belonged to the group of eight patients who were rewarmed by extracorporal circulation. With one exception, they also had the lowest core temperatures. Only a homogeneous and up-to-date documentation will allow further conclusions to be made for improving the concept of therapy. | |||||
| Friberg, H. & Rundgren, M. | Submersion, accidental hypothermia and cardiac arrest, mechanical chest compressions as a bridge to final treatment: a case report. [Abstract] |
2009 | Scand J Trauma Resusc Emerg Med Vol. 17(1), pp. 7 |
article | DOI |
| Abstract: Three young men were trapped in a car at the bottom of a canal at two meters depth, after losing control of their vehicle. They were brought up by rescue divers and found in cardiac arrest. One of three patients had return of spontaneous circulation (ROSC), at 47 min after the accident. This sole survivor had the longest submersion time of the three and he received continued mechanical chest compressions during transportation to the hospital. His temperature at admission was 26.9 degrees C, he was rewarmed to 33 degrees C and kept there for 24 h, followed by continued rewarming to normothermia. On day three, he woke up from coma and was discharged from the intensive care unit after one week. At follow-up six months later, he had a complete cerebral recovery but still had myoclonic twitches in the lower extremities. A mechanical device facilitates chest compressions during transportation and may be beneficial as a bridge to final treatment in the hospital. We recommend that comatose patients after submersion, accidental hypothermia and cardiac arrest are treated with mild hypothermia for 12-24 h. | |||||
| Fritz, K.W., Kasperczyk, W. & Galaske, R. | [Successful resuscitation in accidental hypothermia following drowning] [Abstract] |
1988 | Anaesthesist Vol. 37(5), pp. 331-334 |
article | |
| Abstract: After breaking through thin ice, a 4-year-old boy drowned in a lake. A quickly alerted rescue helicopter found and recovered the child, drifting underneath the clear, thin ice. Primary resuscitation by the helicopter crew was unsuccessful. Upon arrival in the hospital the child had fixed, dilated pupils and asystole. Core temperature was 19.8 degrees C. Rewarming was conducted slowly while cardiopulmonary resuscitation was continued. Twenty minutes after arrival at the hospital, ventricular complexes appeared in the ECG (temperature 22.1 degrees C); after another 10 min this converted to sinus rhythm. At short intervals, blood gas analyses and electrolyte determinations were carried out and corrected adequately. For cerebral protection methohexital was given and the child was hyperventilated. Seventy minutes after arrival at the hospital the child was brought to the pediatric ICU with stable circulation. There, further rewarming (centrally/peripherally combined) was carried out, aiming at 1 degree C rewarming per hour until a normal temperature was reached. The patient had to be kept on the ventilator for 10 days and after another 2 weeks was discharged home. He had recovered completely without any cerebral damage. One of the reasons why 88 min of cardiac arrest were tolerated by this patient without sequelae may have been rapid and deep hypothermia. | |||||
| Frohlich, M.L. | Resuscitation of hypothermia victims. | 1985 | N Z Med J Vol. 98(788), pp. 867 |
article | |
| Fruehan, A.E. | Accidental hypothermia. Report of eight cases of subnormal body temperature due to exposure. | 1960 | Arch Intern Med Vol. 106, pp. 218-229 |
article | |
| Gardiner, J. & Halliday, A. | Resuscitation in special circumstances. [Abstract] |
1994 | Nurs Times Vol. 90(20), pp. 35-37 |
article | |
| Abstract: Basic and Advanced Life Support Guidelines should be followed as normal in cardiorespiratory arrest where there are 'special circumstances' such as near drowning, hypothermia, electrocution, poisoning, anaphylaxis and pregnancy. In order to increase the chances of a successful outcome there are specific considerations and actions that need to be taken. These will be discussed in this paper, the fifth in our resuscitation series. | |||||
| Gentilello, L.M., Cobean, R.A., Offner, P.J., Soderberg, R.W. & Jurkovich, G.J. | Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill patients. [Abstract] |
1992 | J Trauma Vol. 32(3), pp. 316-25; discussion 325-7 |
article | |
| Abstract: Hypothermia in critically ill patients can be difficult to treat with standard rewarming (SR) techniques. We developed a rewarming method that is significantly faster than SR. Percutaneously placed femoral arterial and venous catheters were connected to the inflow and outflow side of a countercurrent fluid warmer to create a fistula through the heating mechanism (CAVR). Over a 10-month period 34 hypothermic (temperature less than 35 degrees C) patients were treated. Eighteen received SR only; CAVR was added to SR in the remaining 16 patients. Both groups were similar in APACHE II, Injury Severity, and Acute Physiology scores, prewarming blood and fluid requirements, and incidence of coagulopathy. Hypothermia resolved in 39 minutes with CAVR vs. 3.23 hours with SR (p less than 0.001). This was associated with an improved survival after moderately severe injury (p = 0.04), and a significant reduction in blood and fluid requirements, organ failures, and length of ICU stay. | |||||
| Gerding, E.C. | Fundamentos de sanidad naval. | 2001 | , pp. 264 | book | URL |
| Giesbrecht, G.G. & Bristow, G.K. | Influence of body composition on rewarming from immersion hypothermia. [Abstract] |
1995 | Aviat Space Environ Med Vol. 66(12), pp. 1144-1150 |
article | |
| Abstract: BACKGROUND: This study was conducted to determine if the differences between efficacies of three treatments for immersion hypothermia are affected by body composition. METHODS: Twelve subjects were divided into equally sized low (LF) and high (HF) fat groups. On three occasions subjects were each immersed in cold water until esophageal temperatures (Tes) decreased to approximately 33.2 degrees C (LF) and approximately 35.8 degrees C (HF). They were then rewarmed by: 1) shivering; 2) application of external heat; or 3) treadmill exercise in a balanced design. RESULTS: For HF, the afterdrop during exercise (1.04 +/- 0.2 degrees C) was greater than during shivering (0.35 +/- 0.3 degrees C) and external heat (0.36 +/- 0.1 degree C) (p < 0.01). In LF, however, the exercise afterdrop (0.75 +/- 0.2 degree C) was greater than only external heat (0.35 +/- 0.2 degree C) (p < 0.05) but not shivering (0.58 +/- 0.4 degree C). There was a positive relationship between % fat and afterdrop for the exercise condition with a slope (95% C.I.) of 0.03 (0.01 to 0.05) degree C.% fat-1 (r2 = 0.37, p < 0.05). The exercise rewarming rate (3.48 +/- 1.1 degrees C.h-1) was greater (p < 0.01) than during both shivering (1.80 +/- 0.7 degrees C.h-1) and external heat (2.22 +/- 0.7 degrees C.h-1) in HF while no difference was seen between the three treatments (5.28 +/- 0.4, 4.86 +/- 1.1 and 5.16 +/- 0.7 degrees C.h-1, respectively) in LF. There were inverse relationships between % fat and rewarming rate in the exercise -0.12 (-0.23 to -0.01) degree C.h-1.% fat-1, (r2 = 0.38), shivering -0.27 (-0.38 to -0.16) degrees C.h-1.% fat-1, (r2 = 0.76) and external heat -0.26 (-0.35 to -0.17) degree C.h-1.% fat-1, (r2 = 0.83) conditions (p < 0.05). CONCLUSIONS: The inter-treatment differences between these techniques are accentuated in the HF, and attenuated (afterdrop) or even eliminated (rewarming rate) in the LF subgroup. | |||||
| Giesbrecht, G.G., Ducharme, M.B. & McGuire, J.P. | Comparison of forced-air patient warming systems for perioperative use. [Abstract] |
1994 | Anesthesiology Vol. 80(3), pp. 671-679 |
article | |
| Abstract: BACKGROUND: Perianesthetic hypothermia is common and produces several complications, including postoperative shivering, decreased drug metabolism and clearance, and impaired wound healing. Forced-air warming transfers more than 50 W to the body and is an efficient method for either preventing or reversing decreases in core temperature. METHODS: The authors compared the efficacy of four complete forced-air warming systems: (1) Bair Hugger 250/PACU Patient Warming System with 300 Warming Cover (Augustine Medical, Eden Prairie, MN); (2) Thermacare TC1000 Power Unit with TC1050 Comfort Quilt (Gaymar Industries, Orchard Park, NY); (3) WarmAir 130 Hypothermia System with 140 Warming Tube (Cincinnati Sub-Zero Products, Cincinnati, OH); and (4) WarmTouch 5000 Patient Warming System and 503-0810 CareQuilt (with the connecting hose compressed [short] and extended [long]) (Mallinckrodt Medical, St. Louis, MO). Six minimally clothed male volunteers were studied supine in a 24.5 degrees C environment. Cutaneous heat flux and skin temperature was measured at 14 area-weighted sites using thermal flux transducers. After 20-min control periods, volunteers were warmed for 40 min in each condition. A cotton blanket was placed over each cover. Power units were placed at the foot end of the bed, started cold, and set at maximum temperature and flow settings. All units reached maximum efficiency within 20 min. RESULTS: Total heat transfer with the Bair Hugger system (95 +/- 7 W) was greater (P < 0.05) than with WarmTouch (short hose 81 +/- 6 W and long hose 68 +/- 8 W), Thermacare (61 +/- 5 W), and WarmAir (38 +/- 6 W) systems. Each cover also was tested on a common power unit (Bair Hugger 200). Total heat transfer was greater (P < 0.05) with the Warming Cover (Bair Hugger) (88 +/- 8 W), followed by the Comfort Quilt (Thermacare) (56 +/- 6 W), CareQuilt (WarmTouch) (50 +/- 7 W), and the Warming Tube (WarmAir) (43 +/- 6 W). CONCLUSIONS: The advantages of the Bair Hugger system and Warming Cover are evident in areas that are important for heat transfer from the periphery to the body core (chest, axilla, abdomen, and upper legs). | |||||
| Giesbrecht, G.G., Goheen, M.S., Johnston, C.E., Kenny, G.P., Bristow, G.K. & Hayward, J.S. | Inhibition of shivering increases core temperature afterdrop and attenuates rewarming in hypothermic humans. [Abstract] |
1997 | J Appl Physiol Vol. 83(5), pp. 1630-1634 |
article | |
| Abstract: During severe hypothermia, shivering is absent. To simulate severe hypothermia, shivering in eight mildly hypothermic subjects was inhibited with meperidine (1.5 mg/kg). Subjects were cooled twice (meperidine and control trials) in 8 degrees C water to a core temperature of 35.9 +/- 0.5 (SD) degrees C, dried, and then placed in sleeping bags. Meperidine caused a 3.2-fold increase in core temperature afterdrop (1.1 +/- 0.6 vs. 0.4 +/- 0.2 degree C), a 4.3-fold increase in afterdrop duration (89.4 +/- 31.4 vs. 20.9 +/- 5.7 min), and a 37% decrease in rewarming rate (1.2 +/- 0.5 vs. 1.9 +/- 0.9 degrees C/h). Meperidine inhibited overt shivering. Oxygen consumption, minute ventilation, and heart rate decreased after meperidine injection but subsequently returned toward preinjection values after 45 min postimmersion. This was likely due to the increased thermoregulatory drive with the greater afterdrop and the short half-life of meperidine. These results demonstrate the effectiveness of shivering heat production in attenuating the postcooling afterdrop of core temperature and potentiating core rewarming. The meperidine protocol may be valuable for comparing the efficacy of various hypothermia rewarming methods in the absence of shivering. | |||||
| Giesbrecht, G.G., Schroeder, M. & Bristow, G.K. | Treatment of mild immersion hypothermia by forced-air warming. [Abstract] |
1994 | Aviat Space Environ Med Vol. 65(9), pp. 803-808 |
article | |
| Abstract: Forced-air warming is used for prevention or reversal of hypothermia in surgical patients. In the present study, the efficacy of this system for treatment of immersion hypothermia was evaluated. Six men and two women were twice immersed in 8 degrees C water until hypothermic. They were then rewarmed by either: 1) shivering-only inside a sleeping bag; or 2) forced-air warming. Esophageal and skin temperature, cutaneous heat flux and metabolism were measured. Afterdrop (+/- SD) during forced-air warming (0.43 +/- 0.26 degrees C) was approximately 30% less than during shivering (0.61 +/- 0.26 degrees C) (p < 0.001). Rewarming rate during forced-air warming (3.26 +/- 1.8 degrees C.h-1) was not significantly different from shivering (3.02 +/- 1.2 degrees C.h-1). Skin temperature was higher during forced-air warming by 3.7 degrees C early and 4.5 degrees C after 35 min of warming. Heat production increased by 77 W over the initial 20 min of shivering, and subsequently declined, compared to an immediate decrease with forced-air warming. During shivering heat flux ranged from 30 W early in rewarming, to 50 W after 35 min, compared to -237 W and -163 W respectively, for forced-air warming. Forced-air warming attenuated afterdrop and the metabolic stress of shivering while maintaining an average rate of rewarming comparable to shivering. Forced-air warming is a safe, simple, noninvasive treatment and could be used effectively in an emergency medical facility, and possibly in some rescue/emergency vehicles or marine vessels. | |||||
| Gilbert, M., Busund, R., Skagseth, A., Nilsen, P.A. & Solbø, J.P. | Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. [Abstract] |
2000 | Lancet Vol. 355(9201), pp. 375-376 |
article | DOI |
| Abstract: In a victim of very deep accidental hypothermia, 9 h of resuscitation and stabilisation led to good physical and mental recovery. This potential outcome should be borne in mind for all such victims. | |||||
| Gilston, A. | Hypothermic cardiopulmonary resuscitation. | 1992 | Crit Care Med Vol. 20(3), pp. 441-443 |
article | |
| Ginsberg, M.D. | Temperature Elevations are Deleterious in the Brain Injured Patient. | 1999 | booklet | ||
| Giuffre, M., Finnie, J., Lynam, D.A. & Smith, D. | Rewarming postoperative patients: lights, blankets, or forced warm air. [Abstract] |
1991 | J Post Anesth Nurs Vol. 6(6), pp. 387-393 |
article | |
| Abstract: This study was designed to determine if the forced warm air system is more effective than warmed cotton blankets or radiant heat lamps for rewarming postoperative patients. PACU admission temperatures were taken on 370 adult patients. The study population of 90 patients with admission temperatures of 35 degrees C (95 degrees F) or less was randomly assigned to one of three intervention groups: (b) warmed cotton blankets, (L) radiant heat lamps, or (A) forced warm air. Oral or axillary temperatures were monitored every 15 minutes and the warming intervention continued until the patient reached the discharge criteria of 36 degrees C (96.8 degrees F). The three groups were comparable for sex, age, admitting temperature, OR time, and OR fluid. The mean rewarming times for patients who shivered were similar for all groups. For those patients who did not shiver, those treated with forced warm air rewarmed significantly faster than patients in the other groups. Nonshivering patients treated with forced warm air were ready for discharge somewhat sooner than those treated with either of the other two interventions. | |||||
| Glaum, J. & Verhoff, M.A. | Kälteidiotie - ein weithin unbekanntes Phänomen. Auffinden unbekleideter oder teilentkleideter Leichen während der Kälteperiode. | 2007 | Kriminalist Vol. 3, pp. 108-112 |
article | |
| Goheen, M.S., Ducharme, M.B., Kenny, G.P., Johnston, C.E., Frim, J., Bristow, G.K. & Giesbrecht, G.G. | Efficacy of forced-air and inhalation rewarming by using a human model for severe hypothermia. [Abstract] |
1997 | J Appl Physiol Vol. 83(5), pp. 1635-1640 |
article | |
| Abstract: We recently developed a nonshivering human model for severe hypothermia by using meperidine to inhibit shivering in mildly hypothermic subjects. This thermal model was used to evaluate warming techniques. On three occasions, eight subjects were immersed for approximately 25 min in 9 degrees C water. Meperidine (1.5 mg/kg) was injected before the subjects exited the water. Subjects were then removed, insulated, and rewarmed in an ambient temperature of -20 degrees C with either 1) spontaneous rewarming (control), 2) inhalation rewarming with saturated air at approximately 43 degrees C, or 3) forced-air warming. Additional meperidine (to a maximum cumulative dose of 2.5 mg/kg) was given to maintain shivering inhibition. The core temperature afterdrop was 30-40% less during forced-air warming (0.9 degree C) than during control (1.4 degrees C) and inhalation rewarming (1.2 degrees C) (P < 0.05). Rewarming rate was 6- to 10-fold greater during forced-air warming (2.40 degrees C/h) than during control (0.41 degree C/h) and inhalation rewarming (0.23 degree C/h) (P < 0.05). In nonshivering hypothermic subjects, forced-air warming provided a rewarming advantage, but inhalation rewarming did not. | |||||
| Golden, F. & Tipton, M. | Essentials of Sea Survival. | 2002 | , pp. 314 | book | URL |
| Abstract: This is a comprehensive and informative guide to open-water survival, blending science with the authors' own research and examinations of real-life survival accounts. It provides up-to-date information on sustained survival in cold water a common sense approach to survival gear. | |||||
| Review: 'The mix of hard science, the authors' own extensive research, and examinations of real-life survival accounts, both historic and recent, provide intensely practical recommendations for all likely emergencies at sea. I've found no other source that combines the research, experience, commonsense and practical information found in 'Essentials of Sea Survival,' Everyone that uses open water for work or recreation should read this book.' Dr. Ian Mackie. Retired medical chairman. International Life Saving Federation 'If you are going to be on the water, you need a survival strategy. This book tells you just what you need for developing one, and how to make it work.' B. Chris Brewster. Former lifeguard chief. Editor, The United States Lifesaving Association Manual of Open Water Lifesaving ''Essentials of Sea Survival 'clearly explains how the body reacts to the stress and shock of a sea accident. Knowing this information can help you formulate a risk assessment and survival strategy so that your chances of survival can be improved when you're faced with an unfortunate event at sea.''' Tony Mooney. Technical manager. Australian Yachting Federation. Member ORC Special Regulations Committee 'From Living Aboard' ''extraordinarily dense with interesting and useful information.'' 'From The Mariner' Scientists and academic audiences should find the technical research of interest, and recreational water sport participants should enjoy the real-life scenarios as well as the practical advice on how to endure the elements at sea. 'From California Diving News' Essentials of Sea Survival is a fasciniating blend of historical anecdote, scientificfact, and practical application. 'From Equipped.org' This is a must read for anyone interested in the subject of water survival.' |
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| Golden, F.S., Hervey, G.R. & Tipton, M.J. | Circum-rescue collapse: collapse, sometimes fatal, associated with rescue of immersion victims. | 1991 | J R Nav Med Serv Vol. 77(3), pp. 139-149 |
article | |
| Golden, F.S. & Tipton, M.J. | Human adaptation to repeated cold immersions. [Abstract] |
1988 | J Physiol Vol. 396, pp. 349-363 |
article | |
| Abstract: 1. The present investigation was designed to examine human adaptation to intermittent severe cold exposure and to assess the effect of exercise on any adaptation obtained. 2. Sixteen subjects were divided into two equal groups. Each subject performed ten head-out immersions; two into thermoneutral water which was then cooled until they shivered vigorously, and eight into water at 15 degrees C for 40 min. During the majority of the 15 degrees C immersions, one group (dynamic group) exercised whilst the other (static group) rested. 3. Results showed that both groups responded to repeated cold immersions with a reduction in their initial responses to cold. The time course of these reductions varied, however, between responses. 4. Only the static group developed a reduced metabolic response to prolonged resting immersion. 5. It is concluded that repeated resting exposure to cold was the more effective way of producing an adaptation. The performance of exercise during repeated exposure to cold prevented the development of an adaptive reduction in the metabolic response to cold during a subsequent resting immersion. In addition, many of the adaptations obtained during repeated resting exposure were overridden or masked during a subsequent exercising immersion. | |||||
| Golden, F.S. & Tipton, M.J. | Human thermal responses during leg-only exercise in cold water. [Abstract] |
1987 | J Physiol Vol. 391, pp. 399-405 |
article | |
| Abstract: 1. Exercise during immersion in cold water has been reported by several authors to accelerate the rate of fall of core temperature when compared with rates seen during static immersion. The nature of the exercise performed, however, has always been whole-body in nature. 2. In the present investigation fifteen subjects performed leg exercise throughout a 40 min head-out immersion in water at 15 degrees C. The responses obtained were compared with those seen when the subjects performed an identical static immersion. 3. Aural and rectal temperatures were found to fall by greater amounts during static immersion. 4. It is concluded that 'the type of exercise performed' should be included in the list of factors which affect core temperature during cold water immersion. | |||||
| Golden, F.S., Tipton, M.J. & Scott, R.C. | Immersion, near-drowning and drowning. [Abstract] |
1997 | Br J Anaesth Vol. 79(2), pp. 214-225 |
article | |
| Abstract: [extract] "Drowning" is defined as "suffocation by submersion, especially in water"; it continues to be the third most common cause of accidental death in the general population and, for children in many countries, the second most common cause after road accidents. In the USA, 40% of drowning victims are less than 4 yr old. In Britain, the Office of Population Census reports that child deaths from this cause continue to be the third most common cause of accidental death after road accidents and burns. "Near-drowning" is defined as "survival, at least temporarily, after suffocation by submersion in ... | |||||
| Golle, C.M. & Golle, K. | [Deep hypothermia following an accident--a case report] | 1987 | Anaesthesiol Reanim Vol. 12(4), pp. 243-248 |
article | |
| Goode, H.F. & Webster, N.R. | Free radicals and antioxidants in sepsis. [Abstract] |
1993 | Crit Care Med Vol. 21(11), pp. 1770-1776 |
article | |
| Abstract: OBJECTIVES: The clinical condition of sepsis is caused by the release of numerous mediators from many cells. The purpose of this review is to describe the results of studies in which the role of free radicals and/or the potential therapeutic value of antioxidants are assessed. DATA SOURCES: The studies described in this review come from a variety of sources, including Med-Line CD-ROM computerized database, Index Medicus, and references identified from the bibliographies of pertinent articles and books. Reports were confined to English language articles from 1966 to 1992. STUDY SELECTION: All retrieved references in which free-radical activity was assessed or antioxidants were measured or administered in sepsis or endotoxemia were included. This selection process encompassed clinical, animal and in vitro cell culture work. DATA EXTRACTION: Cited literature was found in reputable peer-reviewed clinical or basic science journals. DATA SYNTHESIS: Any contradictions in the results of studies are discussed. CONCLUSIONS: There is evidence that free radicals play an important role in the pathogenesis of sepsis. Antioxidant therapy has the potential to protect against such injury. It is suggested that combination therapy, which augments the endogenous antioxidant defenses, is likely to be the best approach. | |||||
| Graf, D., Meier, P., Güse, H.G., Leitz, K.H. & Bachmann, H. | [A drowning accident of long duration with deep hypothermia and rewarming with extracorporeal circulation. A report of 2 patients] [Abstract] |
1989 | Monatsschr Kinderheilkd Vol. 137(7), pp. 415-418 |
article | |
| Abstract: Two nearly drowned, 2 9/12 and 3 6/12 years old boys with profound hypothermia were admitted to our pediatric intensive care unit with all signs of clinical death. Both patients could be rewarmed and oxygenated by extracorporeal circulation. One of them died 36 hours after the accident with severe brain edema. The second one survived without any defect. Rewarming of cold-water nearly-drowned patients by extra-corporeal circulation seems to be a very effective way of treatment. | |||||
| Granberg, P.O. | Human physiology under cold exposure. [Abstract] |
1991 | Arctic Med Res Vol. 50 Suppl 6, pp. 23-27 |
article | |
| Abstract: In order to minimize heat loss cold stress induces peripheral vasoconstriction via the sympathetic nervous system. This effect is most pronounced in the extremities. Vasoconstriction does not appear in the head-neck region--a fact of great importance in emergency situations. In order to compensate for heat loss shivering is an early event, where involuntary muscle contractions increase metabolic rate 2-6 fold. Early tachycardia and elevated blood-pressure, followed by progressive bradycardia and lowered pressure are common cardiovascular effects of hypothermia. Death due to ventricular fibrillation or asystole occurs between 28 degrees-25 degrees C. Cold stress causes an osmolal diuresis with sodium and chloride as the main constituents. The natriuresis is of tubular origin and could be due to impaired autoregulation in the kidney and/or depend on the natriuretic polypeptide. The augmented urine flow decreases blood volume, lowers physical working capacity and increases blood viscosity--all negative events in a hazardous situation. Sudden immersion initiates hyperventilation for 1-2 minutes with an increasing risk of drowning. Thereafter ventilation decreases to rates consistent with metabolic requirements. In severe hypothermia carbon dioxide retention causes respiratory and metabolic acidosis. Hypothermia induces progressive depression of mental functions starting with apathy and bizarre behaviour and ending in lethargy and coma often between 30 degrees-28 degrees C. The paradoxal feeling of heat with undressing in agony could depend on cerebral receptor disturbances. | |||||
| Grant, P., Snadden, D., Syme, D. & Walker, T. | Freezing to death--the treatment of accidental hypothermia in the Scottish mountains. | 1998 | Scott Med J Vol. 43(2), pp. 36-37 |
article | |
| Gravlee, G.P. | Heparin-coated cardiopulmonary bypass circuits. [Abstract] |
1994 | J Cardiothorac Vasc Anesth Vol. 8(2), pp. 213-222 |
article | |
| Abstract: The indications for heparin-coated extracorporeal circuits cannot be defined or limited at present. Clinical investigation remains at an early stage of development. In situations where the risk of systemic anticoagulation is high, this technology would seem to hold great promise. Examples include extracorporeal lung assist and resuscitation from accidental hypothermia. Some have also suggested the use of heparin-coated circuits for percutaneous bypass in cardiopulmonary resuscitation. A significant advantage might also accrue in noncardiac surgical procedures requiring cardiopulmonary bypass, such as complex cerebral aneurysm or arteriovenous malformation resections, resections of the tracheal carina, or bilateral lung transplantations. Its role in routine cardiac surgical procedures remains uncertain, but the work of von Segesser et al suggests a need for continued investigation in that setting using reduced levels of systemic anticoagulation. That endeavor will be greatly assisted by the recent development of heparin-coated cardiotomy reservoirs. Although heparin-coated circuits have been safely used for extracorporeal lung assist with little or no systemic anticoagulation, prospective studies are clearly needed to determine if this approach is advantageous, and it would seem appropriate to develop heparin coating for silicone-based membrane oxygenators. | |||||
| Green, A. | The offshore special regulations handbook. | 2005 | book | ||
| Gregory, J.S., Bergstein, J.M., Aprahamian, C., Wittmann, D.H. & Quebbeman, E.J. | Comparison of three methods of rewarming from hypothermia: advantages of extracorporeal blood warming. [Abstract] |
1991 | J Trauma Vol. 31(9), pp. 1247-51; discussion 1251-2 |
article | |
| Abstract: We developed a new technique, extracorporeal venovenous rewarming (EVR), to rewarm hypothermic patients in the intensive care unit or operating room. We compared this method with the active external (standard) techniques of warming blankets; heated ventilator circuits, intravenous fluids, and gastric and peritoneal lavage; and cardiopulmonary bypass. The EVR technique warmed patients' blood or additional blood products and crystalloids to 40 degrees C at 150-400 mL/min and allowed survival from a core temperature of 31.1 degrees C after massive injury. The EVR technique rewarming patients more rapidly than standard techniques and may be most appropriate in patients with multisystem trauma when rapid correction of hypothermia-related hypovolemia, coagulopathy, and arrhythmia is necessary. Cardiopulmonary bypass is required in severely hypothermic patients with cardiac arrest. Standard techniques can be used when these immediately life-threatening conditions are not present. | |||||
| Greif, R., Rajek, A., Laciny, S., Bastanmehr, H. & Sessler, D.I. | Resistive heating is more effective than metallic-foil insulation in an experimental model of accidental hypothermia: A randomized controlled trial. [Abstract] |
2000 | Ann Emerg Med Vol. 35(4), pp. 337-345 |
article | |
| Abstract: STUDY OBJECTIVE: We study a resistive-heating blanket in a volunteer model of severe accidental hypothermia to evaluate differences in rates of rewarming, core temperature afterdrop, and body heat content and distribution during active and passive rewarming. METHODS: Eight volunteers participated in a crossover design on 2 days. The volunteers were anesthetized and cooled to 33 degrees C (91.4 degrees F); anesthesia was subsequently discontinued, and shivering was prevented with meperidine. On one randomly assigned day, the volunteers were rewarmed passively with reflective foil (passive insulation), whereas on the other they were covered with a carbon fiber-resistive heating blanket set to 42 degrees C (107.6 degrees F; active rewarming). Trunk and head temperature and heat content were calculated from core (tympanic membrane) temperature. Peripheral (arm and leg) tissue temperature and heat content were estimated by using fourth-order regressions and integration over volume from 30 tissue and skin temperatures. RESULTS: Core heat content increased 73+/-14 kcal (mean+/-SD) during 3 hours of active warming, but only 31+/-24 kcal with passive insulation, a difference of 41+/-20 kcal (95% confidence interval [CI] 27 to 55 kcal; P <. 001). Peripheral tissue heat content increased linearly by 111+/-16 kcal during active warming but only by 38+/-31 kcal during passive warming, a difference of 74+/-34 kcal (95% CI 50 to 97; P <.001). Consequently, total body heat increased 183+/-22 kcal during active warming but only 68+/-54 kcal with passive insulation, a difference of 115+/-42 kcal (95% CI 86 to 144 kcal; P <.001). Core temperature increased from 32.9 degrees C+/-0.2 degrees C to 35.2 degrees C+/-0. 4 degrees C during 3 hours of active warming, a difference of 2.3 degrees C+/-0.4 degrees C. In contrast, core temperature with foil insulation only increased from 32.9 degrees C+/-0.2 degrees C to 33. 8 degrees C+/-0.5 degrees C, a difference of only 0.8 degrees C+/-0. 4 degrees C. The difference in the core temperature increase between the two treatments was thus 1.5 degrees C+/-0.4 degrees C (95% CI 1. 2 degrees C to 1.7 degrees C; P <.001 between treatments). Active warming was not associated with an afterdrop, whereas the afterdrop was 0.2 degrees C+/-0.2 degrees C and lasted a median of 45 minutes (interquartile range, 41 to 64 minutes) with passive insulation. CONCLUSION: Resistive heating more than doubles the rewarming rate compared with that produced by reflective metal foil and does so without producing an afterdrop. It is therefore likely to be useful in the prehospital setting. | |||||
| Gretenkort, P. & Weissenfels, M. | [Ice-Water Drowning with Cardiac Arrest: Is Resuscitation by Means of Extracorporeal Circulation Realistic?] [Abstract] |
2000 | Notarzt Vol. 4(16), pp. 133-137 |
article | DOI |
| Abstract: Drowning in ice-water provided survival without sequelae even after submersion times of more than one hour in single case reports. Method of choice for rewarming in cases of ice-water drowning with cardiac arrest is the use of extracorporeal circulation. The decision whether to initiate or terminate resuscitation in victims of ice-water drowning is almost impossible at the scene of accident, so that immediate hospital transfer under conditions of advanced life support becomes necessary. Even at hospital admission, no valid prognostic markers are existing today to serve as a rationale to determine invasive rewarming procedures. By means of a case report and data from the literature, chances and limits of rescue and clinical therapy are discussed. | |||||
| Griepp, R.B., Ergin, M.A., Lansman, S.L., Galla, J.D. & Pogo, G. | The physiology of hypothermic circulatory arrest. | 1991 | Semin Thorac Cardiovasc Surg Vol. 3(3), pp. 188-193 |
article | |
| Gries, A. | [Emergency management in near-drowning and accidental hypothermia] [Abstract] |
2001 | Anaesthesist Vol. 50(11), pp. 887-98; quiz 899, 901 |
article | DOI |
| Abstract: Ertrinken ist insbesondere bei Kindern im Alter von 2–4 Jahren eine häufige Unfalltodesursache. Neben 597 auf diese Weise tödlich verunfallten Personen hat die Deutsche-Lebens-Rettungsgesellschaft (DLRG) 1999 464 Personen vor dem Ertrinkungstod gerettet. Die Dunkelziffer liegt deutlich höher, in den USA schätzungsweise um den Faktor 500–600. Bei den pathophysiologischen Veränderungen nach “Beinahe-Ertrinken”, d.h. einem mindestens 24 Stunden überlebtem Ertrinkungsunfall, steht die zerebrale Hypoxie im Vordergrund. Eine Hypothermie kann möglicherweise zerebroprotektiv wirken. Verschiedene Konzepte zur Wiedererwärmung in Abhängigkeit vom Grad der Hypothermie liegen vor. Bei stattgehabter Aspiration komplizieren schließlich pulmonale Veränderungen den weiteren Verlauf. Die Rettung des Verunfallten erfolgt unter Berücksichtigung möglicher Begleitverletzungen. Die Beseitigung einer Hypoxie nach Beinahe-Ertrinken hat höchsten Stellenwert. Bei der Reanimation normothermer Patienten können die bekannten Algorithmen ohne besondere Modifikationen angewandt werden, bei hypothermen Patienten muss allerdings die besondere Pathophysiologie berücksichtigt werden. Prädiktoren zur Einschätzung der individuellen Prognose liegen nicht vor, vielmehr konnten auch nach prolongierter Reanimation beim Einsatz extrakorporaler Verfahren schwer hypotherme Patienten nach Beinahe-Ertrinken ohne neurologisches Defizit entlassen werden. |
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| Gunn, A.J. & Thoresen, M. | Hypothermic neuroprotection. [Abstract] |
2006 | NeuroRx Vol. 3(2), pp. 154-169 |
article | DOI |
| Abstract: The possibility that hypothermia during or after resuscitation from asphyxia at birth, or cardiac arrest in adults, might reduce evolving damage has tantalized clinicians for a very long time. It is now known that severe hypoxia-ischemia may not necessarily cause immediate cell death, but can precipitate a complex biochemical cascade leading to the delayed neuronal loss. Clinically and experimentally, the key phases of injury include a latent phase after reperfusion, with initial recovery of cerebral energy metabolism but EEG suppression, followed by a secondary phase characterized by accumulation of cytotoxins, seizures, cytotoxic edema, and failure of cerebral oxidative metabolism starting 6 to 15 h post insult. Although many of the secondary processes can be injurious, they appear to be primarily epiphenomena of the 'execution' phase of cell death. Studies designed around this conceptual framework have shown that moderate cerebral hypothermia initiated as early as possible before the onset of secondary deterioration, and continued for a sufficient duration in relation to the severity of the cerebral injury, has been associated with potent, long-lasting neuroprotection in both adult and perinatal species. Two large controlled trials, one of head cooling with mild hypothermia, and one of moderate whole body cooling have demonstrated that post resuscitation cooling is generally safe in intensive care, and reduces death or disability at 18 months of age after neonatal encephalopathy. These studies, however, show that only a subset of babies seemed to benefit. The challenge for the future is to find ways of improving the effectiveness of treatment. | |||||
| Hakim, E.A., Chiverton, N. & Hossenbocus, A. | Rhabdomyolysis with renal dysfunction in a hypothermic man. [Abstract] |
1990 | Br J Clin Pract Vol. 44(12), pp. 778-779 |
article | |
| Abstract: We describe a case of rhabdomyolysis with renal dysfunction in a 41-year-old previously healthy man with hypothermia. We believe this to be the first case of rhabdomyolysis and hypothermia so far described in the UK. | |||||
| Hall, K.N. & Syverud, S.A. | Closed thoracic cavity lavage in the treatment of severe hypothermia in human beings. [Abstract] |
1990 | Ann Emerg Med Vol. 19(2), pp. 204-206 |
article | |
| Abstract: Life-threatening hypothermia can be treated by active and passive rewarming techniques, the treatment of choice being partial cardiopulmonary bypass. The use of closed thoracic cavity lavage has been evaluated in animals, but no formal presentations in human beings have been reported. We report two cases in which rapid rewarming in severe hypothermia was accomplished when cardiopulmonary bypass was not available. | |||||
| Hammersborg, S.M., Farstad, M., Haugen, O., Kvalheim, V., Onarheim, H. & Husby, P. | Time course variations of haemodynamics, plasma volume and microvascular fluid exchange following surface cooling: an experimental approach to accidental hypothermia. [Abstract] |
2005 | Resuscitation Vol. 65(2), pp. 211-219 |
article | DOI |
| Abstract: OBJECTIVE: To describe how surface cooling influences fluid distribution, vascular capacity and haemodynamic variables. METHODS: Seven anaesthetised pigs, following normothermic stabilization for 60 min, were cooled to 27.8+/-1.6 degrees C. Fluid balance, haemodynamics, colloid osmotic pressures (plasma/interstitial fluid), haematocrit [s-albumin/protein] were recorded and plasma volume measured together with tissue perfusion during normothermia, cooling and stable hypothermia (coloured microspheres). Fluid shifts and changes in albumin and protein masses were calculated. At the end tissue water content was assessed. RESULTS: Haemodynamic variables changed with the start of cooling in parallel with a decreasing cardiac output. During hypothermia the haematocrit increased from 0.31+/-0.01 to 0.35+/-0.01 (P < 0.01). Plasma volume decreased from 1139.0+/-65.4 ml at start of cooling to 882.0+/-67.5 ml 3 h later (P < 0.05). In parallel the plasma albumin and protein masses decreased from 37.8+/-2.5 g and 54.6+/-4.0 g to 28.0+/-2.7 g (P < 0.05) and 41.2+/-4.1 g (P > 0.05), respectively. The main changes occurred 120-180 min after start of each experiment. In this period the fluid extravasation rate was elevated (P < 0.05) without influencing the colloid osmotic pressure of plasma/interstitial fluid. The increased fluid filtration was reflected by an increase in tissue water content. CONCLUSION: Our results are in favour of a shift of plasma from circulation to the interstitial space during surface cooling. This conclusion is based on the parallel losses of fluid and proteins from circulation with unchanged colloid osmotic pressures (plasma/interstitial fluid). Inflammation may be involved. | |||||
| Harman, K.R. & Herndon, T.M. | Cold-water immersion in a 22-year-old service member. [Abstract] |
2006 | Mil Med Vol. 171(5), pp. 459-462 |
article | |
| Abstract: Cold-water immersion can include aspects of both hypothermia and near drowning. We present a case of a 22-year-old active duty service member who became a victim of cold-water immersion in Alaska. His rescue by the U.S. Coast Guard and subsequent treatment in a small community emergency room are reviewed using a case management format. Care of the cold-water immersion patient with limited resources is highlighted and the potential complications of cold-water immersion are emphasized. Disturbances in acid base balance, pulmonary function, and cardiac rhythm are discussed. Changes in some of the hematological indices seen in the cold-water immersion patient are reported for the first time. | |||||
| Harnett, R.M., Pruitt, J.R. & Sias, F.R. | A review of the literature concerning resuscitation from hypothermia: Part I--the problem and general approaches. | 1983 | Aviat Space Environ Med Vol. 54(5), pp. 425-434 |
article | |
| Harnett, R.M., Pruitt, J.R. & Sias, F.R. | A review of the literature concerning resuscitation from hypothermia: Part II--Selected rewarming protocols. [Abstract] |
1983 | Aviat Space Environ Med Vol. 54(6), pp. 487-495 |
article | |
| Abstract: In Part I of this paper, a description of the problems confronted in resuscitation from immersion hypothermia was presented and the debate between passive and active rewarming approaches was summarized. In this paper, a review of the literature concerning selected specific rewarming protocols is given. The protocols considered are: peritoneal irrigation, gastrointestinal rewarming, extracorporeal blood rewarming, airway rewarming, and diathermy. | |||||
| Harrison, M.R., Hysing, E.S. & Bo, G. | Control of body temperature: use of the respiratory tract as a heat exchanger. [Abstract] |
1977 | J Pediatr Surg Vol. 12(6), pp. 821-828 |
article | |
| Abstract: The theoretical potential of the respiratory tract as a heat exchanger is enormous because the large alveolor surface area is in intimate contact with pulmonary blood flow. However, this potential is severely limited by some powerful physiologic mechanisms that ensure thermal isolation of alveolar gas, by the detrimental effects of dry gas and extremes of temperature on respiratory epithelium, and by the unfavorable thermal properties of respiratory gases in general. Optimal respiratory cooling using hyperventilation with cold helium-oxygen-CO2 through a double lumen tube increased the rate of body heat loss by only 1.1°C/hr. Although respiratory cooling alone cannot effect heat transfer of sufficient magnitude to produce rapid cooling far induced hypothermia, it may find use as an adjunct in treating hyperthermic conditions and in induced hypothermia. Respiratory warming does not suffer the limitations of respiratory cooling and should find use in inhalation warming of hypothermic patients and in maintaining the body temperature of patients, especially small babies under anesthesia, who are unable to defend their own central temperature. | |||||
| Hasibeder, W., Friesenecker, B. & Mayr, A. | [Near drowning: epidemiology--pathophysiology--therapy] [Abstract] |
2003 | Anasthesiol Intensivmed Notfallmed Schmerzther Vol. 38(5), pp. 333-340 |
article | DOI |
| Abstract: Near-drowning is a frequent preventable accident with a significant morbidity and mortality in a previous healthy population. In most patients the primary injury is pulmonary failure due to fluid aspiration, resulting in severe arterial hypoxemia and secondary damage to other organs. Immediate interruption of hypoxia is of utmost importance in the emergency situation. Accurate neurologic prognosis cannot be predicted from initial clinical presentation, laboratory, radiological or electrophysiological examinations. Prompt resuscitation and aggressive respiratory and cardiovascular treatment are crucial for optimal survival. This review provides the reader with detailed information on epidemiology, pathophysiology, emergency decision making and general treatment in near drowning accidents. | |||||
| Hauty, M.G., Esrig, B.C., Hill, J.G. & Long, W.B. | Prognostic factors in severe accidental hypothermia: experience from the Mt. Hood tragedy. [Abstract] |
1987 | J Trauma Vol. 27(10), pp. 1107-1112 |
article | |
| Abstract: The May 1986 Mt. Hood climbing disaster presented Portland area hospitals the opportunity to initiate a trial of extracorporeal rewarming using cardiopulmonary bypass in ten severely hypothermic patients (two survivors). The data from this experience as well as others previously reported can yield prognostic indicators of survival in cases of accidental hypothermia. These are demonstrated to include: the presence of underlying medical illness, duration of cold exposure, initial core temperature, mental status, the presence of spontaneous respirations, presenting cardiac rate and rhythm, and arterial oxygen tension. Profound hyperkalemia and markedly elevated serum ammonia levels indicate cell lysis; significant hypofibrinogenemia suggests intravascular thrombosis and each laboratory marker predicts a dire outcome. The treatment of choice for severe accidental hypothermia is felt to be rapid core rewarming on cardiopulmonary bypass. | |||||
| Hayward, J.S. | On the effectiveness of airway heat donation. [Abstract] |
1995 | electronic | URL | |
| Abstract: [extract] There is no doubt that the amount of heat that can potentially be donated to a hypothermic victim by airway heat donation is relatively small, certainly not enough on its own to significantly increase the temperature of the whole "body" or even the "core" as it is usually conceived. Then why does this method of heat donation appear to "work" in helping to save the lives of hypothermic victims? The answer may lie in its probable effect on specific "critical tissues" for maintenance of vital functions, such as the brainstem, cervical sympathetics, and the pacemaker region of the heart ... | |||||
| Hayward, J.S. & Eckerson, J.D. | Physiological responses and survival time prediction for humans in ice-water. [Abstract] |
1984 | Aviat Space Environ Med Vol. 55(3), pp. 206-211 |
article | |
| Abstract: Lightly-clothed, nonexercising humans - 10 females and 11 males - were immersed in 0 degree C water for durations of 25-40 min until their core temperatures decreased to 35 degrees C. Ventilation rate increased 434% in the first 1-2 min of immersion, which increased the respiratory exchange ratio from 0.8 to 1.4. After 10 min of immersion, mean skin temperature had fallen to 5 degrees C and mean rectal and tympanic cooling rates were 6.02 and 5.40 degrees C/h, respectively. No sex differences occurred. By 15-20 min of immersion, maximum shivering metabolism was attained with levels nearly 4 times the preimmersion metabolic rate. This metabolic response was accompanied by heart rates in the range of 90-110 beats/min and increases in respiratory minute volume that were 250-300% greater than preimmersion. Predictions of survival time in 0 degree C water (based on hypothermia rather than drowning) were 1-1.5 h for the average person under the conditions of this study. | |||||
| Hayward, J.S., Eckerson, J.D. & Kemna, D. | Thermal and cardiovascular changes during three methods of resuscitation from mild hypothermia. [Abstract] |
1984 | Resuscitation Vol. 11(1-2), pp. 21-33 |
article | |
| Abstract: The interrelations among core temperatures (cardiac, esophageal, tympanic, rectal), skin temperature, and cardiovascular function (cardiac output, arterial pressure, heart rate, total peripheral resistance) were studied in a conscious subject during entry into mild hypothermia through cold water (10 degrees C) immersion, and during rewarming by three basic procedures: peripheral heat donation (bath); core heat donation (inhalation); and no exogenous heat (spontaneous). Swan-Ganz catheterization of the heart enabled measurement of cardiac temperature as well as cardiac output by the thermal dilution method. During cooling, all sites of core temperature measurement showed similar rates of entry into hypothermia. However, during the rewarming procedures, divergent patterns of temperature change among the four sites occurred. Rectal and tympanic temperatures were not representative of cardiac temperature, but esophageal temperature was, and is therefore most suitable as a criterion for experimental evaluation of the thermal benefit of various core rewarming techniques. During the first 30 min of rewarming, rates of increase in cardiac temperature for bath, inhalation, and spontaneous procedures varied according to the proportions 4:2:1, respectively. No afterdrop of cardiac temperature occurred with the inhalation or spontaneous procedures, but an afterdrop at this site did occur during the first 15 min of bath rewarming as soon as skin temperature was greater than 30 degrees C. This afterdrop coincided with cardiovascular changes including abrupt decreases in arterial pressure and total peripheral resistance, along with increases in heart rate and cardiac output. Such evidence of increased peripheral circulation was not observed with the inhalation and spontaneous methods. The findings relate to experimental evaluation of rewarming techniques and principles for resuscitation of hypothermia victims, especially in the first-aid situation. | |||||
| Hector, M.G. | Treatment of accidental hypothermia. [Abstract] |
1992 | Am Fam Physician Vol. 45(2), pp. 785-792 |
article | |
| Abstract: Hypothermia is an underreported cause of death in the United States. The clinical presentation of hypothermia may include neurologic, cardiovascular and metabolic abnormalities. In severely hypothermic patients, evaluation may reveal no signs of life until the patient is rewarmed. Treatment is directed at restoring normal body temperature and attending to fluid resuscitation, electrolyte disorders, cardiac arrhythmias and associated disease states or conditions. Groups at particular risk for hypothermia include outdoor workers, the homeless, trauma victims and the very young or very old. Also at risk are persons with preexisting serious illnesses and those who are taking medications or abusing drugs. Cardiac arrest, hypotension, unresponsiveness and severe hyperkalemia portend a poorer prognosis. | |||||
| Heise, D., Rathgeber, J. & Burchardi, H. | [Severe, accidental hypothermia: active rewarming with a simple extracorporeal veno-venous warming-circuit] [Abstract] |
1996 | Anaesthesist Vol. 45(11), pp. 1093-1096 |
article | |
| Abstract: We report the case of a 35-year-old male who was admitted to the intensive care unit because of somnolence due to accidental hypothermia. Initial examination showed a Glasgow coma score of 10 and a rectal temperature of 27.4 degrees C. Because of stable circulatory conditions, there was no mandatory indication for rewarming by means of cardiopulmonary bypass. We rewarmed the patient with an extracorporeal veno-venous haemofiltration device combined with a countercurrent fluid warmer. An average increase in body temperature of 1.34 degrees Ch-1 could be obtained. We conclude that the described technique represents an effective and well-controllable method for treatment of hypothermia in patients with stable haemodynamic conditions. Because of the availability of the required equipment, this method can also be practised in hospitals without cardiac surgical departments and cardiopulmonary bypass facilities. | |||||
| Heiß, W.D., Grond, M., Mitrenga, D. & Lechleuthner, A. | [The Cologne Concept of Stroke Management] | 1999 | Dtsch Arztebl Vol. 96(17), pp. A-1117 |
article | URL |
| Abstract: Reducing the time from stroke onset to hospital arrival is critical for the success of stroke therapy. Public education and improvement of prehospital and in-hospital stroke care are of major importance for the optimization of stroke management. Therefore a cooperation between the emergency services, the 14 departments of internal medicine and two neurologic departments was established. The aim was to provide all acute stroke patients with a state of the art stroke therapy and to refer patients suitable for thrombolysis to the neurologic stroke centers. We started an intensive public educational program focussing on risk factors and signs and symptoms of ischemic events and the chances and potential benefits of emergency management of stroke. In addition, standard protocols for diagnosis and therapy were developed to be used in all participating hospitals. From the data it can be estimated that in an 18-month period 4 032 patients were referred to Cologne hospitals with suspected acute stroke. In the same time period 453 patients were referred to the stroke center for thrombolytic therapy. 100 of them were treated with systemic rt-PA (recombinant tissue plasminogen activator). The outcome and complication rates were comparable to those of controlled trials. | |||||
| Helm, M., Hauke, J., Lampl, L. & Bock, K.H. | Accidental hypothermia in trauma patients. | 1997 | Acta Anaesthesiol Scand Suppl Vol. 111, pp. 44-46 |
article | |
| Helm, M., Lampl, L., Hauke, J. & Bock, K.H. | [Accidental hypothermia in trauma patients. Is it relevant to preclinical emergency treatment?] [Abstract] |
1995 | Anaesthesist Vol. 44(2), pp. 101-107 |
article | |
| Abstract: Trauma patients are at great risk of accidental hypothermia (body temperature [BT] < 36 degrees C). Hypothermia influences the functioning of all organ systems and can lead to pathological changes, which in turn additionally complicate the trauma. Furthermore, hypothermia can, e.g., by influencing blood coagulation (reduction of thrombocyte aggregation, increased fibrinolysis) have a markedly unfavourable impact upon the in-hospital surgical treatment of the trauma patient. In a prospective study involving 302 trauma patients treated during primary helicopter rescue missions over a 1-year period, we studied the following factors: (1) incidence and degree of severity of hypothermia; (2) seasonal influence; (3) possibility of individual risk groups within the study group; (4) changes in BT during the prehospital treatment phase; and (5) their consequences for emergency treatment. METHOD. BT was taken upon commencement of emergency treatment and upon release of the patient to the receiving hospital. To avoid possible damage to the patient's tympanic membrane by the thermometer probe, we excluded all patients under 16 years of age and those with an indication of an ear or temporal-bone injury. In all cases standardized patient positioning was applied. The statistical evaluation was performed utilizing descriptive presentations and the Mann-Whitney U test and chi-square test. RESULTS. During study period, a total of 302 trauma patients were treated. On 228 of these, prehospital temperature monitoring was performed (151 males and 77 females, average age 41.8 years). Because of the established criteria for exceptions and equipment malfunction, no monitoring was performed on 74 patients. Traffic accidents (69 were the major cause of injury (Table 2), predominantly the group with NACA III (32, followed by NACA IV (22 and NACA V (18 (Table 3); 27% had multi-system trauma. BT monitoring disclosed that 49.6% or almost every second trauma patient, had hypothermia. The proportion of hypothermia II degrees (BT 34 degrees-30 degrees C) versus hypothermia III degrees (BT < 30 degrees C) was 6.6% to 0.5 Our statistical evaluation did not disclose any significant connection between season of the year and frequency of accidental hypothermia. Special risk factors in regard to frequency and degree of severity turned out to be "entrapment" (98.1% of patients with an entrapment trauma [ET] versus 34.5% without such; P < 0.001) and age (56.8% of patients > 65 years of age without ET and 100% with ET; P < 0.001) (Figs. 2, 3). No significant changes in BT were noted during the prehospital treatment phase. Clinical symptoms pointing to hypothermia or other indicators, i.e., shivering, were only noted in 4.4% of the cases where the patients BT was below normal. CONCLUSION. Based upon our findings, accidental hypothermia poses a relevant problem in the prehospital treatment of trauma patients. It is not limited to a special season of the year. The variability or total absence of definite diagnostic symptoms underlines the necessity for prehospital BT monitoring, whereby tympanic-membrane thermometry has proven to be a worthwhile method. | |||||
| Herity, B., Daly, L., Bourke, G.J. & Horgan, J.M. | Hypothermia and mortality and morbidity. An epidemiological analysis. [Abstract] |
1991 | J Epidemiol Community Health Vol. 45(1), pp. 19-23 |
article | |
| Abstract: STUDY OBJECTIVE--The aim was to identify socioeconomic variables associated with deaths and hospital admissions due to hypothermia and to quantify the risk due to ambient outside temperature. DESIGN--The study was a survey of deaths and hospital admissions due to hypothermia (ICD 991.6), for the period 1979-85 inclusive, identified from death certificates and Hospital Inpatient Enquiry (HIPE) data. SETTING--The study included all deaths and hospital admissions due to hypothermia (1979-85) in the 26 counties of the Republic of Ireland, population 3.5 million. SUBJECTS--All deaths coded during the study period as being due to hypothermia and all persons admitted to hospital during the study period for whom hypothermia was recorded as a discharge diagnosis in HIPE data. MEASUREMENTS AND MAIN RESULTS--Demographic data and date of death/diagnosis were obtained from both data sets. Complete national temperature records were obtained from the meteorological service and a temperature was assigned to each case representing ambient outside temperature at which hypothermia developed. Risk of hypothermia at a given temperature was obtained by dividing the number of cases at that temperature by the appropriate person-years of exposure of the entire national population. Incidence of and mortality from hypothermia doubled with each 5 degrees C and 4 degrees C fall in temperature respectively; the majority of deaths and hospital admissions occurred between October and March. Incidence and mortality increased with age and men had 30% higher case fatality than women. Single men had four times the incidence and 6.5 times the mortality, and single women had double the incidence and four times the mortality of married men and women respectively. Low population density was also an important risk marker. CONCLUSIONS--The risk of hypothermia due to ambient outside temperature has been quantified and a high risk group was identified. A combination of statutory support measures and good neighbourliness could prevent illness and deaths from hypothermia. | |||||
| Hernandez, E., Praga, M., Alcazar, J.M., Morales, J.M., Montejo, J.C., Jimenez, M.J. & Rodicio, J.L. | Hemodialysis for treatment of accidental hypothermia. [Abstract] |
1993 | Nephron Vol. 63(2), pp. 214-216 |
article | |
| Abstract: Accidental hypothermia is defined as a spontaneous decrease in core temperature to 35 degrees C or below. Several techniques of active core rewarming have been described. We present the case of a 34-year-old man with severe hypothermia (27 degrees C) caused by cold environment exposure and barbiturate intoxication treated with general supportive measures and active core rewarming with hemodialysis. Core temperature increased by 2.15 degrees C/h with hemodialysis and became normal in 4 h. The clinical situation clearly improved during the hemodialysis session and the patient recovered without any defect. Hemodialysis is a rapid and effective treatment for accidental hypothermia. | |||||
| Herr, R.D. & White, G.L. | Hypothermia: threat to military operations. [Abstract] |
1991 | Mil Med Vol. 156(3), pp. 140-144 |
article | |
| Abstract: Hypothermia has altered the course of military history. Military casualties tend to occur in epidemics, associated with cold weather combat or maneuvers, trauma, immobilization, improper clothing, exhaustion, and underlying illness. Symptoms of hypothermia begin subtly with fatigue and loss of concentration, but progress to stupor, coma, and resemble rigor mortis. Treatment of mild hypothermia is with body heat and warm clothes and fluids. Moderate and severe cases require gentle evacuation and active core rewarming method(s). Inhalation of warm (40 degrees C, 104 degrees F) humidified oxygen is safe, effective, and can be begun in the field. Recognition of risk factors and active measures can lessen the menance of cold weather for military personnel. | |||||
| Herz, B.L., Coville, F.A. & Kocsis, C.A. | Management of submersion hypothermia: successful resuscitation of a 14-year-old girl. | 1988 | N Y State J Med Vol. 88(8), pp. 434-436 |
article | |
| Hilbert, P., Konschak, A. & zur Nieden, K. | [Accidental Hypothermia] [Abstract] |
2002 | Notarzt Vol. 18, pp. 262-265 |
article | DOI |
| Abstract: In most of the German emergency services areas accidental hypothermia is uncommon. In the alpine area it seems to be more common. The care of patients with a severe hypothermia requires some unusual features how: careful rescue, avoiding of heavy movements or head depression storage, strive for one for a horizontal position, preventing the further cooling by wind protection and isolation blankets etc., uninterrupted supervision of the vital functions. Dreaded and frequent complications in the context of the severe hypothermia are the Afterdrop and rhythm disturbance. A re-warming should be carried out under intensive medical conditions for instance with one of the following methods: extracorporeal circulation (ECMO) or continuous hemofiltration/hemodialysis. We report about a patient who presumably developed a severe hypothermia in the context of a severe hypoglycemia with unconsciousness. | |||||
| Hildebrand, F., Giannoudis, P.V., van Griensven, M., Chawda, M. & Pape, H.-C. | Pathophysiologic changes and effects of hypothermia on outcome in elective surgery and trauma patients. [Abstract] |
2004 | Am J Surg Vol. 187(3), pp. 363-371 |
article | DOI |
| Abstract: Generally, hypothermia is defined as a core temperature <35 degrees C. In elective surgery, induced hypothermia has beneficial effects. It is recommended to diminish complications attributable to ischemia reperfusion injury. Experimental studies have shown that hypothermia during hemorrhagic shock has beneficial effects on outcome. In contrast, clinical experience with hypothermia in trauma patients has shown accidental hypothermia to be a cause of posttraumatic complications. The different etiology of hypothermia might be one reason for this disparity because induced therapeutic hypothermia, with induction of poikilothermia and shivering prevention, is quite different from accidental hypothermia, which results in physiological stress. Other studies have shown evidence that this contradictory effect is related to the plasma concentration of high-energy phosphates (e.g., adenosine triphosphate [ATP]). Induced hypothermia preserves ATP storage, whereas accidental hypothermia causes depletion. Hypothermia also has an impact on the immunologic response after trauma and elective surgery by decreasing the inflammatory response. This might have a beneficial effect on outcome. Nevertheless, posttraumatic infectious complications may be higher because of an immunosuppressive profile. Further studies are needed to investigate the impact of induced hypothermia on outcome in trauma patients. | |||||
| Hirvonen, J. | Necropsy findings in fatal hypothermia cases. [Abstract] |
1976 | Forensic Sci Vol. 8(2), pp. 155-164 |
article | |
| Abstract: A series of 22 cases of fatal accidental or suicidal hypothermia is presented. Necropsy findings on which the diagnosis can be based were analysed. Purple skin and swelling of face, hands and feet, as well as violet patches on elbows or knees were the most frequent external signs (Frequency 54--59. The most conspicuous internal macroscopic signs were gastric erosions or haemorrhages, which were seen in half of the cases. Other less frequent signs were pulmonary oedema and acute renal and hepatic degeneration. Microscopically the myocardium showed small degenerative foci and/or fuchsinophilic fibres in two thirds of the cases. The myocardium was macroscopically normal. Histamine and serotonin assays from urine did not indicate increased excretion during exposure. Catecholamine concentrations in urine were high (greater than 0.1 mug/ml) in most hypothermia deaths indicating increased excretion due to cold. The best diagnostic signs seem to be purple skin and oedema in face and ears, stomach erosions, degenerative foci in myocardium and high concentration of catecholamines in the urine. | |||||
| Hirvonen, J. & Huttunen, P. | Increased urinary concentration of catecholamines in hypothermia deaths. [Abstract] |
1982 | J Forensic Sci Vol. 27(2), pp. 264-271 |
article | |
| Abstract: Observations are presented on 24 hypothermia deaths, either accidental or suicidal. Most cases occurred in dry, cold circumstances, the air temperature being below 0 degree C. More cases were seen in early winter, suggesting a lack of acclimatization to the cold. Purple skin and swelling of the ears and nose (mild frostbite) were the most frequent external signs of exposure. Frequent internal signs were stomach ulcerations or hemorrhagic gastritis and small degenerative foci in the myocardium. High blood alcohol (about 200 mg/dL) was the most common contributory factor, but psychotropic drugs were detected in a few cases. The total urinary catecholamine content was increased in the hypothermia deaths, with levels of 0.20 +/- 0.16 microgram/mL (mean +/- standard deviation) versus 0.07 +/- 0.07 microgram/mL in sudden natural deaths and 0.02 +/- 0.02 microgram/mL in rapid violent deaths. Adrenaline was more abundant than noradrenaline. It is suggested that urine catecholamine measurements can give useful information for the diagnosis of acute hypothermia. | |||||
| Hobbhahn, J., Conzen, P., Forst, H. & Peter, K. | [Effect of inhalation anesthetics on the myocardium] [Abstract] |
1989 | Anaesthesist Vol. 38 Suppl 2, pp. S561-S596 |
article | |
| Abstract: A review of the myocardial effects of the volatile anesthetics halothane (HAL), enflurane (ENF) and isoflurane (ISO) is presented. In the first part the effects on cardiac rhythm, myocardial contractility and oxygen supply are discussed. In the second part the pathophysiology of myocardial ischemia during anesthesia and surgery is summarized. Finally the role of inhalation anesthetics in inducing or preventing myocardial ischemia is considered, with special regard to the "coronary steal" phenomenon. | |||||
| Hoeft, A., Korb, H., Rieke, H., Hellige, G. & Sonntag, H. | Auswirkungen von Sympathomimetika in Hypothermie auf die Energetik und Ökonomie der kardialen Pumpfunktion. | 1989 | Anaesthesist Vol. 38, pp. 689-690 |
article | |
| Hoffman, R.G. | Human Psychological Performance in Cold Environments [Abstract] |
2002 | Vol. 2Medical Aspects of Harsh Environments: 2, pp. 383-410 |
incollection | URL |
| Abstract: [extract] INTRODUCTION Military personnel are expected to perform at optimal levels in all varieties of hostile environments, including cold and extreme cold. The cold can be a potent stressor in field conditions, causing both a deterioration in morale and decrements in performance, including the performance of mission-sensitive duties. This chapter reviews those decrements in human psychological performance that are expectable in mild, moderate, and extreme cold environments in an attempt to provide guidance in framing reasonable performance expectations. In addition, this chapter highlights areas where additional training or pretraining may prove beneficial, including the possible role of acclimatization as a ... | |||||
| Hohlrieder, M., Kaufmann, M., Moritz, M. & Wenzel, V. | [Management of accidental hypothermia] [Abstract] |
2007 | Anaesthesist Vol. 56(8), pp. 805-811 |
article | DOI |
| Abstract: Patients with hypothermia are frequently encountered in emergency medicine. Particularly trauma patients, but also other predisposed persons, can be expected to suffer from hypothermia at any time of the year. Therapy focuses not only on symptom-oriented intensive care to stabilize and secure vital functions, but also on rewarming. Even in cases of severe hypothermia with circulatory arrest, therapy can produce excellent results. This paper first gives a brief overview of the typical clinical symptoms of hypothermia, before giving a detailed description of the preclinical and in-hospital management of the hypothermia patient. The various rewarming strategies are the subject of special attention and critical evaluation. | |||||
| Holmström, P., Boyd, J., Sorsa, M. & Kuisma, M. | A case of hypothermic cardiac arrest treated with an external chest compression device (LUCAS) during transport to re-warming. [Abstract] |
2005 | Resuscitation Vol. 67(1), pp. 139-141 |
article | DOI |
| Abstract: The recommended treatment for severe hypothermia with circulatory collapse is re-warming using cardiopulmonary by-pass. This may require transporting a patient to hospital with on-going cardiopulmonary resuscitation (CPR). Manual CPR during patient transport may result in sub-optimal chest compressions and can be a hazard for the ambulance crew. We report a case of a patient with a core temperature of 22.2 degrees C and crew-witnessed cardiac arrest due to hypothermia. After unsuccessful initial resuscitation he was transported to hospital for re-warming with cardiopulmonary by-pass. CPR was continued during transport using a mechanical active compression-decompression device (the LUCAS-device). During cardiopulmonary by-pass ROSC was achieved after 90 min of cardiac arrest. The patient recovered with a cerebral performance category of 3. Using a mechanical device for chest compressions during transport of a hypothermic patient with on-going CPR is feasible, effective and safe. | |||||
| Holzman, S., Connolly, R.J. & Schwaitzberg, S.D. | The effect of in-line microwave energy on blood: a potential modality for blood warming. [Abstract] |
1992 | J Trauma Vol. 33(1), pp. 89-93; discussion 93-4 |
article | |
| Abstract: The treatment of hypothermia associated with hemorrhage, exposure, or intraoperative intervention continues to represent a challenge for trauma care teams. An innovative technique for combining microwave heating with continuous temperature monitoring into a feedback-controlled system for blood warming has been developed. The effect of microwave warming on the structure and function of blood was compared with that in nonheated controls. Erythrocyte structural integrity (hemolysis) was evaluated by comparing levels of lactate dehydrogenase (LDH), potassium (K+), and plasma hemoglobin (PHGB), and hematocrit (HCT) in heated and nonheated (control) samples of banked red blood cells. Hemoglobin function was evaluated in fresh blood by comparing the P50 and hemoglobin electrophoresis of experimental and control samples. Prewarming temperatures were 3 degrees or 23 degrees C; temperatures after warming were 35 degrees, 37 degrees, or 39 degrees C. The results reflect the percentage of changes for 84 heated and 24 unheated blood samples. There were no statistical differences in any of the biochemical variables measured. The P50 for three heated and three unheated samples was 30.7 +/- 1.2 and 30.5 +/- 0.9 mm Hg (p greater than 0.05). There were no changes in the hemoglobin electrophoretic patterns in experimental or control samples. This system is designed to deliver microwave energy in a uniform and controlled manner, overcoming the limitations of conventional microwave ovens that in the past caused local overheating and subsequent hemolysis when used for blood warming. The structural and functional integrity of erythrocytes after microwave warming indicate the safety and effectiveness of this technique. | |||||
| Hopkins, R.O. | Neurobehavioral Grand Rounds introduction: Does near drowning in ice water prevent anoxic induced brain injury? [Abstract] |
2008 | J Int Neuropsychol Soc Vol. 14(4), pp. 656-659 |
article | DOI |
| Abstract: Cold water near-drowning is often thought to be neuroprotective in individuals with anoxia of a longer duration than that usually required to produce irreversible neurologic damage. There is a paucity of data in adults with cold water near-drowning that assess neuropsychological outcomes. Information regarding long-term effects of near cold water near-drowning on neuropathology, neuropsychological and neurobehavioral outcomes are uncommon. This paper provides an introduction to two cases of cold water near-drowning reported in this issue of JINS by Sameulson and colleagues and provides background information for interpretation of the findings of these cases in the context of outcomes following anoxia. | |||||
| Hoskin, R.W., Melinyshyn, M.J., Romet, T.T. & Goode, R.C. | Bath rewarming from immersion hypothermia. [Abstract] |
1986 | J Appl Physiol Vol. 61(4), pp. 1518-1522 |
article | |
| Abstract: Trunk-only bath rewarming has often been recommended over whole-body bath rewarming as a method for the treatment of immersion hypothermia. At present, no report of a direct comparison of the relative merits of these techniques has been made. Authorities in favor of trunk-only bath rewarming base their proposal on the assumption that core temperature afterdrop would be minimized by preventing peripheral vasodilation when the subject's limbs are not immersed in the rewarming bath. In the present study, trunk-only and whole-body bath rewarming are compared by rewarming eight mildly hypothermic male subjects twice, once via each technique. It was concluded that trunk-only rewarming is not superior to whole-body bath rewarming as a therapy for mild immersion hypothermia, based on the findings that no significant differences existed between the two techniques, either in size or duration of core temperature afterdrop, or in rate of rewarming. | |||||
| Huckabee, H.C., Craig, P.L. & Williams, J.M. | Near drowning in frigid water: a case study of a 31-year-old woman. [Abstract] |
1996 | J Int Neuropsychol Soc Vol. 2(3), pp. 256-260 |
article | |
| Abstract: A 31-yr-old woman demonstrated intact neuropsychological functioning after being submerged for at least 30 minutes in icy cold water. Following submersion, the patient received CPR for approximately 1 hr. Eight hours after submersion, the patient's temperature was 31 degrees C (87 degrees F). She remained nonresponsive for 2 days after the accident. Extensive neuropsychological testing was completed 3 mo after the accident with no objective or subjective deficits evidenced. This case of hypothermically mediated neuroprotection from anoxia in an adult supports the need for further research on the putative neurophysiological mechanisms invoked and the potential for application of clinically induced hypothermia in the acute management of other types of cerebral insults. | |||||
| 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. [Abstract] |
2007 | Emerg Med J Vol. 24(7), pp. 511-512 |
article | DOI |
| Abstract: The case of a 17-year-old girl brought into the emergency department (ED) having been found in a field semi-clad and overtly hypothermic is reported. A weak carotid pulse, agonal breathing and fixed dilated pupils were noted. On arrival in the ED she was in asystolic cardiopulmonary arrest. Initial core body temperature was 18 degrees C. After 4 h of closed cardiopulmonary resuscitation and rewarming using a haemofiltration circuit, she made a full recovery with no adverse neurological sequelae. In this case report, the importance of prolonged resuscitation in cardiopulmonary arrest secondary to acute severe environmental hypothermia and the successful use of a haemofiltration circuit to deliver active core rewarming are highlighted. | |||||
| Iaizzo, P.A., Jeon, Y.M. & Sigg, D.C. | Facial warming increases the threshold for shivering. [Abstract] |
1999 | J Neurosurg Anesthesiol Vol. 11(4), pp. 231-239 |
article | |
| Abstract: A decrease of 1-2 degrees C core temperature provides protection against cerebral ischemia. However, shivering usually prevents reduction in core temperature in unanesthetized patients. Therefore, it was tested whether facial and airway heating increases the shivering threshold and enables core cooling in unanesthetized patients. Nine trials were performed on seven healthy male volunteers. Each subject was positioned supine on a circulating-water mattress (8-15 degrees C) with a convective-air coverlet (15-18 degrees C) extending from the neck to the feet. A dynamic study protocol governed by individualized physiological responses was used. Focal facial (and airway) warming was employed to suppress involuntary motor activity (muscle tensing, shivering) and, thereby, enabling noninvasive cooling to lower the core temperature. The following parameters were monitored: 1) heart rate, 2) blood pressure, 3) core temperature (tympanic, axilla, and rectal), 4) cutaneous temperatures, and 5) a subjective shiver index (scale 1-10). In three, electromyograms and infrared thermographs were also obtained. Upon cooling without facial and airway warming, involuntary motor activity increased until it was widespread. This vigorous motor activity prevented any significant lowering of core temperature or caused it to slightly increase. Subsequently, in all subjects, within seconds after the application of facial focal warming, motor activity was suppressed almost completely, and within minutes core temperatures significantly decreased. Preliminary studies described here indicate that focal facial warming applied during active whole body cooling to initiate mild hypothermia might minimize the need to pharmacologically suppress involuntary motor activity. Such a procedure might be useful for initiating as soon as possible (such as during emergency transport), cerebral mild hypothermia in order to maximize protection and thus improve outcome in neurologically injured patients (head trauma, stroke). | |||||
| IMO | A pocket guide to cold water survival. | 2006 | Vol. 3. ed., pp. 21 |
book | |
| Incagnoli, P., Bourgeois, B., Teboul, A. & Laborie, J.-M. | [Resuscitation from accidental hypothermia of 22 degrees C with circulatory arrest: importance of prehospital management] [Abstract] |
2006 | Ann Fr Anesth Reanim Vol. 25(5), pp. 535-538 |
article | DOI |
| Abstract: In winter, French Medicalised Ambulance Service rescued a 50-year-old patient after suicide attempts by jump from a bridge in the Seine. The body was discovered after more than 10 minutes of immersion. She was unconscious and in deep hypothermia with circulatory arrest. Basic CPR was started immediately and oral intubation and 100% oxygen ventilation was performed. Ventricular fibrillation appeared but repeated defibrillation failed due to profound hypothermia (rectal temperature: 28 degrees C). The patient was immediately transported to hospital. CPR and mechanical ventilation was continued during transport. The patient was taken in emergency room. The oesophageal temperature was 22 degrees C. Rewarming using extracorporeal circulation was immediately initiated after insertion of femoral access. At 27 degrees C, ventricular fibrillation started and was converted by external defibrillation to a pulse-generating cardiac rhythm. At 360 minutes, the patient's rectal temperature had reached 36 degrees C and she was disconnected from cardiopulmonary bypass with inotropic support. She was transferred to the intensive care unit after 9 hours of resuscitation, rewarming and stabilisation. Mechanical ventilation was needed for 15 days because of adult respiratory distress syndrome. Renal failure, pneumonia also occurred. She was successfully extubated on day 15 and was discharged from intensive care unit on day 21, suffering no neurological side effects. | |||||
| Ireland, A.J., Pathi, V.L., Crawford, R. & Colquhoun, I.W. | Back from the dead: extracorporeal rewarming of severe accidental hypothermia victims in accident and emergency. [Abstract] |
1997 | J Accid Emerg Med Vol. 14(4), pp. 255-257 |
article | |
| Abstract: Severe accidental hypothermia in an urban environment is usually associated with drug or alcohol abuse or serious illness in elderly or debilitated patients. In the presence of cardiovascular instability, extracorporeal rewarming by cardiopulmonary bypass is the gold standard of treatment of such patients. Three cases of profound hypothermia with circulatory collapse are presented. Each was successfully resuscitated to a full neurological recovery using this method in an accident and emergency (A&E) department, although one died later of respiratory complications. All three cases had a serum potassium in the normal range at the start of treatment. Where facilities exist, extracorporeal rewarming can be performed in A&E for patients with profound hypothermia and circulatory collapse. Cardiopulmonary resuscitation must be continued throughout the rewarming process. | |||||
| Ittner, K.P., Bachfischer, M., Zimmermann, M. & Taeger, K. | Convective air warming is more effective than resistive heating in an experimental model with a water dummy. [Abstract] |
2004 | Eur J Emerg Med Vol. 11(3), pp. 151-153 |
article | |
| Abstract: Trauma patients with accidental hypothermia have adverse outcomes when compared with normothermic patients. Studies with a small number of mild hypothermic volunteers suggested that convective warming is more effective than warming with 12 volt resistive heating blankets. In a laboratory study, we compared the warming effectiveness of two electric blankets and convective air warming. The average speed of convective rewarming during anaesthesia in patients is approximately 0.6 degree C per hour. Accordingly, calibration of the dummy was performed with increasing amounts of water during convective warming until we reached a temperature gain of 0.6 degree C per hour. The following warming experiments were performed: 12 volt electric warming blanket (SH6012, Hella); 12 volt electric warming blanket (Thermamed, whole-body blanket); convective air warming (Warm Touch, Mallinckrodt, whole-body blanket). Each experiment was repeated four times. The temperature development was measured and recorded online. Convective warming increased the dummy temperature 0.6 degree C per hour, Thermamed 0.3 degree C per hour (P<0.001 versus convective warming) and two Hella blankets 0.2 degree C per hour (P<0.001 versus convective warming). Our laboratory investigation confirmed the superiority of convective warming over resistive heating. Efforts should be made to incorporate convective warming into the out-of-hospital treatment of trauma patients. | |||||
| Ivanov | Physiological blocking of the mechanisms of cold death: theoretical and experimental considerations. [Abstract] |
2000 | J Therm Biol Vol. 25(6), pp. 467-479 |
article | |
| Abstract: The cold inhibited functions of skin thermoreceptors, of the thermoregulation centre, and the respiration centre during deep hypothermia can be restored without rewarming the body. The methods used were developed to test the hypothesis that during deep hypothermia calcium ion concentration [Ca(2+)](i) in the cytoplasm increases. This causes a perturbation of cell metabolism, the impairment of cell membrane function that cause the inhibition of cell functioning, resulting in cell death. Such an increase in [Ca(2+)](i) most likely would result from an energy deficit in a deeply cooled cell, which would compromise the processes that maintain the [Ca(2+)](i) at about 10(-7) M. These processes require large amounts of energy since they occur against a large concentration gradient. With the use of EDTA the extracellular concentration of Ca(2+) has been lowered by 15-27 so reducing the concentration gradient for Ca(2+) between the cell and the medium and in consequence facilitated the process the extrusion of cell Ca(2+).During a period of cooling, sufficient to impair normal functioning, the experimental lowering of blood Ca(2+) allowed the restoration of normal function without the need to rewarm. In such cases the animals survived after cooling the body to temperatures at which they would normally have succumbed. The data presented support the stated hypothesis that the impairment of cellular function in mammals by low temperatures is the result of an uncorrected rise in [Ca(2+)](i). | |||||
| Iversen, R.J., Atkin, S.H., Jaker, M.A., Quadrel, M.A., Tortella, B.J. & Odom, J.W. | Successful CPR in a severely hypothermic patient using continuous thoracostomy lavage. [Abstract] |
1990 | Ann Emerg Med Vol. 19(11), pp. 1335-1337 |
article | |
| Abstract: Severe hypothermia with cardiopulmonary arrest often requires prolonged resuscitation while rewarming procedures are implemented. A 63-year-old male in cardiopulmonary arrest with a core body temperature of 23.7 C was resuscitated successfully after core rewarming by means of a two-chest-tube continuous thoracostomy lavage procedure. This lavage procedure resulted in effective and rapid rewarming after other conventional rewarming methods had failed. | |||||
| Jacomet, H. | Bergungstod - Medizinische Aspekte, Therapeutische Konsequenzen. | 1991 | "Ideen entwickeln - Zukunft planen" Referate, gehalten auf dem 11. Bundeskongreß Rettungsdienst ; 24.Mai bis 26.Mai 1991., pp. 42-48 | incollection | |
| Jakubeniene, M., Irnius, A., Chaker, G.A., Paliulis, J.M. & Bechelis, A. | Post-mortem investigation of calcium content in liver, heart, and skeletal muscle in accidental hypothermia cases. [Abstract] |
2009 | Forensic Sci Int Vol. 190(1-3), pp. 87-90 |
article | DOI |
| Abstract: The identification of hypothermia as cause of the death was always quite problematic in the field of forensic medicine. The aim of the present study was to verify the determination of calcium content in post-mortem liver, heart, and skeletal muscle samples as the biochemical marker defining hypothermia as the cause of death. The study involved 43 autopsy cases in which the circumstances of death indicated the effects of overcooling. The control group consisted of material collected from the corpses of 30 persons who were not exposed to low temperatures but died due to technical injuries (n=5), asphyxia (n=6), intoxication with ethanol and other substances (n=8), and acute myocardial infarction/ischemia (n=11). The concentration of calcium in autopsy samples was determined applying flame atomic absorption spectroscopy. Our study showed no significant differences of calcium content in tissues of persons who died due to hypothermia, over those who died in normothermic conditions. | |||||
| Janas, R., Jutley, R.S., Clinton, S. & Sarkar, P.K. | Profound hypothermic cardiac arrest treated successfully using minimally invasive cardiopulmonary bypass: a case report. [Abstract] |
2006 | Heart Surg Forum Vol. 9(2), pp. E601-E603 |
article | |
| Abstract: BACKGROUND: Hypothermia is defined as a core temperature of less than 35 degrees C. The decision to resuscitate a hypothermic patient can be difficult, as consideration must be given to whether the patient died before the cooling process. The modality for rewarming must also be considered. CASE REPORT: A severely hypothermic 54-year-old man with a core temperature of 21 degrees C was successfully rewarmed using cardiopulmonary bypass via the femoro-femoral route. The patient made a full neurological recovery. CONCLUSION: Cardiopulmonary bypass provides excellent circulatory support for profound hypothermia and allows rapid core rewarming. The femoro-femoral approach is the preferred method for this scenario. | |||||
| Jessen, K. & Hagelsten, J.O. | Peritoneal dialysis in the treatment of profound accidental hypothermia. | 1978 | Aviat Space Environ Med Vol. 49(2), pp. 426-429 |
article | |
| Johnston, T.D., Chen, Y. & Reed, R.L. | Functional equivalence of hypothermia to specific clotting factor deficiencies. [Abstract] |
1994 | J Trauma Vol. 37(3), pp. 413-417 |
article | |
| Abstract: Hypothermia prolongs clotting times when the tests are performed at hypothermic temperatures, in contrast to standard clinical tests performed at 37 degrees C. The relative impact of hypothermia on plasma clotting factor activity was investigated by determining the specific clotting factor deficiencies required to produce an equivalent effect. Clotting factor concentration curves were constructed for clotting factors II, V, and VII through XII using assayed reference plasma (ARP) diluted with specific factor-deficient plasmas (FDP). Prothrombin times and partial thromboplastin times were measured as appropriate for each factor at test temperatures ranging from 37 degrees to 25 degrees C using a modified fibrometer. The clotting times for each temperature with undiluted ARP were compared with the clotting times at 37 degrees C obtained with FDP dilution. Hypothermia at temperatures below 33 degrees C produces a coagulopathy that is functionally equivalent to significant (< 50% of normal activity) factor-deficiency states under normothermic conditions, despite the presence of normal clotting factor levels. | |||||
| Jolly, B.T. & Ghezzi, K.T. | Accidental hypothermia. [Abstract] |
1992 | Emerg Med Clin North Am Vol. 10(2), pp. 311-327 |
article | |
| Abstract: Hypothermia continues to be a major public health problem and a challenge to health care providers. The very young, the very old, and the poor are at greatest risk. Life-threatening physiologic changes make rapid rewarming mandatory. Numerous rewarming methods have been described in the literature; the decision to use any of the methods available depends on the degree of hypothermia present, the condition of the patient, and the rewarming rate possible with the method chosen. Cardiopulmonary bypass, if available, is the optimal method for rewarming the severely hypothermic patient. | |||||
| Jones, A.I. & Swann, I.J. | Prolonged resuscitation in accidental hypothermia: use of mechanical cardio-pulmonary resuscitation and partial cardio-pulmonary bypass. [Abstract] |
1994 | Eur J Emerg Med Vol. 1(1), pp. 34-36 |
article | |
| Abstract: We report a case of profound accidental hypothermia with asystolic cardiac arrest which was reversed after 5.5 hours of mechanical cardio-pulmonary resuscitation. Rewarming was achieved by the use of partial cardio-pulmonary bypass. | |||||
| Junge, M., Anders, S., Weckmüller, J., Seigert, D. & Gehl, A. | Injury patterns in hypothermia induced disorientation: three case reports. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 233-241 | incollection | |
| Jurkovich, G.J., Greiser, W.B., Luterman, A. & Curreri, P.W. | Hypothermia in trauma victims: an ominous predictor of survival. [Abstract] |
1987 | J Trauma Vol. 27(9), pp. 1019-1024 |
article | |
| Abstract: Hypothermia in trauma patients is generally considered an ominous sign, although the actual temperature at which hypothermia affects survival is ill defined. In this study, the impact of body core hypothermia on outcome in 71 adult trauma patients with Injury Severity Scores (ISS) greater than or equal to 25 was analyzed. Forty-two per cent of the patients had a core temperature (Tc) below 34 degrees C, 23% below 33 degrees C, and 13% below 32 degrees C. The mortality of hypothermia patients was consistently greater than those who remained warm, regardless of index core temperature. Mortality if Tc less than 34 degrees C = 40 less than 33 degrees C = 69 less than 32 degrees C = 100 whereas mortality if Tc greater than or equal to 34 degrees C = 7 and greater than or equal to 32 degrees C = 10 Mortality and the incidence of hypothermia increased with higher ISS, massive fluid resuscitation, and the presence of shock. Within each subgroup (i.e., greater ISS, massive fluid administration, shock) the mortality of hypothermic patients was significantly higher than those who remained warm. No patient whose core temperature fell below 32 degrees C survived. | |||||
| Kangas, E., Niemelä, H. & Kojo, N. | Treatment of hypothermic circulatory arrest with thoracotomy and pleural lavage. [Abstract] |
1994 | Ann Chir Gynaecol Vol. 83(3), pp. 258-260 |
article | |
| Abstract: We describe a successful case of severe hypothermia due to coldwater immersion. An eight-year-old boy was saved from cold water (4 degrees C) after forty minutes. Open rewarming and resuscitation was performed by thoracotomy and pleural lavage for cardiac arrest due to the low core temperature (25 degrees C). The patient recovered primarily well without any postoperative complications. The follow-up of two years shows good state of physical health but some neuropsychological defects disturbing normal progress in school work. | |||||
| Karhunen, U. & Cozanitis, D.A. | Hypothermia diagnosed as near-drowning in a child. [Abstract] |
1983 | J R Soc Med Vol. 76(11), pp. 967-969 |
article | |
| Abstract: [extract] Hypothermia may be overlooked in apparent near-drowning. We report a patient who was originally diagnosed and treated for immersion, but it later became obvious that the problem was accidental acute hypothermia. Case report On 15 April 1981, an 18-month-old girl dressed in warm clothing wandered away from her home and fell through an ice-covered ditch into some 15 cm of water. According to the Finnish Meteorological Institute, the temperature then was + 2°C. It is believed that the child had been submerged some 15 minutes before her mother, seeing one foot protruding from the ditch, pulled her out and ... | |||||
| Kaufman, J.W., Hamilton, R., Dejneka, K.Y. & Askew, G.K. | Comparative effectiveness of hypothermia rewarming techniques: radio frequency energy vs. warm water. [Abstract] |
1995 | Resuscitation Vol. 29(3), pp. 203-214 |
article | |
| Abstract: The purpose of this study was to compare the rewarming effectiveness of a radio frequency coil (13.56 MHz) at a specific absorption rate (SAR) of 2.5 W/kg (RF) with warm water immersion (40 degrees C) (WW) and an insulated mummy-type insulating sack (IS) under simulated field conditions. Four male subjects, ages 24-35, were immersed in 10 degrees C water for up to 90 min or until their rectal temperatures (Tre) decreased to 35 degrees C. Each subject had 3 trials in which they were immersed. After each immersion, rewarming was accomplished with either RF, WW, or IS, so that each subject was rewarmed once with each method. Comparisons of the 3 rewarming methods were based on the rate of increase of Tre during rewarming (Tre/t), Tre 60 min after the start of rewarming (Tre60), the time-interval measured from extraction from the water to the end of afterdrop (tad), and the magnitude of any observed Tre afterdrop (Tad). WW had significantly greater Tre/t and Tre60 than either RF or IS (P < 0.03) and a smaller tad than IS (P < 0.05). IS had significantly greater Tad than either WW or RF (P < 0.05). No significant differences in Tre/t, Tre60, or tad were observed between IS and RF. The results of this study indicate that for mildly hypothermic individuals, active rewarming with RF at a SAR of 2.5 W/kg is less effective than WW and roughly equivalent to passive rewarming with IS. | |||||
| Keatinge, W.R. | Hypothermia: dead or alive? [Abstract] |
1991 | BMJ Vol. 302(6767), pp. 3-4 |
article | |
| Abstract: [extract] At this time of year exposure on the hills, cold immersion, or collapse induced by alcohol may all cause hypothermia in healthy people. Whether they do so depends greatly on the individual's internal insulation from subcutaneous fat and on recent carbohydrate intake. Such intake is particularly important in preventing alcohol induced hypothermia, caused by thermoregulatory failure due to hypoglycaemia. The principles of treating simple hypothermia remain straightforward and generally uncontroversial for victims who still have a carotid pulse and respiration, however slow and difficult these may be to detect. External rewarming in the horizontal position by warm air, or ... | |||||
| Kellersmann, M., Tank, S., Böhm, D., Preponis-Bode, E., Goetz, A. & Fiege, M. | [Resuscitation lasting several hours for severe hypothermia] [Abstract] |
2009 | Notfall Rettungsmed Vol. 12(7), pp. 534-536 |
article | DOI |
| Abstract: We report the case of a 46-year-old man who was found in a ditch, alcohol intoxicated, hypothermic and somnolent. The ambient temperature was around 0°C. During the rescue operation the cardiac rhythm degenerated into ventricular fibrillation. Cardiopulmonary resuscitation (CPR) was started and the patient transported to a nearby hospital and later on to the closest university medical center. The patient was transferred to the operating theatre 190 min after the beginning of CPR for rewarming on extracorporeal circulation. The core temperature at that time was 24.7°C. At 30.3°C an attempt at defibrillation resulted in a stable sinus rhythm and the patient was referred to the intensive care unit with mild hypothermia. The patient demonstrated a complete neurological recovery after extubation on day 3. | |||||
| Kelly, K.J., Glaeser, P., Rice, T.B. & Wendelberger, K.J. | Profound accidental hypothermia and freeze injury of the extremities in a child. [Abstract] |
1990 | Crit Care Med Vol. 18(6), pp. 679-680 |
article | |
| Abstract: [extract] Accidental hypothermia is a significant cause of morbidity and mortality in pediatric and elderly populations. The depth of hypothermia is often inversely related to survival, with most deaths occurring at a body temperature <32°C and when environmental temperature is | |||||
| Kempainen, R.R. & Brunette, D.D. | The evaluation and management of accidental hypothermia. [Abstract] |
2004 | Respir Care Vol. 49(2), pp. 192-205 |
article | |
| Abstract: Accidental hypothermia is defined as an unintentional decrease in core body temperature to below 35 degrees C. Hypothermia causes hundreds of deaths in the United States annually. Victims of accidental hypothermia present year-round and in all climates with a potentially confusing array of signs and symptoms, but increasing severity of hypothermia produces a predictable pattern of systemic organ dysfunction and associated clinical manifestations. The management of hypothermic patients differs in several important respects from that of euthermic patients, so advance knowledge about hypothermia is prerequisite to optimal management. The paucity of randomized clinical trials with hypothermic patients precludes creation of evidence-based treatment guidelines, but a clinically sound management strategy, tailored to individual patient characteristics and institutional expertise and resources, can nonetheless be gleaned from the literature. This article reviews the epidemiology, pathophysiology, clinical presentation, and treatment of accidental hypothermia. Initial evaluation and stabilization, selection of a rewarming strategy, and criteria for withholding or withdrawing support are discussed. | |||||
| Kernbach-Wighton, G. & Saternus, K.-S. | On the postmortem biochemical diagnosis of hypothermia. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 221-229 | incollection | |
| Khalil, A.A., Aziz, F.A. & Hall, J.C. | Reperfusion injury. [Abstract] |
2006 | Plast Reconstr Surg Vol. 117(3), pp. 1024-1033 |
article | DOI |
| Abstract: The restoration of blood flow to ischemic tissues causes additional damage, which is termed reperfusion injury. All tissues are susceptible to reperfusion injury, but this susceptibility varies between tissues. Reperfusion has wide clinical relevance. It influences the outcome of patients after myocardial infarction, stroke, organ transplantation, and cardiovascular surgery. Advances in the treatment of reperfusion injury have created an opportunity for plastic surgeons to apply these treatments to flaps and reimplanted tissues. The main putative mechanisms identified in animal models involve leukocyte-endothelium interactions, reactive oxygen species, and the complement system. However, it has become evident that these fundamental biological systems are controlled by many interrelated pathways. Attempts to bypass this complexity have led to a search for the early "upstream" initiating events, rather than the "downstream" cascading events. This contrasts with current clinical efforts that are directed toward hypothermia, intraarterial flushing, and preconditioning. This article outlines the molecular and cellular events that occur during reperfusion injury and then reviews the efforts that have been made to exploit this knowledge for clinical advantage. | |||||
| Khalil, H.H. & MacKeith, R.C. | A simple method of raising and lowering body temperature. [Abstract] |
1954 | Br Med J Vol. 2(4890), pp. 734-736 |
article | |
| Abstract: [extract] While studying the effects of stress in hypothermic rats it was noted that at a body temperature of 20° C. the pituitary response was inhibited and that of the adrenal cortex was much reduced (Khalil, 1954). With these small animals changes in body temperature could be effected readily; when dogs and rabbits have been made hypothermic, rewarming by the external application of heat takes much longer than with rats, and this delay may have contributed to the death of some of the animals. The introduction of warm water into the stomach could provide a simple and rapid method ... | |||||
| Kinoshita, K., Utagawa, A., Ebihara, T., Furukawa, M., Sakurai, A., Noda, A., Moriya, T. & Tanjoh, K. | Rewarming following accidental hypothermia in patients with acute subdural hematoma: case report. [Abstract] |
2006 | Acta Neurochir Suppl Vol. 96, pp. 44-47 |
article | |
| Abstract: A 57-year-old man was admitted to the Emergency and Critical Care Department with accidental hypothermia (31.5 degrees C) after resuscitation from cardiopulmonary arrest (CPA). Brain CT revealed an acute subdural hematoma. Active core rewarming to 33 degrees C was performed using an intravenous infusion of warm crystalloid. The patient underwent craniotomy soon after admission, with bladder temperature maintained at 33 to 34 degrees C throughout the surgery. Therapeutic hypothermia (34 degrees C) was continued for 2 days, followed by gradual rewarming. After rehabilitation, the patient was able to continue daily life with assistance. Traumatic brain injury (TBI) following CPA is associated with extremely unfavorable outcomes. Very few patients with acute subdural hematomas presenting with accidental hypothermia and CPA have been reported to recover. No suitable strategies have been clearly established for the rewarming performed following accidental hypothermia in patients with TBI. Our experience with this patient suggests that therapeutic hypothermia might improve the outcome in some patients with severe brain injury. It also appears that the method used for rewarming might play an important role in the therapy for TBI with accidental hypothermia. | |||||
| Kirk, U. & Duus, L. | Hypothermia. first aid for victims of cold at sea. | 1995 | BIMCO Bulletin Vol. 90(2), pp. 47-49 |
article | |
| Kirsch, K.A. & Gunga, H.-C. | Physiological aspects of accidental hypothermia (AHT). | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 43-54 | incollection | |
| Kirsch, U. | Experimentelle Untersuchungen zum Herzflimmern bei Unterkühlung. | 1968 | Überleben auf See; Rahmenthema: neue Wege des Tieftauchens und der Tiefseeforschung. Marinemedizinisch-Wissenschaftliches Symposium (2nd : 1968 : Kiel)., pp. 151-158 | incollection | |
| Kjaergaard, B. & Bach, P. | Warming of patients with accidental hypothermia using warm water pleural lavage. [Abstract] |
2006 | Resuscitation Vol. 68(2), pp. 203-207 |
article | DOI |
| Abstract: In all, five patients with accidental hypothermia below 32 degrees C are described. All were unconscious and in mortal danger, but with an intact circulation. The youngest was 11 years and the oldest 85 years of age. The two oldest patients suffered from critical hypothermia only, while the other cases were complicated by other trauma and drug poisoning. All were warmed using pleural lavage with warm saline. All were discharged to their own homes neurologically intact. | |||||
| Kjaergaard, B., Tølbøll, P., Lyduch, S. & Trautner, S. | A mobile system for the treatment of accidental hypothermia with extracorporeal circulation. [Abstract] |
2001 | Perfusion Vol. 16(6), pp. 453-459 |
article | |
| Abstract: When deep accidental hypothermia causes circulatory failure, the best chance of survival is treatment with extracorporeal circulation (ECC) and warming of the blood. This may be difficult to achieve if the patient is first admitted to a hospital without a department of thoracic surgery. Our aim was to test a lightweight mobile system for ECC. The equipment could be transported almost anywhere, making it possible to start ECC on the spot and during transfer. The system was tested on six hypothermic pigs, two of the pigs at the institute laboratory, two of the pigs in a normal ambulance, and two of the pigs in an air force rescue helicopter. All of the pigs were transported back to the institute for warming to normal temperature. After warming, and the ECC stopped, all the pigs were in sinus rhythm and had an obviously satisfactory circulation. It is possible to bring a lightweight ECC system to the unstable patient. Treatment is possible in any hospital, ambulance or helicopter. | |||||
| Kjaergaard, B., Yoshida, K., Christensen, T. & Tosato, M. | Ordinary surface ECG electrodes accurately reflect cardiac electric activity at hypothermia. [Abstract] |
2008 | Eur J Emerg Med Vol. 15(5), pp. 256-260 |
article | DOI |
| Abstract: BACKGROUND: It has been claimed that needle electrodes can be a useful means to detect weak ECG signals in cases of accidental hypothermia. METHODS: Four pigs were cooled by immersion in ice water, followed by direct cooling of the blood through an extracorporeal circulation system until the core temperature was lowered to 12 degrees C and surface-measured ECG indicated asystole. Following cooling, the pigs were rewarmed and weaned from extracorporeal circulation if possible. ECG and interelectrode impedance were measured between surface electrodes, needle electrodes and electrodes sewn to the epicardium during the cooling and rewarming procedure. RESULTS: Needle and surface electrodes showed exactly the same ECG whatever the temperature of the skin or the core was. The impedance varied only slightly with temperature and could not explain the disappearance of surface ECG. The QRS wave amplitude showed the greatest sensitivity to temperature, disappearing completely before the P-wave disappeared. The P-wave showed the least sensitivity, and was the last wave to disappear, indicating that the sinus node is the most resistant part of the heart to cooling. Between 19 and 17 degrees C, a commercial monitor indicated asystole although P-waves could be seen in the ECG and atrial contractions could be visually observed on the heart. CONCLUSION: Surface electrodes had a similar high accuracy to indicate electric activity as needle electrodes. Higher amplification and reduction of the timebase made it possible to detect ECG in a situation where asystole was indicated by commercial monitors. | |||||
| Kloeck, W., Cummins, R.O., Chamberlain, D., Bossaert, L., Callanan, V., Carli, P., Christenson, J., Connolly, B., Ornato, J.P., Sanders, A. & Steen, P. | Special resuscitation situations: an advisory statement from the International Liaison Committee on Resuscitation. [Abstract] |
1997 | Circulation Vol. 95(8), pp. 2196-2210 |
article | |
| Abstract: [extract] Background. Children who require basic life support (BLS) and advanced life support (ALS) interventions account for 5% to 10% of all ambulance runs and approximately one quarter of emergency department visits in the United States. The principles, equipment, and drugs used for pediatric BLS and ALS are similar to those used for adults. However, the care of seriously ill or injured children requires specific knowledge of pediatric anatomy, physiology, and psychology plus practical pediatric expertise. Key Interventions to Prevent Arrest. In infants and children, respiratory distress and failure is a much more common cardiac arrest etiology than sudden dysrhythmia ... | |||||
| Klöss, T. | Pathophysiologie, Diagnose und Behandlung akzidenteller Unterkühlungen - Teil 2. | 1983 | Anaesthesiol Intensivmed Vol. 24(2), pp. 43-50 |
article | |
| Knoch, M., Kwee, M. & Lennartz, H. | [Successful therapy of accidental deep hypothermia] [Abstract] |
1984 | Anasth Intensivther Notfallmed Vol. 19(3), pp. 133-135 |
article | |
| Abstract: A case of extreme accidental hypothermia to 23,5 degrees rectal temperature in a 79 years old female with a skull-brain-trauma is reported. Under continuous monitoring and maintenance of vital functions, we succeeded by means of slow surface rewarming in prevention of noxious side effects on the circulatory system. The favourable course during the rewarming process probably was due to elimination of thermoregulation in brain trauma. The patient had a good longterm out-come. | |||||
| Kobbe, P., Lichte, P., Wellmann, M., Hildebrand, F., Nast-Kolb, D., Waydhas, C. & Oberbeck, R. | [Impact of hypothermia on the severely injured patient.] [Abstract] |
2009 | Unfallchirurg Vol. 112(12), pp. 1055-1061 |
article | DOI |
| Abstract: Accidental hypothermia is a common complication in severely injured patients. Risk factors include environmental exposure of the patient at the accident site or in the clinic, infusion of cold fluids, hemorrhagic shock and anesthetics which influence thermoregulation. In contrast to animal studies, human studies and clinical experiences have identified accidental hypothermia of the severely injured patient to be associated with increased complication and mortality rates. As a consequence, hypothermia together with acidosis and coagulopathy, have been coined the lethal triad in severely injured patients. On a cellular level hypothermia reduces cellular activity and metabolism resulting in reduced oxygen consumption, which is therapeutically used in patients following cardiac arrest. However, the activity of important enzymes, such as those of the coagulation pathway, is simultaneously down regulated. Hypothermia-induced coagulopathy, which is refractory to substitution of coagulation factors, is a major complication of hypothermia in traumatized patients. Therefore, hypothermic trauma patients with hemodynamic instability require aggressive rewarming. | |||||
| Kober, A., Scheck, T., Fülesdi, B., Lieba, F., Vlach, W., Friedman, A. & Sessler, D.I. | Effectiveness of resistive heating compared with passive warming in treating hypothermia associated with minor trauma: a randomized trial. [Abstract] |
2001 | Mayo Clin Proc Vol. 76(4), pp. 369-375 |
article | |
| Abstract: OBJECTIVES: To determine the occurrence of hypothermia in patients with minor trauma, to test the hypotheses that resistive heating during transport is effective treatment for hypothermia and that this treatment reduces patients' thermal discomfort, pain, and fear, and to evaluate the accuracy of oral temperatures obtained at the scene of injury. PATIENTS AND METHODS: In December 1999 and January 2000, 100 patients with minor trauma were randomly assigned to passive warming or resistive heating. All patients were covered with a carbon-fiber resistive warming blanket and a wool blanket, but the warming blanket was activated only in those assigned to resistive heating. Core (tympanic membrane) and oral temperatures, heart rate, pain, fear, and overall satisfaction of patients were compared between the 2 groups on arrival at a hospital. RESULTS: Hypothermia was noted in 80 patients at the time of rescue. Mean initial core temperatures were 35.4 degrees C (95% confidence interval [CI], 35.2 degrees C - 35.6 degrees C) in the patients who received passive warming and 35.3 degrees C (95% CI, 35.1 degrees C - 35.5 degrees C) in those who received resistive heating. From the time of rescue until arrival at the hospital, mean core temperature decreased 0.4 degrees C/h (95% CI, 0.3 degrees C/h - 0.5 degrees C/h) with passive warming, whereas it increased 0.8 degrees C/h (95% CI, 0.7 degrees C/h - 0.9 degrees C/h) with resistive heating. Oral and tympanic membrane temperatures were similar. Mean heart rate decreased 23 beats/min in those assigned to resistive heating but remained unchanged in those assigned to passive warming. Patients in the resistive heating group felt warmer, had less pain and anxiety, and overall were more satisfied with their care. CONCLUSIONS: Oral temperatures are sufficiently accurate for field use. Hypothermia is common even in persons with minor trauma. Resistive heating during transport augments thermal comfort, increases core temperature, reduces pain and anxiety, and improves overall patient satisfaction. | |||||
| Koch, P. | Unterkühlung im Seenotfall. Bericht über das Symposium vom 25.- 27.4.1980 in Cuxhaven. | 1981 | , pp. 132 | book | |
| Koch, P. & Kohfahl, M. | Unterkühlung im Seenotfall. 2. Symposium 22.- 24. April 1982 Cuxhaven. | 1982 | , pp. 295 | book | |
| Kochanek, P.M. & Safar, P.J. | Therapeutic hypothermia for severe traumatic brain injury. [Abstract] |
2003 | JAMA Vol. 289(22), pp. 3007-3009 |
article | DOI |
| Abstract: [extract] HYPOTHERMIA HAS BEEN RECOMMENDED IN THE treatment of severe traumatic brain injury (TBI) since at least the 1800s. By the mid 1960s, moderate hypothermia (28°C-32°C) had become part of the routine treatment of patients with severe TBI in a number of centers worldwide. 8 However, by the early 1980s, moderate hypothermia for TBI had fallen out of favor because of infectious complications associated with its prolonged and uncontrolled use. In contrast, hypothermia has remained an accepted treatment for refractory intracranial hypertension in both adults and children. In the 1990s, there was renewed interest in the application of mild (33°C-36°C) hypothermia ... | |||||
| Koller, R. | Deep accidental hypothermia: therapeutic experiences by using forced air. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 257-261 | incollection | |
| Koller, R., Schnider, T.W. & Neidhart, P. | Deep accidental hypothermia and cardiac arrest--rewarming with forced air. [Abstract] |
1997 | Acta Anaesthesiol Scand Vol. 41(10), pp. 1359-1364 |
article | |
| Abstract: BACKGROUND: During the last two cold winters we have treated 5 severely hypothermic patients (temperature below 30 degrees C) with active external rewarming rather than with extracorporal circulation and heat exchanger. PATIENTS: Two patients were found in cardiac arrest, and 3 victims of mountain accidents suffered deep hypothermia without arrest. In one of them, ventricular fibrillation (VF) was converted successfully to a sinus rhythm at a core temperature of 25.9 degrees C. Both arrested patients developed an adequate hemodynamic state during resuscitation although they were at very low temperature. All the patients were warmed with a convective cover inflated with warm air of about 38 degrees C (Bair Hugger). The core temperature increased by approximately 1 degree C/h in all patients. During rewarming we observed neither an initial drop of the core temperature (afterdrop) nor cardiac arrhythmias. The outcome of all 5 patients was good without neurological sequelae. CONCLUSION: We conclude that external rewarming with forced air is a feasible alternative to cardiopulmonary bypass in severely hypothermic patients with electrical activity. This method can be used even in patients with VF because defibrillation can be successfully performed in deep hypothermia. Although after-drop during external rewarming is feared, we did not observe this phenomenon. Rewarming with forced air is inexpensive, easy to perform and direct access to the patient is possible at any time. It does not require heparinisation and can be used in hospitals where they do not have cardiopulmonary bypass facilities. Thus, this method is particularly useful in situations when the hypothermic patient cannot be transferred to a major medical center. | |||||
| Komatsu, S., Shimomatsuya, T., Kobuchi, T., Nakajima, M., Amaya, H., Konishi, S., Shiraishi, S., Ono, S. & Maruhashi, K. | Severe accidental hypothermia successfully treated by rewarming strategy using continuous venovenous hemodiafiltration system. [Abstract] |
2007 | J Trauma Vol. 62(3), pp. 775-776 |
article | DOI |
| Abstract: [extract] Accidental hypothermia is a serious condition, often with fatal consequences. Several active internal rewarming modalities have been described in its management. However, currently, there is no worldwide consensus concerning severity staging and rewarming strategy according to the severity of hypothermia. We report here a case of accidental hypothermia in which continuous venovenous hemodiafiltration (CVVHDF) in combination with a convective air warmer was successfully used as a rewarming technique. We present it with a review of the literature. CASE REPORT. A 48-year-old Japanese man was admitted in coma, with severe hemodynamic derangement, bradypnea (SpO2 85%), anemia (Hb 11.2 g/dL), a ... | |||||
| Kondratiev, T.V., Flemming, K., Myhre, E.S.P., Sovershaev, M.A. & Tveita, T. | Is oxygen supply a limiting factor for survival during rewarming from profound hypothermia? [Abstract] |
2006 | Am J Physiol Heart Circ Physiol Vol. 291(1), pp. H441-H450 |
article | DOI |
| Abstract: It has been postulated that unsuccessful resuscitation of victims of accidental hypothermia is caused by insufficient tissue oxygenation. The aim of this study was to test whether inadequate O2 supply and/or malfunctioning O2 extraction occur during rewarming from deep/profound hypothermia of different duration. Three groups of rats (n = 7 each) were used: group 1 served as normothermic control for 5 h; groups 2 and 3 were core cooled to 15 degrees C, kept at 15 degrees C for 1 and 5 h, respectively, and then rewarmed. In both hypothermic groups, cardiac output (CO) decreased spontaneously by > 50% in response to cooling. O2 consumption fell to less than one-third during cooling but recovered completely in both groups during rewarming. During hypothermia, circulating blood volume in both groups was reduced to approximately one-third of baseline, indicating that some vascular beds were critically perfused during hypothermia. CO recovered completely in animals rewarmed after 1 h (group 2) but recovered to only 60% in those rewarmed after 5 h (group 3), whereas blood volume increased to approximately three-fourths of baseline in both groups. Metabolic acidosis was observed only after 5 h of hypothermia (15 degrees C). A significant increase in myocardial tissue heat shock protein 70 after rewarming in group 3, but not in group 2, indicates an association with the duration of hypothermia. Thus mechanisms facilitating O2 extraction function well during deep/profound hypothermia, and, despite low CO, O2 supply was not a limiting factor for survival in the present experiments. | |||||
| Kondratiev, T.V., Myhre, E.S.P., Simonsen, O., Nymark, T.-B. & Tveita, T. | Cardiovascular effects of epinephrine during rewarming from hypothermia in an intact animal model. [Abstract] |
2006 | J Appl Physiol Vol. 100(2), pp. 457-464 |
article | DOI |
| Abstract: Rewarming from accidental hypothermia is often complicated by "rewarming shock," characterized by low cardiac output (CO) and a sudden fall in peripheral arterial pressure. In this study, we tested whether epinephrine (Epi) is able to prevent rewarming shock when given intravenously during rewarming from experimental hypothermia in doses tested to elevate CO and induce vasodilation, or lack of vasodilation, during normothermia. A rat model designed for circulatory studies during experimental hypothermia and rewarming was used. A total of six groups of animals were used: normothermic groups 1, 2, and 3 for dose-finding studies, and hypothermic groups 4, 5, and 6. At 20 and 24 degrees C during rewarming, group 4 (low-dose Epi) and group 5 (high-dose Epi) received bolus injections of 0.1 and 1.0 microg Epi, respectively. At 28 degrees C, Epi infusion was started in groups 4 and 5 with 0.125 and 1.25 microg/min, respectively. Group 6 served as saline control. After rewarming, both CO and stroke volume were restored in group 4, in contrast to groups 5 and 6, in which both CO and stroke volume remained significantly reduced (30. Total peripheral resistance was significantly higher in group 5 during rewarming from 24 to 34 degrees C, compared with groups 4 and 6. This study shows that, in contrast to normothermic conditions, Epi infused during hypothermia induces vasoconstriction rather than vasodilation combined with lack of CO elevation. The apparent dissociation between myocardial and vascular responses to Epi at low temperatures may be related to hypothermia-induced myocardial failure and changes in temperature-dependent adrenoreceptor affinity. | |||||
| Kopsa, H., Zazgornik, J., Schmidt, P., Pall, H., Pok, S.J., Bayer, P.M., Balcke, P. & Pils, P. | [Acute kidney failure in hypothermia] [Abstract] |
1977 | Schweiz Med Wochenschr Vol. 107(27), pp. 942-947 |
article | |
| Abstract: Two cases with acute renal failure after prolonged hypothermia are presented. Both patients were found in come, became rapidly uremic and required hemodilaysis treatment. Although the laboratory findings were typical of severe muscle damage, e.g. elevated levels of serum creatinine phosphokinase, serum lactic dehydrogenase and serum aldolase activities, visible "crush-injuries" were not found. Acute renal failure was characterized by extreme catabolism and severe metabolic acidosis. After 4 and 10 hemodialyses respectively, the patients became polyuric and finally were discharges with normal renal and muscle function. Hypotension with diminished renal perfusion and nontraumatic rhabdomyolysis due to prolonged hypothermia are regarded as the dominant pathogenetic factors in the acute renal failure. | |||||
| Kornberger, E. & Mair, P. | Important aspects in the treatment of severe accidental hypothermia: the Innsbruck experience. [Abstract] |
1996 | J Neurosurg Anesthesiol Vol. 8(1), pp. 83-87 |
article | |
| Abstract: The purpose of this paper is to review important aspects in the treatment of accidental hypothermia, based on our own experience in rewarming 55 patients with severe accidental hypothermia and a core temperature < 30 degrees C. We used three different methods of rewarming, adjusted to the patients' hemodynamics: airway rewarming, warmed fluids and insulation in patients with stable hemodynamics (group 1, n = 24), peritoneal dialysis in patients with unstable hemodynamics (group 2, n = 7) and extracorporeal circulation in patients with cardiocirculatory arrest (group 3, n = 24). Survival rates were 100% (group 1), 72% (group 2) and 13% (group 3) retrospectively. Published data supporting our strategy and alternative approaches are reviewed. The method used to rewarm a patient with severe accidental hypothermia should be adjusted to the hemodynamic status. The prognosis is excellent in patients in whom no hypoxic event precedes hypothermia and no serious underlying disease exists. | |||||
| Kornberger, E., Schwarz, B., Lindner, K.H. & Mair, P. | Forced air surface rewarming in patients with severe accidental hypothermia. [Abstract] |
1999 | Resuscitation Vol. 41(2), pp. 105-111 |
article | |
| Abstract: Methods of rewarming patients with severe accidental hypothermia remain controversial. This paper reports our experience with the use of forced air rewarming in patients with severe accidental hypothermia and a body core temperature below 30 degrees C. Fifteen hypothermic patients (body core temperature 24-30 degrees C) were successfully treated with forced air rewarming to a body core temperature above 35 degrees C (mean rewarming rate 1.7 degrees C/h, range from 0.7 to 3.4 degrees C/h). An afterdrop phenomenon was not observed in any of the patients. Nine hypothermic patients (group 1) had no prehospital cardiac arrest, all nine were long-term survivors and made a full recovery. Six patients (group 2) had prehospital cardio circulatory arrest with restoration of spontaneous circulation. None of the group 2 patients survived long-term. Group 1 and group 2 patients did not differ in core temperature (26.6+/-1.6 degrees C group 1 and 27.0+/-1.8 degrees C group 2). Group 2 patients needed catecholamine support during rewarming more frequently (83 versus 22 and had higher lactate levels and lower pH values at all points of observation. In conclusion our preliminary data indicate that forced air rewarming is an efficient and safe method of managing patients with severe accidental hypothermia. The poor outcome of patients with a history of prehospital cardiopulmonary resuscitation is probably due to irreversible ischaemic brain damage in primarily asphyxiated avalanche and near-drowning victims, rather than the consequence of the rewarming method used. | |||||
| Krandick, G. & Mantel, K. | [Drowning accidents in childhood] [Abstract] |
1990 | Fortschr Med Vol. 108(28), pp. 527-530 |
article | |
| Abstract: This is a report on five boys aged between 1 and 5 years who, after prolonged submersion in cold water, were treated at our department. On being taken out of the water, all the patients were clinically dead. After 1- to 3-hour successful cardiopulmonary resuscitation, with a rectal temperature of about 27 degrees C, they were rewarmed at a rate of 1 degree/hour. Two patients died within a few hours after the accident. One patient survived with an apallic syndrome, 2 children survived with no sequelae. In the event of a water-related accident associated with hypothermia, we consider suitable resuscitation to have preference over rewarming measures. The most important treatment guidelines and prognostic factors are discussed. | |||||
| Kristensen, G., Drenck, N.E. & Jordening, H. | Simple system for central rewarming of hypothermic patients. | 1986 | Lancet Vol. 2(8521-22), pp. 1467-1468 |
article | |
| Kristensen, G., Gravesen, H., Benveniste, D. & Jordening, H. | An oesophageal thermal tube for rewarming in hypothermia. [Abstract] |
1985 | Acta Anaesthesiol Scand Vol. 29(8), pp. 846-848 |
article | |
| Abstract: Five dogs were cooled externally with ice-bags to rectal temperatures of 21.8-24.8 degrees C. Rewarming was performed with a specially constructed double-lumen oesophageal tube with circulating water at 42 degrees C. With this device, rewarming of the dogs to 30 degrees C took place in 60-102 min (mean 82 min). Up to a temperature of 31 degrees C (the "cardiac safety temperature"), the rise in blood temperature was 4.5 degrees C/h +/- 0.79 (s.d.). Calculation of a "rewarming efficiency index" showed an inverse relationship between surface area and temperature rise per hour. The efficiency of this rewarming method is comparable to that of peritoneal dialysis. No after-drop in temperature was observed and there were no other complications during these experiments. Rewarming with an oesophageal thermal tube is very simple and safe to use. | |||||
| Kristensen, G., Gravesen, H. & Jordening, H. | Internal rewarming in hypothermia using a specially constructed gastro-oesophageal tube. A non-invasive method. | 1984 | Acta Anaesthesiol Belg Vol. 35 Suppl, pp. 175-177 |
article | |
| Kristensen, G., Guldager, H. & Gravesen, H. | Prevention of peroperative hypothermia in abdominal surgery. [Abstract] |
1986 | Acta Anaesthesiol Scand Vol. 30(4), pp. 314-316 |
article | |
| Abstract: It is important to reduce or prevent heat loss during anaesthesia, especially in patients with restricted cardiopulmonary reserves. To test a specially developed esophageal thermal tube (GK-esophageal thermal tube) for this purpose, 33 patients were randomly divided into two groups: Group A were given heat transferred to the central core during operation, using the GK-tube with circulating 41.7 degrees C warm water. Group B received no active warming. All patients were scheduled for major abdominal operation. In both groups there was a temperature fall in the induction phase. In Group B the temperature continued to fall slowly during operation, resulting in a median end-temperature of 34.9 degrees C. In Group A the temperature rose slowly after induction of heat via the tube, resulting in a median end-temperature of 36.8 degrees C in this actively warmed group. The temperature difference is significant (P less than 0.001). The median operating time was 3h 30 min in both groups. After 2 h of anaesthesia the median temperature in Group A was 36.1 degrees C and in Group B 35.0 degrees C. This difference is also significant (P less than 0.001). The described method was easy to use and without complications. We recommend this method to prevent peroperative hypothermia in all patients suspected to have limited cardiopulmonary reserves. The possible hazards and how to avoid these are described. | |||||
| Kröll, W., Matzer, C., Schalk, H.V. & Tscheliessnigg, K.H. | [Deep accidental hypothermia (24 degrees C). A case report] [Abstract] |
1988 | Anasth Intensivther Notfallmed Vol. 23(6), pp. 330-333 |
article | |
| Abstract: A 65 year old female patient was submitted to the ICU in deep accidental hypothermia, due to lying in cold water after intoxication with Melperon. Body temperature after submission was 24 degrees C; therefore rewarming was done by an extracorporal bypass. After successful rewarming, the further posttraumatic course was free of complications and the patient could be discharged 14 days after the event. | |||||
| Kudo, R., Adachi, J., Uemura, K., Maekawa, T., Ueno, Y. & Yoshida, K. | Lipid peroxidation in the rat brain after CO inhalation is temperature dependent. [Abstract] |
2001 | Free Radic Biol Med Vol. 31(11), pp. 1417-1423 |
article | |
| Abstract: We reported previously that 7-hydroperoxycholesterols, 7 alpha- and 7 beta-hydroperoxycholest-5-en-3 beta-ol (7 alpha-OOH and 7 beta-OOH), indicated lipid peroxidation. In the present study, we measured not only 7-hydroperoxycholesterols but also oxysterols (7 alpha- and 7 beta-hydroxycholesterol, 7 alpha-OH, and 7 beta-OH) and 3 beta-hydroxycholest-5-en-7-one (7-keto) in the brains of rats that underwent either a sham operation (control), hypoxia, or CO inhalation (1005 ppm) at 37 degrees C for 90 min followed by 48 h of recovery. The levels of 7-hydroperoxycholesterols, 7 beta-OH, and 7-keto were low in the hypoxia group, while the levels were unaltered in the CO group compared with the controls. Among the three groups of CO inhalation, these levels were high in the hyperthermia group (39 degrees C), and the 7-hydroperoxycholesterols were low in the hypothermia group (32 degrees C), compared with the control group. The blood O(2) saturation was almost normal in the hypothermia group, while it was similarly low in the hyperthermia and normothermia groups. The temperature-dependent lipid peroxidation in the brain after CO inhalation and recovery can not be explained by hypoxia due to CO-hemoglobin formation, but may contribute to the delayed neuronal death following CO inhalation. Hypothermia may be applicable to treat patients after CO inhalation. | |||||
| Kugelberg, J., Schüller, H., Berg, B. & Kallum, B. | Treatment of accidental hypothermia. | 1967 | Scand J Thorac Cardiovasc Surg Vol. 1(2), pp. 142-146 |
article | |
| Kulkarni, R.G. & Thomas, S.H. | Severe accidental hypothermia: the need for prolonged aggressive resuscitative efforts. | 1999 | Prehosp Emerg Care Vol. 3(3), pp. 254-259 |
article | |
| Kumle, B., Döring, B., Mertes, H. & Posival, H. | [Resuscitation of a near-drowning patient by the use of a portable extracorporeal circulation device] [Abstract] |
1997 | Anasthesiol Intensivmed Notfallmed Schmerzther Vol. 32(12), pp. 754-756 |
article | |
| Abstract: We report on a 21-year old patient who nearly drowned in cold water under inexplicable circumstances. About 1/2 hour later he was found with cardiac arrest. Immediate cardiopulmonary resuscitation remained unsuccessfully but was continued. After transportation to the nearest hospital a core temperature of 26.1 degrees C was recorded. A team of our hospital arrived 2 1/2 hours after start of cardiopulmonary resuscitation. After introducing a femo-femoral bypass the patient was rapidly rewarmed and oxygenated using a portable extracorporeal circulation and membrane oxygenation. Defibrillation succeeded at a core temperature of 34.4 degrees C. A severe ARDS developed the same day which was successfully treated by membrane oxygenation. 41 days later the patient left the hospital fully recovered. | |||||
| Kunze, S., Hacke, W. & Schwab, S. | [Clinical Course and Therapy of Severe Ischemic Stroke] | 1999 | Dtsch Arztebl Vol. 96(42), pp. A-2670 |
article | URL |
| Abstract: We report on the clinical findings and therapeutical options in patients with severe ischemic stroke. The prognosis of the so- called "malignant middle cerebral artery infarction” can be established by neuroradiological and clinical examinations within the first hours after stroke. Despite optimal medical therapy this syndrome carries a mortality of 80 per cent and more. Two new therapeutical modalities, induced moderate hypothermia and decompressive surgery, can reduce mortality and improve clinical outcome. | |||||
| Kurz, A., Sessler, D.I. & Lenhardt, R. | Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. [Abstract] |
1996 | N. Engl. J. Med. Vol. 334(19), pp. 1209-1215 |
article | |
| Abstract: BACKGROUND. Mild perioperative hypothermia, which is common during major surgery, may promote surgical-wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension. Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen. Hypothermia also directly impairs immune function. We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization. METHODS. Two hundred patients undergoing colorectal surgery were randomly assigned to routine intraoperative thermal care (the hypothermia group) or additional warming (the normothermia group). The patient's anesthetic care was standardized, and they were all given cefamandole and metronidazole. In a double-blind protocol, their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks; wounds containing culture-positive pus were considered infected. The patients' surgeons remained unaware of the patients' group assignments. RESULTS. The mean (+/- SD) final intraoperative core temperature was 34.7 +/- 0.6 degrees C in the hypothermia group and 36.6 +/- 0.5 degrees C in the normothermia group (P < 0.001) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia (19 percent) but in only 6 of 104 patients assigned to normothermia (6 percent, P = 0.009). The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia (P = 0.002), and the duration of hospitalization was prolonged by 2.6 days (approximately 20 percent) in hypothermia group (P = 0.01). CONCLUSIONS. Hypothermia itself may delay healing and predispose patients to wound infections. Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations. | |||||
| KYCD | Sicher an Bord ... | 2005 | , pp. 72 | booklet | |
| Kyriacou, P.A. | Pulse oximetry in the oesophagus. [Abstract] |
2006 | Physiol Meas Vol. 27(1), pp. R1-35 |
article | DOI |
| Abstract: Pulse oximetry has been one of the most significant technological advances in clinical monitoring in the last two decades. Pulse oximetry is a non-invasive photometric technique that provides information about the arterial blood oxygen saturation (SpO(2)) and heart rate, and has widespread clinical applications. When peripheral perfusion is poor, as in states of hypovolaemia, hypothermia and vasoconstriction, oxygenation readings become unreliable or cease. The problem arises because conventional pulse oximetry sensors must be attached to the most peripheral parts of the body, such as finger, ear or toe, where pulsatile flow is most easily compromised. Since central blood flow may be preferentially preserved, this review explores a new alternative site, the oesophagus, for monitoring blood oxygen saturation by pulse oximetry. This review article presents the basic physics, technology and applications of pulse oximetry including photoplethysmography. The limitations of this technique are also discussed leading to the proposed development of the oesophageal pulse oximeter. In the majority, the report will be focused on the description of a new oesophageal photoplethysmographic/SpO(2) probe, which was developed to investigate the suitability of the oesophagus as an alternative monitoring site for the continuous measurement of SpO(2) in cases of poor peripheral circulation. The article concludes with a review of reported clinical investigations of the oesophageal pulse oximeter. | |||||
| Köpcke, J., Westphal, B. & Benad, G. | [Successful resuscitation of a hypothermic patient with extracorporeal circulation--a case report] [Abstract] |
1996 | Anaesthesiol Reanim Vol. 21(6), pp. 159-162 |
article | |
| Abstract: A case of cardiopulmonary arrest due to accidental hypothermia and its successful therapy is described. A 46-year-old man with deep accidental hypothermia (25.3 degrees C esophageal) was found outside showing respiratory and cardiac arrest. Resuscitation was immediately started and continuously performed during the transport to the University Hospital of Rostock, where a treatment with extracorporeal circulation was possible. After cardiopulmonary resuscitation for 120 minutes, the patient could finally be connected to the extracorporeal circulation. Over a period of 130 minutes the patient could be rewarmed up to a body temperature of 36.0 degrees C. The following therapy was complicated by the development of an alcoholic delirium, which was treated by clomethiazol, droperidol and clonidin infusion. After seven days of intensive therapy, he recovered completely and could be transferred from the intensive care unit to the department of psychiatry without neurological deficits showing only healing of frostbite of the feet. Based on this case report, the use of extracorporeal circulation for adequate rewarming in combination with cardiopulmonary resuscitation is described. Compared to other therapeutic measures such as peritoneal dialysis or veno-venous haemofiltration treatment with extracorporeal circulation is the method of choice. | |||||
| Küster-Kaufmann, M., Ebeling, B.J., Clusmann, H. & Schultheiss, R. | [Accidental severe hypothermia and cranio-cerebral trauma: resuscitation, anesthesiological management and neurosurgical intervention cerebral preotection through hypothermia?] | 1996 | Anaesthesiol Intensivmed Vol. 37, pp. 565-572 |
article | |
| Labitzke, R., Pröbsting, H. & Schwerdt, R. | Körperkernerwärmung bei hochgradig Unterkühlten mittels Hämofiltration. | 1986 | Dtsch Arztebl Vol. 35(7), pp. 391-393 |
article | |
| Larach, M.G. | Accidental hypothermia. [Abstract] |
1995 | Lancet Vol. 345(8948), pp. 493-498 |
article | |
| Abstract: [extract] When individuals without intrinsic thermoregulatory dysfunction experience decreases in core temperatures below 35°C during cold exposure they have accidental hypothermia. As core temperature drops below 30°C, treatment becomes imperative to prevent death from cardiopulmonary arrest. In the US, annual age-adjusted death rates from accidental hypothermia range from 2-2 to 4-3 per million population (about 780 persons per year). In Ireland, annual death rates from hypothermia are estimated to be as high as 18-1 1 per million population. I have analysed the decision to initiate or continue resuscitation once a hypothermic patient arrives in the hospital emergency department, and ... | |||||
| Laub, G.W., Banaszak, D., Kupferschmid, J., Magovern, G.J. & Young, J.C. | Percutaneous cardiopulmonary bypass for the treatment of hypothermic circulatory collapse. [Abstract] |
1989 | Ann Thorac Surg Vol. 47(4), pp. 608-611 |
article | |
| Abstract: Environmentally induced hypothermia has a very high mortality. Cardiopulmonary bypass affords the best chance of survival from hypothermia but can be time-consuming to institute. We have utilized percutaneous cardiopulmonary bypass with recently developed bypass catheters to resuscitate a patient with profound hypothermia complicated by circulatory collapse. Percutaneous cardiopulmonary bypass appears to be the treatment of choice for profound hypothermia. | |||||
| Launay, J.-C. & Savourey, G. | Cold adaptations. [Abstract] |
2009 | Ind Health Vol. 47(3), pp. 221-227 |
article | |
| Abstract: Nowdays, occupational and recreational activities in cold environments are common. Exposure to cold induces thermoregulatory responses like changes of behaviour and physiological adjustments to maintain thermal balance either by increasing metabolic heat production by shivering and/or by decreasing heat losses consecutive to peripheral cutaneous vasoconstriction. Those physiological responses present a great variability among individuals and depend mainly on biometrical characteristics, age, and general cold adaptation. During severe cold exposure, medical disorders may occur such as accidental hypothermia and/or freezing or non-freezing cold injuries. General cold adaptations have been qualitatively classified by Hammel and quantitatively by Savourey. This last classification takes into account the quantitative changes of the main cold reactions: higher or lower metabolic heat production, higher or lesser heat losses and finally the level of the core temperature observed at the end of a standardized exposure to cold. General cold adaptations observed previously in natives could also be developed in laboratory conditions by continuous or intermittent cold exposures. Beside general cold adaptation, local cold adaptation exists and is characterized by a lesser decrease of skin temperature, a more pronounced cold induced vasodilation, less pain and a higher manual dexterity. Adaptations to cold may reduce the occurrence of accidents and improve human performance as surviving in the cold. The present review describes both general and local cold adaptations in humans and how they are of interest for cold workers. | |||||
| Lazar, H.L. | The treatment of hypothermia. [Abstract] |
1997 | N. Engl. J. Med. Vol. 337(21), pp. 1545-1547 |
article | |
| Abstract: [extract] The leading causes of accidental hypothermia in urban medical centers in the United States are exposure due to alcoholism, drug addiction, or mental illness and accidents involving immersion in cold water.1 Accidental hypothermia is classified as mild (body temperature, 32.2 to 35°C), moderate (temperature, 28 to <32.2°C), or severe (temperature, <28°C)2 and results in multiple systemic derangements that lead to decreased tissue oxygenation. These include depressed myocardial contractility, a shift in the oxyhemoglobin dissociation curve to the left, vasoconstriction, ventilation–perfusion mismatches, and increased blood viscosity. These disturbances lead to circulatory collapse, which results in lactic acidosis, hepatic and renal ... | |||||
| Ledingham, I.M., Douglas, I.H., Routh, G.S. & Macdonald, A.M. | Central rewarming system for treatment of hypothermia. [Abstract] |
1980 | Lancet Vol. 1(8179), pp. 1168-1169 |
article | |
| Abstract: [extract] A new method of rewarming hypothermic patients has been studied in the laboratory, and has been used successfully in one patient. The system consists of a modified Sengstaken tube through which Ringer lactate solution is circulated in the oesophageal and gastric balloons at 41°C. In this way the central organs are rewarmed before the peripheral tissues. LABORATORY STUDIES. EIGHT greyhound dogs (mean weight 26 kg) were anaesthetised and ventilated with oxygen-enriched air to achieve normal blood-gas values. Central (rectal), blood, and peripheral (skin) temperatures were monitored; the electrocardiogram (ECG) and arterial pressure were displayed continuously and cardiac output was ... | |||||
| Ledingham, I.M. & Mone, J.G. | Treatment of accidental hypothermia: a prospective clinical study. [Abstract] |
1980 | Br Med J Vol. 280(6222), pp. 1102-1105 |
article | |
| Abstract: A 15-year prospective study was carried out of 44 patients with accidental hypothermia (mean age 60 years) admitted to an intensive therapy unit. The lowest core temperature recorded in each patient ranged from 20.0 to 34.3 degrees C. The precipitating factors were poisoning (by drugs, alcohol, or coal gas) in 25 cases and various illnesses in 19. Rewarming was achieved in 42 patients by applying a radiant heat cradle over the torso, and in two patients by mediastinal irrigation with warmed fluids. Twelve patients died, but only two during the period of rewarming. Thus rewarming may be consistently and safely achieved irrespective of the cause of hypothermia, and normal body temperature may be regained as rapidly as is compatible with adequate tissue perfusion and oxygenation. Surface rewarming of the torso is perhaps the simplest technique available, but internal rewarming procedures may be desirable or essential in the presence of, for example, profound hypothermia, severe hypotension, or ventricular fibrillation. Mortality was attributable to underlying factors or disease and not to hypothermia. | |||||
| Leftheriotis, G., Savourey, G., Saumet, J.L. & Bittel, J. | Finger and forearm vasodilatatory changes after local cold acclimation. [Abstract] |
1990 | Eur J Appl Physiol Occup Physiol Vol. 60(1), pp. 49-53 |
article | |
| Abstract: To determine the vascular changes induced by local cold acclimation, post-ischaemia and exercise vasodilatation were studied in the finger and the forearm of five subjects cold-acclimated locally and five non-acclimated subjects. Peak blood flow was measured by venous occlusion plethysmography after 5 min of arterial occlusion (PBFisc), after 5 min of sustained handgrip at 10% maximal voluntary contraction (PBFexe), and after 5 min of both treatments simultaneously (PBFisc + exe). Each test was performed at room temperature (25 degrees C, SE 1 C) (non-cooled condition) and after 5 min of 5 degrees C cold water immersion (cooled condition). After the cold acclimation period, the decrease in skin temperature was more limited in the cold-acclimated compared to the non-acclimated (P less than 0.01). The PBFisc was significantly reduced in the cooled condition only in the cold-acclimated subjects (finger: 8.4 ml.100 ml-1.min-1, SE 1.1, P less than 0.01; forearm: 5.8 ml.100 ml-1.min-1, SE 1.5, P less than 0.01) compared to the non-cooled condition. Forearm PBFexe was significantly decreased in the cooled condition only in the cold-acclimated subjects (non-cooled: 7.4 ml.100 ml-1.min-1, SE 1.2; cooled: 3.9 ml.100 ml-1.min-1, SE 2.6, P less than 0.05) indicating that muscle blood flow was also reduced.(ABSTRACT TRUNCATED AT 250 WORDS) | |||||
| Leitz, K.H., Tsilimingas, N., Güse, H.G., Meier, P. & Bachmann, H.J. | [Accidental drowning with extreme hypothermia--rewarming with extracorporeal circulation] [Abstract] |
1989 | Chirurg Vol. 60(5), pp. 352-355 |
article | |
| Abstract: A 3 1/2 year old boy had fallen into a fishpond. After about one hour the boy was brought to our hospital. He was cyanotic and bloated, the rectal temperature was 18.4 degrees C. There was no heart beat, the pupils were wide without reaction to light. Via a sternotomy the heart lung machine was connected and core rewarming was achieved. After 7 days of artificial respiration the boy could be extubated, after 16 days the boy left our hospital without neurological consequences. | |||||
| Letsou, G.V., Kopf, G.S., Elefteriades, J.A., Carter, J.E., Baldwin, J.C. & Hammond, G.L. | Is cardiopulmonary bypass effective for treatment of hypothermic arrest due to drowning or exposure? [Abstract] |
1992 | Arch Surg Vol. 127(5), pp. 525-528 |
article | |
| Abstract: Various techniques have been advocated for resuscitation from hypothermic arrest caused by ice-cold freshwater drowning or exposure. We have resuscitated five such patients after emergency hospital admission using cardiopulmonary bypass initiated via median sternotomy. All patients presented to our facility with core temperatures less than 26 degrees C. Three patients had been in full cardiopulmonary arrest for more than 30 minutes prior to arrival. The fourth patient presented in ventricular fibrillation; the fifth was admitted to the hospital in sinus bradycardia that quickly deteriorated to asystole. All had cardiopulmonary bypass emergently initiated via median sternotomy. All were rewarmed on bypass to 37 degrees C and all survived at least 24 hours. Three of the five patients are currently alive and well with normal neurologic function. Cardiopulmonary bypass is an effective technique for resuscitation after hypothermic arrest due to near drowning and/or exposure. | |||||
| Lexow, K. | Severe accidental hypothermia: survival after 6 hours 30 minutes of cardiopulmonary resuscitation. [Abstract] |
1991 | Arctic Med Res Vol. 50 Suppl 6, pp. 112-114 |
article | |
| Abstract: This report describes a severely hypothermic victim, who was treated with conventional cardiopulmonary resuscitation and conventional rewarming technique using warm-water bags, warm fluids intravenously and peritoneal lavage. This case demonstrates more than any previous report that hypothermic victims with cardiac arrest may survive for many hours if CPR is carried out vigorously until core temperature is raised. 6 hours continuous CPR is, as far as the author knows, the longest reported conventional PCR in a hypothermic victim followed by survival. | |||||
| Light, I.M., Norman, J.N. & Stoddart, M. | Rewarming from immersion hypothermia: reduction of afterdrop. | 1983 | Scott Med J Vol. 28(1), pp. 80-81 |
article | |
| Linder, F. | Accidental hypothermia. | 1988 | Unfallchirurg Vol. 91(12), pp. 536-538 |
article | |
| Lins, M., Petersen, B., Tiroke, A. & Simon, R. | [Reversible electrocardiographic changes in hypothermia] [Abstract] |
2004 | Z Kardiol Vol. 93(8), pp. 630-633 |
article | DOI |
| Abstract: A homeless man with accidental hypothermia showed massive ECG changes on hospital admission. Including sinus bradycardia, AV-block 1 degree, widened QRS complex with Osborne waves and QT prolongation. These changes were slowly but completely reversible after surface rewarming. | |||||
| Lloyd, E.L. | Accidental hypothermia. [Abstract] |
1996 | Resuscitation Vol. 32(2), pp. 111-124 |
article | |
| Abstract: Hypothermia and its management are examined and logical explanations are given for discarding many traditional views. Hypothermia is classified according to physiological changes, and a practical approach is suggested for management. | |||||
| Lloyd, E.L. | Treatment of accidental hypothermia with the Clinitron bed. | 1987 | Anaesthesia Vol. 42(10), pp. 1121-1122 |
article | |
| Lloyd, E.L. | Hypothermia: the cause of death after rescue. | 1984 | Alaska Med Vol. 26(3), pp. 74-76 |
article | |
| Lloyd, E.L. & Croxton, D. | Equipment for the provision of airway warming (insulation) in the treatment of accidental hypothermia in patients. [Abstract] |
1981 | Resuscitation Vol. 9(1), pp. 61-65 |
article | |
| Abstract: [extract] SUMMARY. Equipment is described which will provide airway warming (insulation) for the treatment of accidental hypothermia. The equipment is light, compact and self contained and is therefore suitable for carriage by the rescue services. Equipment is also described which could be carried by groups as part of their first aid equipment. Airway warming as a method of treating accidental hypothermia in young people relies upon preventing the loss of the heat and moisture/heat normally lost through breathing and should maybe be called respiratory insulation. In hospital an electrically heated water bath humidifier provides the necessary warm moist air ... | |||||
| Locher, T., Walpoth, B., Pfluger, D. & Althaus, U. | [Accidental hypothermia in Switzerland (1980-1987)--case reports and prognostic factors] [Abstract] |
1991 | Schweiz Med Wochenschr Vol. 121(27-28), pp. 1020-1028 |
article | |
| Abstract: This retrospective study comprises 234 cases of accidental hypothermia (core temperature less than 35 degrees C) hospitalized in 95 Swiss clinics between 1980 and 1987. The most frequent accidents were alpine (n = 78) in origin, followed by cold exposure after injuries (n = 63) and suicide attempts (n = 43). Hypothermia was induced by cold air in 129 cases and by water in 47 cases. Patients were divided evenly between the degree of hypothermia: 75 mild (32-35 degrees C), 79 moderate (28-32 degrees C) and 66 severe (less than 28 degrees C). Among the survivors the coldest patient had a core temperature of 17.5 degrees C and the longest cardiac arrest with a favourable outcome lasted 4.75 hours. Out of the 234 patients 68 died (29. We assessed all variables relative to outcome, in particular the mechanism of the accident, the mode of cooling, temperature, circulation, age and sex, underlying diseases, rewarming methods, medication and complications during the hospital course. All variables were tested in two multiple regression analysis models (retrospective model n = 181: prospective model n = 128) with regard to significance (p less than 0.05) and survival. Results are expressed with ODD's ratios (OR). The negative survival factors are asphyxia (OR 30), invasive rewarming methods (OR 20), slow rate of cooling (OR 10), asystole on arrival (OR 9), pulmonary edema or ARDS during hospitalization (OR 8), elevated serum potassium (OR 2/mmol/l) and age (OR 1.03/year). The positive survival factors are rapid cooling rate (OR 10), presence of ventricular fibrillation in cardiac arrest patients (OR 9) and presence of narcotics and/or alcohol during hypothermia (OR 5).(ABSTRACT TRUNCATED AT 250 WORDS) | |||||
| Low, A., Herrmann, R. & Störmer, A. | Kälteschutzversuche bei der Bundesmarine in Neustadt/Holstein im April 1982. | 1982 | unpublished | ||
| Luna, G.K., Maier, R.V., Pavlin, E.G., Anardi, D., Copass, M.K. & Oreskovich, M.R. | Incidence and effect of hypothermia in seriously injured patients. [Abstract] |
1987 | J Trauma Vol. 27(9), pp. 1014-1018 |
article | |
| Abstract: Hypothermia is a well recognized consequence of severe injury, even in temperate climates, and the physiologic consequences of hypothermia are known to be detrimental. To analyze the frequency and risk factors for hypothermia and its effect on patient outcome, we prospectively studied 94 intubated injured patients at a regional trauma center during a 16-month period. Esophageal temperature probes were placed in the field or ER and core temperatures (T) were followed for 24 hours or until rewarming. Patients were designated as normothermic (greater than 36 degrees C), mildly hypothermic (34 degrees C-36 degrees C) or severely hypothermic (less than 34 degrees C) based on initial T. The risk factors for hypothermia evaluated included age, severity and location of injuries, blood alcohol level, blood transfusion requirements, and time spent in the field, ER, or OR. The average initial T was 35 degrees C, with no seasonal variation. Injury severity and survival correlated with severe hypothermia. Normothermic patients had an average ISS of 28 with a 78% survival. Severely hypothermic patients had an average ISS of 36 with a 41% survival (p less than 0.05). Patient age strongly correlated with outcome although there was no relationship between age and initial temperature. Sixty-two per cent of patients tested were positive for blood alcohol, and one half were legally intoxicated (BAC greater than 100 mg. However, no consistent correlation was found between alcohol intoxication and initial temperature or patient survival. Blood transfusion requirements paralleled injury severity and patients receiving greater than 10 unit transfusions had significantly lower core temperature (p less than 0.05). The average temperature change was positive in the ER, OR, and ICU with time to rewarming correlating with the aggressiveness of warming measures.(ABSTRACT TRUNCATED AT 250 WORDS) | |||||
| Lurie, K., Voelckel, W., Plaisance, P., Zielinski, T., McKnite, S., Kor, D., Sugiyama, A. & Sukhum, P. | Use of an inspiratory impedance threshold valve during cardiopulmonary resuscitation: a progress report. [Abstract] |
2000 | Resuscitation Vol. 44(3), pp. 219-230 |
article | |
| Abstract: Building upon studies on the mechanism of active compression-decompression (ACD) cardiopulmonary resuscitation, a new inspiratory impedance threshold valve has been developed to enhance the return of blood to the thorax during the decompression phase of CPR. Use of this device results in a greater negative intrathoracic pressure during chest wall decompression. This leads to improved vital organ perfusion during both standard and ACD CPR. Animal and human studies suggest that this simple device increases cardiopulmonary circulation by harnessing more efficiently the kinetic energy of the outward movement of the chest wall during standard CPR or active chest wall decompression. When used in conjunction with ACD CPR during clinical evaluation, addition of the impedance valve resulted in sustained systolic pressures of greater than 100 mmHg and diastolic pressures of greater than 55 mmHg. The new valve may be beneficial in patients in asystole or shock refractory ventricular fibrillation, when enhanced return of blood flow to the chest is needed to 'prime the pump'. The potential long-term benefits of this new valve remain under investigation. | |||||
| Lurie, K., Zielinski, T., McKnite, S. & Sukhum, P. | Improving the efficiency of cardiopulmonary resuscitation with an inspiratory impedance threshold valve. [Abstract] |
2000 | Crit Care Med Vol. 28(11 Suppl), pp. N207-N209 |
article | |
| Abstract: In an effort to improve the efficiency of cardiopulmonary resuscitation (CPR), a new inspiratory impedance threshold valve has been developed to enhance the return of blood to the thorax during the chest decompression phase. This new device enhances negative intrathoracic pressure during chest wall recoil or the decompression phase, leading to improved vital organ perfusion during both standard CPR and active compression-decompression CPR. With active compression-decompression CPR, addition of the impedance threshold valve results in sustained diastolic pressures of >55 mm Hg in patients in cardiac arrest. The new valve shows promise for patients in asystole or shock refractory ventricular fibrillation, when enhanced return of blood flow to the chest is needed to "prime the pump." The potential long-term benefits of this new valve remain under study. | |||||
| Lurie, K.G., Coffeen, P., Shultz, J., McKnite, S., Detloff, B. & Mulligan, K. | Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve. [Abstract] |
1995 | Circulation Vol. 91(6), pp. 1629-1632 |
article | |
| Abstract: BACKGROUND: Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) has recently been demonstrated to provide significantly more blood flow to vital organs during cardiac arrest. To further enhance the effectiveness of this technique, we tested the hypothesis that intermittent impedance to inspiratory gas exchange during the decompression phase of ACD CPR enhances vital organ blood flow. METHODS AND RESULTS: ACD CPR was performed with a pneumatically driven automated compression-decompression device in a porcine model of ventricular fibrillation (VF). Nine pigs were randomized to receive ACD CPR alone, while 8 pigs received ACD CPR plus intermittent impedance to inspiratory gas exchange with a threshold valve set to 40 cm H2O. Results comparing 2 minutes of ACD CPR alone versus ACD CPR with the inspiratory impedance threshold valve (ITV) revealed significantly higher mean (+/- SEM) coronary perfusion pressures (diastolic aortic minus diastolic right atrial pressures) in the ITV (31.0 +/- 2.3 mm Hg) group versus with ACD CPR alone (21 +/- 3.6 mm Hg) (P < .05). Total left ventricular and cerebral blood flows, determined by radiolabeled microspheres, were 0.77 +/- 0.095 and 0.47 +/- 0.06 mL/min per gram, respectively, with ACD CPR plus the ITV versus 0.45 +/- 0.1 and 0.32 +/- 0.016 mL/min per gram, respectively, with ACD CPR alone (P < .05). Similar improvements in the ITV group were observed after 7 minutes of ACD CPR. After 16 minutes of VF and 13 minutes of ACD CPR, 6 of 8 pigs in the ITV group were successfully resuscitated with less than three successive 150-J shocks, whereas only 2 of 9 pigs with ACD CPR alone were resuscitated with equivalent energy levels (P < .02). With up to three additional and successive 200-J shocks, all pigs in the ITV group and 7 of 9 pigs with ACD CPR alone were resuscitated (P = .18). CONCLUSIONS: Intermittent impedance to inspiratory flow of respiratory gases during ACD CPR significantly improves coronary perfusion pressures and vital organ blood flow and lowers defibrillation energy requirements in a porcine model of VF. | |||||
| Lurie, K.G., Mulligan, K.A., McKnite, S., Detloff, B., Lindstrom, P. & Lindner, K.H. | Optimizing standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve. [Abstract] |
1998 | Chest Vol. 113(4), pp. 1084-1090 |
article | |
| Abstract: OBJECTIVES: This study was designed to assess whether intermittent impedance of inspiratory gas exchange improves the efficiency of standard cardiopulmonary resuscitation (CPR). BACKGROUND: Standard CPR relies on the natural elastic recoil of the chest to transiently decrease intrathoracic pressures and thereby promote venous blood return to the heart. To further enhance the negative intrathoracic pressures during the "relaxation" phase of CPR, we tested the hypothesis that intermittent impedance to inspiratory gases during standard CPR increases coronary perfusion pressures and vital organ perfusion. METHODS: CPR was performed with a pneumatically driven automated device in a porcine model of ventricular fibrillation. Eight pigs were randomized to initially receive standard CPR alone, while seven pigs initially received standard CPR plus intermittent impedance to inspiratory gas exchange with a threshold valve set to -40 cm H2O. The compression:ventilation ratio was 5:1 and the compression rate was 80/min. At 7-min intervals the impedance threshold valve (ITV) was either added or removed from the ventilation circuit such that during the 28 min of CPR, each animal received two 7-min periods of CPR with the ITV and two 7-min periods without the valve. RESULTS: Vital organ blood flow was significantly higher during CPR performed with the ITV than during CPR performed without the valve. Total left ventricular blood flow (mean+/-SEM) (mL/min/g) was 0.32+/-0.04 vs 0.23+/-0.03 without the ITV (p<0.05). Cerebral blood flow (mL/min/g) was 20% higher with the ITV (+ITV, 0.23+/-0.02; -ITV, 0.19+/-0.02; p<0.05). Each time the ITV was removed, there was a statistically significant decrease in the vital organ blood flow and coronary perfusion pressure. CONCLUSIONS: Intermittent impedance to inspiratory flow of respiratory gases during standard CPR significantly improves CPR efficiency during ventricular fibrillation. These studies underscore the importance of lowering intrathoracic pressures during the relaxation phase of CPR. | |||||
| Lønning, P.E., Skulberg, A. & Abyholm, F. | Accidental hypothermia. Review of the literature. [Abstract] |
1986 | Acta Anaesthesiol Scand Vol. 30(8), pp. 601-613 |
article | |
| Abstract: The pathophysiology and treatment of accidental hypothermia are discussed. Special attention is paid to the pathophysiologic problems of rewarming. For severely hypothermic patients we would recommend peritoneal dialysis as the method of choice for rewarming in a hospital situation. In a "field situation" passive or slow active rewarming is recommended. | |||||
| MacKenzie, M.A., Aengevaeren, W.R., van der Werf, T., Hermus, A.R. & Kloppenborg, P.W. | Effects of steady hypothermia and normothermia on the electrocardiogram in human poikilothermia. [Abstract] |
1991 | Arctic Med Res Vol. 50 Suppl 6, pp. 67-70 |
article | |
| Abstract: The electrocardiographic changes observed in (short-term) induced and accidental hypothermia are well known. We studied the electrocardiographic effects of steady mild hypothermia in 4 female patients with poikilothermia. 24h Holter recording revealed during mild hypothermia significantly decreased heart rate and prolongation of the QT interval in comparison with normothermia. During hypothermia the short-term heart rate variability and the circadian rhythm of heart rate variability were significantly higher than during normothermia. We conclude that in our patients even mild steady hypothermia induces electrocardiographic alterations. In patients with disorders of thermoregulation one should be on the alert for cardiovascular complications, especially in cold climates. | |||||
| MacLean, D. | Emergency management of accidental hypothermia: a review. [Abstract] |
1986 | J R Soc Med Vol. 79(9), pp. 528-531 |
article | |
| Abstract: [extract] Emergency investigation of hypothermic patients in the Accident & Emergency Department must include X-rays of the chest, especially to detect features of infection, and of the abdomen to show when severe gastric dilatation heralds the danger of inhalation pneumonia. Continuous ECG monitoring is necessary to reveal episodic severe bradycardia necessitating intracardiac pacing as well as to facilitate the immediate recognition of ventricular asystole or fibrillation. Biochemical monitoring is necessary to assist the clinical assessment of fluid and electrolyte requirements and to reveal the need for specific interventions; this should include urea and creatinine, electrolytes, glucose, amylase and arterial blood ... | |||||
| Madea, B., Preuss, J., Henn, V. & Lignitz, E. | Morphological findings in fatal hypothermia and their pathogenesis. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 181-204 | incollection | |
| Madl, C. & Holzer, M. | Brain function after resuscitation from cardiac arrest. [Abstract] |
2004 | Curr Opin Crit Care Vol. 10(3), pp. 213-217 |
article | |
| Abstract: PURPOSE OF REVIEW: In industrial countries the incidence of cardiac arrest is still increasing. Almost 80% of cardiac arrest survivors remains in coma for varying lengths of time and full cerebral recovery is still a rare event. After successful cardiopulmonary resuscitation, cerebral recirculation disturbances and complex metabolic postreflow derangements lead to death of vulnerable neurons with further deterioration of cerebral outcome. This article discusses recent research efforts on the pathophysiology of brain injury caused by cardiac arrest and reviews the beneficial effect of therapeutic hypothermia on neurologic outcome along with the recent approach to prognosticate long-term outcome by electrophysiologic techniques and molecular markers of brain injury. RECENT FINDINGS: Recent experimental studies have brought new insights to the pathophysiology of secondary postischemic anoxic encephalopathy demonstrating a time-dependent cerebral oxidative injury, increased neuronal expression, and activation of apoptosis-inducing death receptors and altered gene expression with long-term changes in the molecular phenotype of neurons. Recently, nuclear MR imaging and MR spectroscopic studies assessing cerebral circulatory recovery demonstrated the precise time course of cerebral reperfusion after cardiac arrest. Therapeutic hypothermia has been shown to improve brain function after resuscitation from cardiac arrest and has been introduced recently as beneficial therapy in ventricular fibrillation cardiac arrest. SUMMARY: Electrophysiologic techniques and molecular markers of brain injury allow the accurate assessment and prognostication of long-term outcome in cardiac arrest survivors. In particular, somatosensory evoked potentials have been identified as the method with the highest prognostic reliability. A recent systematic review of 18 studies analyzed the predictive ability of somatosensory evoked potentials performed early after onset of coma and found that absence of cortical somatosensory evoked potentials identify patients not returning from anoxic coma with a specificity of 100 | |||||
| Mahajan, S.L., Myers, T.J. & Baldini, M.G. | Disseminated intravascular coagulation during rewarming following hypothermia. | 1981 | JAMA Vol. 245(24), pp. 2517-2518 |
article | |
| Mair, P., Kornberger, E., Furtwaengler, W., Balogh, D. & Antretter, H. | Prognostic markers in patients with severe accidental hypothermia and cardiocirculatory arrest. [Abstract] |
1994 | Resuscitation Vol. 27(1), pp. 47-54 |
article | |
| Abstract: The aim of this retrospective study was to investigate whether plasma potassium, pH and activated clotting time (ACT), obtained from a central venous blood sample immediately after admission to hospital, could predict outcome in patients with severe accidental hypothermia and cardiocirculatory arrest. Twenty-two patients rewarmed with cardiopulmonary bypass were studied retrospectively (12 patients after avalanche accidents, seven patients after cold water submersion and three patients after prolonged exposure to cold). In 12 patients stable spontaneous circulation could not be restored. In 10 patients stable spontaneous circulation could be restored. Two of these 10 patients survived long-term. Plasma potassium, central venous pH and ACT were clinically useful prognostic markers in hypothermic arrest victims after avalanche accidents: a plasma potassium value exceeding 9 mmol/l, a pH equal to or less than 6.50 or an ACT exceeding 400 s was seen in patients in whom spontaneous circulation could not be restored. Plasma potassium, central venous pH and ACT were of only limited prognostic value in hypothermic arrest victims following cold water submersion or prolonged exposure to cold. In hypothermic arrest victims after cold water submersion a central venous pH as low as 6.51 on admission did not exclude long-term survival. Moderate and severe hyperkalemia in arrest victims after prolonged exposure to cold need not necessarily indicate postmortem autolysis. A decision to continue or terminate resuscitation cannot be based on laboratory parameters. Nevertheless, our data suggest that plasma potassium, central venous pH and ACT on admission can be used to identify hypothermic arrest victims in whom death preceded cooling. If several hypothermic arrest victims are admitted simultaneously after avalanche accidents, these 3 parameters can help not to waste limited cardiopulmonary bypass facilities for patients with no hope of survival. | |||||
| Mair, P., Kornberger, E. & Hörmann, C. | Accidental hypothermia. | 1995 | Lancet Vol. 345(8956), pp. 1048-1049 |
article | |
| Mair, P., Kornberger, E., Schwarz, B., Baubin, M. & Hoermann, C. | Forward blood flow during cardiopulmonary resuscitation in patients with severe accidental hypothermia. An echocardiographic study. [Abstract] |
1998 | Acta Anaesthesiol Scand Vol. 42(10), pp. 1139-1144 |
article | |
| Abstract: BACKGROUND: The mechanism responsible for the forward blood flow associated with external chest compression is still controversial. Evidence for both blood flow caused by direct cardiac compression and blood flow generated by a general increase in intrathoracic pressure has been found in experimental as well as clinical studies. No data are available concerning the mechanism causing forward blood flow in hypothermic patients undergoing cardiopulmonary resuscitation. Therefore, echocardiographic findings during external chest compression in seven hypothermic arrest victims are reported. METHODS: All transesophageal echocardiographic studies performed at the Anaesthesia department between 1994 and 1997 were reviewed and seven hypothermic patients with transesophageal echocardiography performed during cardiopulmonary resuscitation were identified. RESULTS: An open mitral valve or a circumferential reduction in aortic diameter during the compression phase was found in four of seven patients, indicating that primarily an increase in intrathoracic pressure (thoracic pump mechanism) generated forward blood flow. In three patients, mitral valve closure during external chest compression indicated that direct cardiac compression (cardiac pump mechanism) contributed to forward blood flow. Two patients studied during active compression-decompression cardiopulmonary resuscitation demonstrated enhanced right ventricular filling and aortic valve opening during active decompression of the thorax. CONCLUSIONS: In contrast to normothermic arrest victims, an open mitral valve during external chest compression is a common finding during hypothermia, indicating that thoracic pump mechanism is important for forward blood flow during cardiopulmonary resuscitation in hypothermic arrest victims. Aortic valve opening in two hypothermic arrest victims suggests forward blood flow also during active decompression of the thorax with the Cardiopump. | |||||
| Mair, P., Mair, J., Bleier, J., Waldenberger, F., Antretter, H., Balogh, D. & Puschendorf, B. | Reperfusion after cardioplegic cardiac arrest--effects on intracoronary leucocyte elastase release and oxygen free radical mediated lipid peroxidation. [Abstract] |
1995 | Acta Anaesthesiol Scand Vol. 39(7), pp. 960-964 |
article | |
| Abstract: In experimental animal models reperfusion of ischaemic myocardium causes sequestration of leucocytes within the coronary circulation. Leucocytes contribute to postischaemic myocardial injury by releasing proteolytic enzymes and by generating oxygen free radicals. The aim of this study was to investigate whether leucocytes also contribute to myocardial injury following ischaemia and reperfusion associated with cardioplegic cardiac arrest. Therefore, we studied the release of the proteolytic enzyme elastase and oxygen free radical initiated myocardial lipid peroxidation in coronary sinus blood during reperfusion after cardioplegic cardiac arrest. The elastase-alpha-1-proteinase inhibitor complex and malondialdehyde (a byproduct of myocardial lipid peroxidation) were measured in arterial, central venous and coronary sinus blood samples in 19 patients undergoing elective coronary artery bypass grafting before aortic crossclamping and 1, 5, 10 and 20 m in after aortic declamping. Malondialdehyde concentrations did not increase significantly during the study period, whereas elastase concentrations showed a significant increase during cardiopulmonary bypass in arterial, central venous as well as coronary sinus blood. Neither elastase nor malondialdehyde concentrations in coronary sinus blood differed significantly from arterial or central venous blood at any time point measured. Our data demonstrated increased elastase concentrations during cardiopulmonary bypass, but we did not find enhance intracoronary elastase release or myocardial during cardiopulmonary bypass, but we did not find enhanced intracoronary elastase release or myocardial lipid peroxidation. Our data suggest that patients are sufficiently protected from leucocyte mediated ischaemia reperfusion injury during uncomplicated coronary artery bypass grafting with cardioplegic arrest. | |||||
| Maisch, S., Ntalakoura, K., Boettcher, H., Helmke, K., Friederich, P. & Goetz, A.E. | [Severe accidental hypothermia with cardiac arrest and extracorporeal rewarming. A case report of a 2-year-old child] [Abstract] |
2007 | Anaesthesist Vol. 56(1), pp. 25-29 |
article | DOI |
| Abstract: In patients with severe hypothermia and cardiac arrest, active rewarming is recommended by extracorporeal circulation with cardiopulmonary bypass. The current guidelines for resuscitation of the European Resuscitation Council now include the recommendation regarding patients with hypothermia remaining comatose after initial resuscitation to accomplish an active rewarming only up to a temperature of 32-34 degrees C and to maintain a mild hypothermia for 12-24 h. We report the case of a 2-year-old boy who suffered from severe hypothermia after falling into ice-cold water. On discovery cardiac arrest with asystole was present and the first measured temperature was 23.8 degrees C. Resuscitation led to restoration of spontaneous circulation. The patient was rewarmed by extracorporeal circulation with cardiopulmonary bypass to 33 degrees C then mild hypothermia was maintained for a further 12 h. On the third day after the accident the patient was extubated and after a further 9 days was discharged without any sequelae. | |||||
| Mallet, M.L. | Pathophysiology of accidental hypothermia. [Abstract] |
2002 | QJM Vol. 95(12), pp. 775-785 |
article | |
| Abstract: Accidental hypothermia is an uncommon problem that affects people of all ages, but particularly the elderly. This review briefly outlines the aetiological factors that may predispose to hypothermia, with particular reference to the effects of sepsis, although the specific situation of cold-water immersion is not addressed. A more detailed analysis of the pathophysiology of hypothermia then examines the cardiovascular, haematological, neurological, respiratory, renal, metabolic, and gastrointestinal systems. Clinically relevant findings are highlighted and some associated management points are related to the physiological changes. Most of these changes are reversible on rewarming, and are resistant to pharmacological manipulation; some of the pathological effects are related more to the process of rewarming than to the hypothermia itself. | |||||
| Maresca, L. & Vasko, J.S. | Treatment of hypothermia by extracorporeal circulation and internal rewarming. [Abstract] |
1987 | J Trauma Vol. 27(1), pp. 89-90 |
article | |
| Abstract: The treatment of accidental hypothermia by extracorporeal circulation and internal rewarming can be life saving in patients unconscious from drug overdose or victims of accidental exposure to severe cold. Advantages are the rapidity of treatment, the provision of circulatory support, and a lessened chance of rewarming collapse, since peripheral vasodilation is paralleled by an increase in cardiac output. A premature diagnosis of clinical death was averted in two patients with rectal temperatures of 25 degrees C or below, and their lives were saved by the use of this technique. | |||||
| Martin, T.G. | Neardrowning and cold water immersion. [Abstract] |
1984 | Ann Emerg Med Vol. 13(4), pp. 263-273 |
article | |
| Abstract: Though usually preventable, drowning remains a major cause of accidental death in our society. The lethal common denominator in drowning and neardrowning deaths is hypoxia. Aggressive treatment both at the scene and in the hospital is recommended even in those who initially appear lifeless. Hypothermia and the diving reflex probably explain the incredible survival stories in neardrowning. Remember the maxim in cold water immersion: "One is not dead until warm and dead!" | |||||
| Martineau, L. & Shek, P.N. | Evaluation of a bi-layer wound dressing for burn care I. Cooling and wound healing properties. [Abstract] |
2006 | Burns Vol. 32(1), pp. 70-76 |
article | DOI |
| Abstract: Severe burns remain a significant cause of morbidity and mortality despite the availability of numerous therapies. We assessed the wound healing and skin-cooling properties of a DRDC hydrogel/polyurethane wound dressing using different pre-clinical models. Our results show that 85% of partial-thickness, non-contaminated porcine wounds treated with our dressing healed within 6 days. In contrast, 85% of the wounds treated with commercial dressings healed within 8 days. Application of a moist DRDC dressing (to simulate a condition of exudate absorption) on a scald burn covering 25% of the dorsal area in rats reduced skin temperature by 1.70 +/- 0.14 degrees C for 5 min, the skin temperature being comparable to that of control burned rats after 20 min. The application of a moist DRDC dressing did not induce significant differences in body temperatures compared with that of burned animals without dressing coverage throughout the 90-min experiment. While no change in body temperatures were observed when standard dressings (i.e., not pre-moistened) were applied, skin temperature increased gradually. These data show that our dressing is effective in promoting faster healing of the treated wound; and providing a transient, but beneficial cooling effect to the skin contact-site, without the adverse effect of inducing whole-body hypothermia. | |||||
| Matsushita, Y., Bramlett, H.M., Alonso, O. & Dietrich, W.D. | Posttraumatic hypothermia is neuroprotective in a model of traumatic brain injury complicated by a secondary hypoxic insult. [Abstract] |
2001 | Crit Care Med Vol. 29(11), pp. 2060-2066 |
article | |
| Abstract: OBJECTIVE: Human traumatic brain injury frequently results in secondary complications, including hypoxia. In previous studies, we have reported that posttraumatic hypothermia is neuroprotective and that secondary hypoxia exacerbates histopathologic outcome after fluid-percussion brain injury. The purpose of this study was to assess the therapeutic effects of mild (33 degrees C) hypothermia after fluid-percussion injury combined with secondary hypoxia. In addition, the importance of the rewarming period on histopathologic outcome was investigated. DESIGN: Prospective experimental study in rats. SETTING: Experimental laboratory in a university teaching hospital. INTERVENTION: Intubated, anesthetized rats underwent normothermic parasagittal fluid-percussion brain injury (1.8-2.1 atmospheres) followed by either 30 mins of normoxia (n = 6) or hypoxic (n = 6) gas levels and by 4 hrs of normothermia (37 degrees C). In hypothermic rats, brain temperature was reduced immediately after the 30-min hypoxic insult and maintained for 4 hrs. After hypothermia, brain temperature was either rapidly (n = 6) or slowly (n = 5) increased to normothermic levels. Rats were killed 3 days after traumatic brain injury, and contusion volumes were quantitatively assessed. MEASUREMENTS AND MAIN RESULTS: As previously shown, posttraumatic hypoxia significantly increased contusion volume compared with traumatic brain injury-normoxic animals (p <.02). Importantly, although posttraumatic hypothermia followed by rapid rewarming (15 mins) failed to decrease contusion volume, those animals undergoing a slow rewarming period (120 mins) demonstrated significantly (p <.03) reduced contusion volumes, compared with hypoxic normothermic rats. CONCLUSIONS: These data emphasize the beneficial effects of posttraumatic hypothermia in a traumatic brain injury model complicated by secondary hypoxia and stress the importance of the rewarming period in this therapeutic intervention. | |||||
| Matz, R. | Hypothermia: mechanisms and countermeasures. | 1986 | Hosp Pract (Off Ed) Vol. 21(1A), pp. 45-8, 54-8, 63-71 |
article | |
| McHugh, G.S., Engel, D.C., Butcher, I., Steyerberg, E.W., Lu, J., Mushkudiani, N., Hernández, A.V., Marmarou, A., Maas, A.I.R. & Murray, G.D. | Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. [Abstract] |
2007 | J Neurotrauma Vol. 24(2), pp. 287-293 |
article | DOI |
| Abstract: We determined the relationship between secondary insults (hypoxia, hypotension, and hypothermia) occurring prior to or on admission to hospital and 6-month outcome after traumatic brain injury (TBI). A meta-analysis of individual patient data, from seven Phase III randomized clinical trials (RCT) in moderate or severe TBI and three TBI population-based series, was performed to model outcome as measured by the Glasgow Outcome Scale (GOS). Proportional odds modeling was used to relate the probability of a poor outcome to hypoxia (N = 5661), hypotension ( N = 6629), and hypothermia ( N = 4195) separately. We additionally analyzed the combined effects of hypoxia and hypotension and performed exploratory analysis of associations with computerized tomography (CT) classification and month of injury. Having a pre-enrollment insult of hypoxia, hypotension or hypothermia is strongly associated with a poorer outcome (odds ratios of 2.1 95% CI [1.7-2.6], 2.7 95% CI [2.1-3.4], and 2.2 95% CI [1.6-3.2], respectively). Patients with both hypoxia and hypotension had poorer outcomes than those with either insult alone. Radiological signs of raised intracranial pressure (CT class III or IV) were more frequent in patients who had sustained hypoxia or hypotension. A significant association was observed between month of injury and hypothermia. The occurrence of secondary insults prior to or on admission to hospital in TBI patients is strongly related to poorer outcome and should therefore be a priority for emergency department personnel. | |||||
| McInerney, J.J., Breakell, A., Madira, W., Davies, T.G. & Evans, P.A. | Accidental hypothermia and active rewarming: the metabolic and inflammatory changes observed above and below 32 degrees C. [Abstract] |
2002 | Emerg Med J Vol. 19(3), pp. 219-223 |
article | |
| Abstract: OBJECTIVES: In accidental hypothermia the underlying physiological mechanisms responsible for poor outcome during rewarming through 32 degrees C remain obscure, although possible associations include changes in acid-base balance, divalent cations, and inflammatory markers. This study investigated the metabolic and inflammatory changes that occur during the rewarming of hypothermic patients. METHODS: Eight patients, four men and four women, age 45 to 85 years, admitted with core temperatures <35 degrees C were included in the study. Patients were rewarmed with dry warm blankets and fluid replaced by crystalloid at 40 degrees C. Bloods for pH, ionised calcium (Ca(2+)) and magnesium (Mg(2+)), parathyroid hormone (PTH), interleukin 1 (IL1), interleukin 6 (IL6), tissue necrosis factor alpha (TNFalpha), were collected at presentation, during rewarming, and at 24 hours. RESULTS: Four patients were admitted with mild (32 degrees -35 degrees C) and four with moderate (28 degrees -32 degrees C) hypothermia. Rewarming to 32 degrees C had no significant effect on the presenting acidosis (p=0.1740), although above 32 degrees C pH increased with temperature (p<0.0001). There was a negative correlation between pH and both Ca(2+) (p=0.0005) and Mg(2+) (p=0.0488) below 32 degrees C; above this temperature the relation was significant only for Ca(2+) (p=0.0494). PTH and Ca(2+) correlated positively (p=0.0041) and negatively (p=0.0039) below and above 32 degrees C respectively. There was no relation between IL1 or TNFalpha with Ca(2+) during rewarming, but IL6 and Ca(2+) correlated positively (p=0.0039) and negatively (p=0.0018) when presentation temperature was below and above 32 degrees C respectively. CONCLUSIONS: During rewarming pH remains unchanged until patient temperature approaches 32 degrees C. Ca(2+) and Mg(2+) decline is associated with the pH increase above 32 degrees C. Poor outcome is associated with presentation temperature (<32 degrees C), non-physiological correlation between IL6-PTH-Ca(2+), and age (>or=84 years). | |||||
| Meier, K. | Hypothermia in the avalanche accident - a challenge for the rescue crew. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 153-164 | incollection | |
| Mekjavic, I.B. | Inhalation of warm moist air inhibits shivering thermogenesis. | 1996 | Environmental Ergonomics: recent progress and new frontiers (ICEE: 7th : 1996)., pp. 119-122 | incollection | |
| Menzel-Severing, J., Hering, R. & Schroeder, S. | Präklinisches Notfallmanagement der Unterkühlung - Schnelle Wiedererwärmung verbessert die Prognose. [Abstract] |
2003 | Notfallmed Vol. 29, pp. 514-520 |
article | DOI |
| Abstract: [summary] Every medical rescue assignment should prompt consideration of the possible presence of hypothermia with the aim of initiating effective measures to prevent the negative effects of this condition on the course of the illness or injury. Recovery of a victim requires special care, and often special equipment and additional helpers. When hypothermia is present, prehospital emphasis is on keeping the patient warm and ensuring rapid transport to a suitable hospital with facilities for effective rewarming. The external application of heat requires consideration to be given to associated risks, such as the unmasking of hypovolaemia and cardiac arrhythmias. The diagnosis of cardiac arrest under hypothermia must take account of the special conditions that apply to a cold body. Re-animation algorithms and pharmacotherapy must be adapted to the changed physiological situation caused by the lowered temperature. | |||||
| Merz, M. | Bis zur Erschöpfung: Nachteinsatz im Orkan. | 1994 | MarineForum Vol. 1/2, pp. 18-20 |
article | |
| Metz, C. | [Lactate as an indicator of ischemic-traumatic brain injury] | 1999 | Anasthesiol Intensivmed Notfallmed Schmerzther Vol. 34(4), pp. 239-243 |
article | |
| Meyer, G.-J. | Invasive rewarming methods in severe hypothermia. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 251-256 | incollection | |
| Miles, J.M. & Thompson, G.R. | Treatment of severe accidental hypothermia using the Clinitron bed. [Abstract] |
1987 | Anaesthesia Vol. 42(4), pp. 415-418 |
article | |
| Abstract: Two cases of severe accidental hypothermia (core temperature less than 28 degrees C) rewarmed employing the Clinitron system are described. The physiological changes during hypothermia and rewarming are discussed and the current concepts of rewarming (active external versus internal) outlined. It is suggested that severely hypothermic patients can be successfully treated by rapid external rewarming using the Clinitron heated fluidised-bead bed. This method combines the advantages of rapid rewarming, minimal physiological disturbance and is non invasive. | |||||
| Miller, J.W., Danzl, D.F. & Thomas, D.M. | Urban accidental hypothermia: 135 cases. [Abstract] |
1980 | Ann Emerg Med Vol. 9(9), pp. 456-461 |
article | |
| Abstract: We retrospectively reviewed 135 presentations (114 patients) of urban hypothermia treated at the discretion of the emergency department staff over a nine-year period from February 1971 to March 1980. Rewarming treatment options included passive external, active external, and heated oxygen aerosol administered by mask or intubation. The rates of rewarming were statistically similar for passive external (0.71 C/hr) and heated aerosol via mask (0.74 C/hr). The rate of rewarming for active external methods was 0.90 C/hr. Heated oxygen aerosol using intubation rewarmed the patient at a significantly greater rate than the passive external method (1.22 C/hr) (P < 0.01). The overall mortality rate for the series was 11.9 but 47.9% when serious underlying disease was present. Individual mortality rates were 64.3% for active external (9/14), 7.67% for active core with a mask (1/13), 5.2% for passive external (4/68), and 5.0% for active core with a nasotracheal tube (2/40). Active core rewarming using intubation was selected more frequently with moderate and severe hypothermia (P < 0.001). The group of survivors had a higher mean arrival temperature (31.33 C) than did the non-survivors (27.55 C) (P = 0.01). Active core rewarming with heated aerosolized oygen via nasotraheal tube is a safe technique for the rapid rewarming of selected hypothermic patients. The arrival temperature and the presence of serious underlying disease, in addition to the method of rewarming, appear to be major determinants of prognosis. | |||||
| Mills, W.J. | Summary of treatment of the cold injured patient. Hypothermia. | 1983 | Alaska Med Vol. 25(2), pp. 29-32 |
article | |
| Mitchell, J.W. | Energy exchange during exercise. | 1977 | Problems with temperature regulation during exercise. Proceedings of a symposium held in conjunction with the American College of sports medicine meeting, Anaheim, Calif., May 1976., pp. 11-26 | incollection | |
| Morales, C.F. & Strollo, P.J. | Noncardiogenic pulmonary edema associated with accidental hypothermia. [Abstract] |
1993 | Chest Vol. 103(3), pp. 971-973 |
article | |
| Abstract: The pulmonary system may be significantly affected by hypothermia. The association between NCPE and hypothermia is controversial. A 59-year-old man with mild hypothermia presented with NCPE after passive external rewarming following accidental immersion in water. The patient's course was uneventful after 48 h, allowing immediate withdrawal of assisted ventilation and supplemental oxygen. | |||||
| Morrison, J.B., Conn, M.L. & Hayward, J.S. | Accidental hypothermia: the effect of initial body temperatures and physique on the rate of rewarming. [Abstract] |
1980 | Aviat Space Environ Med Vol. 51(10), pp. 1095-1099 |
article | |
| Abstract: After cooling in sea water, 14 subjects having varied core temperatures were rewarmed by inhalation of saturated air at 44 degrees C. Multiple linear regression analyses were computed for best possible subsets relating rectal and tympanic rewarming rates, phi i (i = R, T), to physiological and anthropometric measures. It was found that there was a good correlation between phi i and metabolic or ventilatory rates (0.61 less than r less than 0.74). Rewarming rates phi i could be more closely predicted by a combination of initial core temperatures and (height/weight)0.5 or by a combination of initial core temperatures and initial skin temperatures (0.75 less than r less than 0.88). The effectiveness of inhalation rewarming has been challenged and experimental studies appear contradictory. It is shown that the different inhalation rewarming rates measured are predictable and can be explained largely in physiological terms. | |||||
| Moss, J. | Accidental severe hypothermia. [Abstract] |
1986 | Surgery, gynecology & obstetrics Vol. 162(5), pp. 501-513 |
article | |
| Abstract: Accidental hypothermia is a health problem with a scope which has been underestimated by the medical community. Limited awareness and limited diagnostic equipment, along with hospital coding inaccuracies, make calculation of the true number of instances of accidental hypothermia nearly impossible. Severe hypothermia occurs when body temperature falls below 28 degrees C. The patient may be unconscious, with such severely depressed vital signs that he appears to be dead. All such patients, regardless of extremis upon presentation, should undergo vigorous cardiopulmonary resuscitation in addition to rewarming, because a reliable determination of death is nearly impossible without the restoration of body temperature. Rewarming must follow the implementation of adequate cardiovascular support, maintaining serum acid base balance, arterial oxygenation and intravascular volume levels within the appropriate physiologic ranges; otherwise, the reawakening of metabolic needs will outpace the recovery of cardiac function, and the patient will die of multiple organ infarction. In addition, standard mechanical or manual CPR can furnish adequate cardiovascular support for the severely failing myocardium. When cardiovascular resuscitation is performed first, followed by rewarming with a continual maintenance of optimum cardiovascular function, then all standard methods of rewarming (external rewarming with a fluid-circulated blanket, peritoneal lavage or partial cardiac bypass) should give equally good results. The preceding guidelines are extrapolated from a retrospective review of available clinical material as well as controlled prospective animal studies. Prospective clinical studies should be performed to confirm the acceptability of these guidelines; an inter-institutional study may be the best way to glean such data and should be considered by researchers interested in this problem. | |||||
| Moss, J.F. | The management of accidental severe hypothermia. | 1988 | N Y State J Med Vol. 88(8), pp. 411-413 |
article | |
| Moss, J.F., Haklin, M., Southwick, H.W. & Roseman, D.L. | A model for the treatment of accidental severe hypothermia. [Abstract] |
1986 | J Trauma Vol. 26(1), pp. 68-74 |
article | |
| Abstract: Central to the controversy that surrounds the treatment of accidental severe hypothermia is the question of how the method of rewarming affects myocardial performance, and therefore survival. We induced severe hypothermia and cardiac arrest in 15 mongrel dogs. Each dog was rewarmed by one of three methods: partial cardiac bypass (Group I); peritoneal dialysis (Group II); or external rewarming with a fluid-circulated blanket (Group III). The cardiac arrest state was supported by partial cardiac bypass in Group I and by standard mechanical cardiopulmonary resuscitation (CPR) in Groups II and III. In all dogs, the hypothermically depressed myocardial performance returned to normal upon rewarming. Groups I and II had similar rewarming times and required similar volumes of crystalloid and bicarbonate solutions to maintain adequate cardiac filling pressures and arterial pH. However, Group III had a significantly slower rewarming time and required significantly greater volumes of crystalloid and bicarbonate solutions. The sole procedural death occurred in Group III. Our results show that partial cardiac bypass, peritoneal dialysis, and the fluid-circulated blanket are equally effective in rewarming severely hypothemic dogs with cardiac arrest, provided that the cardiac arrest is relieved by partial cardiac bypass or standard mechanical CPR and that physiologic levels of intravascular volume, oxygenation, and pH are maintained. | |||||
| Mulpur, A.K., Mirsadraee, S., Hassan, T.B., McKeague, H. & Kaul, P. | Refractory ventricular fibrillation in accidental hypothermia: salvage with cardiopulmonary bypass. [Abstract] |
2004 | Perfusion Vol. 19(5), pp. 311-314 |
article | |
| Abstract: A 20-year old woman presented with prolonged refractory ventricular fibrillation and pulmonary oedema following hypothermia while she was under self-administered heroin in an attempt to commit suicide. She was successfully resuscitated with cardiopulmonary bypass for core rewarming and internal defibrillation. | |||||
| Murphy, K., Nowak, R.M. & Tomlanovich, M.C. | Use of bretylium tosylate as prophylaxis and treatment in hypothermic ventricular fibrillation in the canine model. [Abstract] |
1986 | Ann Emerg Med Vol. 15(10), pp. 1160-1166 |
article | |
| Abstract: We conducted a study to determine if bretylium tosylate (BT) is effective in the prophylaxis and treatment of hypothermic ventricular fibrillation (VF) in the setting of various maneuvers thought to induce this lethal arrhythmia. Twenty-two mongrel dogs were cooled to 24 C after being placed in a cold room. At 24 C, a double-blinded placebo or BT solution was infused. The dogs then were removed from the cold. They underwent the following sequential maneuvers: oral endotracheal extubation and intubation, central line and nasogastric tube placement, vigorous movement, and Swan-Ganz catheter insertion. If VF ensued, arterial blood gases were drawn, and BT was given only if refractory to countershock and epinephrine. Of the dogs that were given placebo, six of 11 (55 fibrillated with manipulation, as compared with one of 11 (9 dogs pretreated with BT (P = .067). Three of the 11 dogs that received BT fibrillated within minutes of its infusion. In the placebo dogs that fibrillated, four required BT and two defibrillated with countershock alone or with epinephrine prior to achieving stable rhythms. | |||||
| Muth, C.-M., Piepho, T. & Schröder, S. | [Water rescue. A unique area of emergency medicine with many facets] [Abstract] |
2007 | Anaesthesist Vol. 56(10), pp. 1047-1057 |
article | DOI |
| Abstract: Emergencies on or in water are relatively rare in the rescue service. For this reason, water accident treatment and management does not receive much attention in the training of emergency medicine physicians. Consequently doctors working in emergency medicine often have minimal knowledge in this area. On the other hand, the number of fatal accidents on and in water has increased in recent years. In Germany the number of non-swimmers is also increasing, so it can be assumed that the number of water-related accidents will continue to rise. Drowning accidents and near drowning are important in this context and will be discussed in detail in this review as well as hypothermia (a frequent problem), accompanying injuries and diving accidents. | |||||
| Mégarbane, B., Axler, O., Chary, I., Pompier, R. & Brivet, F.G. | Hypothermia with indoor occurrence is associated with a worse outcome. [Abstract] |
2000 | Intensive Care Med Vol. 26(12), pp. 1843-1849 |
article | |
| Abstract: OBJECTIVE: To describe patients admitted to intensive care unit (ICU) for hypothermia, evaluate prognostic factors, and test the hypothesis that patients found indoors have a worse outcome. DESIGN AND SETTING: Retrospective clinical investigation in a medical ICU. PATIENTS: Eighty-one consecutive patients admitted to ICU, with a body temperature of 35 degrees C or lower and rewarmed passively or with minimally invasive techniques, over a 17-year period. MEASUREMENTS AND RESULTS: Patients were analyzed by age, gender, and causes of hypothermia and split into two groups (indoors and outdoors), according to the location where hypothermia occurred. Prognostic factors were determined by univariate method and stepwise logistic regression. The major complications were acute renal failure (43 , aspiration pneumonia (22 , rhabdomyolysis (22 , and acute respiratory distress syndrome (12. Principal comorbidities in the outdoor patients (21 were alcohol and drug intoxication, and those in the indoor patients (79 were sepsis and neuropsychiatric disorders. Stepwise logistic regression identified two variables predictive of death: illness severity at admission (SAPS II > or = 40) and the location where hypothermia occurred (indoors versus outdoors). CONCLUSIONS: With equivalent body temperature, patients found indoors were more severely affected and died more frequently than those found outdoors. | |||||
| Mülling, C.K.W. & Rothschild, M.A. | Hypothermia in animals: adaptive strategies, behavioural patterns, cold death. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 55-67 | incollection | URL |
| Nesemann, M.E., Busch, H.M., Gundersen, A.L., Gundersen, A.E. & Newcomer, K.L. | Asystolic cardiac arrest in hypothermia. | 1983 | Wis Med J Vol. 82(1), pp. 19-20 |
article | |
| Niazi, S.A. & Lewis, F.J. | Profound hypothermia in man; report of a case. [Abstract] |
1958 | Ann Surg Vol. 147(2), pp. 264-266 |
article | |
| Abstract: [extract] Introduction. NUMEROUS CASES of accidental hypothermia resulting from exposure of man to cold have been recorded. Recovery from rectal temperatures of 24 to 300 C. (75 to 860 F.) has been reported by many observers, and Laufman reported recovery from a rectal temperature of 180 C. (640 F.), which was the lowest recorded body temperature reached accidentally by man with survival.' Intentional hypothermia at levels between 25 and 300 C. (77-86o F.) has become relatively popular for cardiac surgery during the last few years since it allows total circulatory interruption for a long enough time to do certain operations ... | |||||
| Nicodemus, H.F., Chaney, R.D. & Herold, R. | Hemodynamic effects of inotropes during hypothermia and rapid rewarming. [Abstract] |
1981 | Crit Care Med Vol. 9(4), pp. 325-328 |
article | |
| Abstract: The hemodynamic effects of propranolol, lidocaine, and dopamine were studied in anesthetized, mechanically ventilated dogs, cooled to 25 degrees C with a venovenous shunt through a heat exchanger. After 1 h at 25 degrees C, the shunt was converted to an arteriovenous shunt which remained functional until the study was completed. Before rewarming, the authors treated each group of 8 dogs with intravenous doses of the drugs: group 1: 10 ml saline as control; group 2: propranolol 0.3 mg/kg; group 3: 50 mg lidocaine initially, followed with continuous infusion of 40-50 microgram/kg.min; group 4: dopamine infusion at 12 microgram/kg.min; and group 5: lidocaine as in group 3 and dopamine as in group 4. For the dopamine-treated groups, 2 min of infusion was allowed; in all other groups, 5 min elapsed after injection before the hemodynamic data were recorded. The hemodynamic data were collected at esophageal temperatures of 25, 30, and 37 degrees C. The findings were: (1) hypothermia impaired cardiovascular function; (2) lidocaine and propranolol had minimal hemodynamic effects during hypothermia; lidocaine was physiologically more desirable than propranolol; (3) dopamine, alone or combined with lidocaine, reversed the cardiovascular depression from hypothermia; the improvement was equivalent to rewarming by as much as 5 degrees C; and (4) at the completion of rewarming, cardiovascular recovery was more complete with dopamine/lidocaine-treated animals compared to untreated and propranolol-treated animals. Based on these findings, these inotropes appear to be safe adjuncts to resuscitation during hypothermia. | |||||
| Nielsen, H.K., Toft, P., Koch, J. & Andersen, P.K. | Hypothermic patients admitted to an intensive care unit: a fifteen year survey. [Abstract] |
1992 | Dan Med Bull Vol. 39(2), pp. 190-193 |
article | |
| Abstract: In the period 1975-1989, 620 (4.5 of 13,645 patients admitted to the intensive care unit of a Danish university hospital were diagnosed as suffering from hypothermia. The aim of the retrospective survey carried out is to describe this group of patients and to evaluate the methods used for rewarming. The degree of hypothermia was mild in 554 of the patients, moderate in 60, and severe in six. The rewarming method used was passive rewarming with the use of endogenous heat production. Rewarming was established with a median temperature increment of 0.1 to 2.5 degrees centigrade. The mortality rate showed no relationship to the hypothermia. With the exception of extracorporal circulation, the rewarming and mortality rates did not differ from the results shown in studies carried out using active and invasive rewarming procedures. In conclusion, with the exception of extracorporal circulation, rewarming of hypothermic patients by preservation of the endogenous heat production seems as effective as active and invasive rewarming methods. | |||||
| Nincević, N. & Mlinarić, J. | [Accidental hypothermia with cardiorespiratory arrest. Case report] [Abstract] |
1995 | Lijec Vjesn Vol. 117 Suppl 2, pp. 89-90 |
article | |
| Abstract: A case of an effective cardiopulmonary resuscitation in a 71-year-old woman following drowning in a cold water and cardiopulmonary arrest for at least 20 minutes is presented. Intubation, ventilation with 100% oxygen, external cardiac massage and administration of adrenaline, 1 mg intravenously, were implemented. Ventricular fibrillation, which occurred after adrenaline therapy, responded to electrical defibrillation with 200 J and converted into a sinus rhythm. Metabolic acidosis was corrected by intravenous sodium bicarbonate administration. The patient became gradually conscious, and she was weaned from mechanical respiration after 12 hours. Subsequently, the patient was extubated. There were no neurological deficits. | |||||
| Ning, X.-H., Chen, S.-H., Xu, C.-S., Hyyti, O.M., Qian, K., Krueger, J.J. & Portman, M.A. | Hypothermia preserves myocardial function and mitochondrial protein gene expression during hypoxia. [Abstract] |
2003 | Am J Physiol Heart Circ Physiol Vol. 285(1), pp. H212-H219 |
article | DOI |
| Abstract: Hypothermia before and/or during no-flow ischemia promotes cardiac functional recovery and maintains mRNA expression for stress proteins and mitochondrial membrane proteins (MMP) during reperfusion. Adaptation and protection may occur through cold-induced change in anaerobic metabolism. Accordingly, the principal objective of this study was to test the hypothesis that hypothermia preserves myocardial function during hypoxia and reoxygenation. Hypoxic conditions in these experiments were created by reducing O2 concentration in perfusate, thereby maintaining or elevating coronary flow (CF). Isolated Langendorff-perfused rabbit hearts were subjected to perfusate (Po2 = 38 mmHg) with glucose (11.5 mM) and perfusion pressure (90 mmHg). The control (C) group was at 37 degrees C for 30 min before and 45 min during hypoxia, whereas the hypothermia (H) group was at 29.5 degrees C for 30 min before and 45 min during hypoxia. Reoxygenation occurred at 37 degrees C for 45 min for both groups. CF increased during hypoxia. The H group markedly improved functional recovery during reoxygenation, including left ventricular developed pressure (DP), the product of DP and heart rate, dP/dtmax, and O2 consumption (MVo2) (P < 0.05 vs. control). MVo2 decreased during hypothermia. Lactate and CO2 gradients across the coronary bed were the same in C and H groups during hypoxia, implying similar anaerobic metabolic rates. Hypothermia preserved MMP betaF1-ATPase mRNA levels but did not alter adenine nucleotide translocator-1 or heat shock protein-70 mRNA levels. In conclusion, hypothermia preserves cardiac function after hypoxia in the hypoxic high-CF model. Thus hypothermic protection does not occur exclusively through cold-induced alterations in anaerobic metabolism. | |||||
| Nobel, G., Eiken, O., Tribukait, A., Kölegård, R. & Mekjavic, I.B. | Motion sickness increases the risk of accidental hypothermia. [Abstract] |
2006 | Eur J Appl Physiol Vol. 98(1), pp. 48-55 |
article | DOI |
| Abstract: Motion sickness (MS) has been found to increase body-core cooling during immersion in 28 degrees C water, an effect ascribed to attenuation of the cold-induced peripheral vasoconstriction (Mekjavic et al. in J Physiol 535(2):619-623, 2001). The present study tested the hypothesis that a more profound cold stimulus would override the MS effect on peripheral vasoconstriction and hence on the core cooling rate. Eleven healthy subjects underwent two separate head-out immersions in 15 degrees C water. In the control trial (CN), subjects were immersed after baseline measurements. In the MS-trial, subjects were rendered motion sick prior to immersion, by using a rotating chair in combination with a regimen of standardized head movements. During immersion in the MS-trial, subjects were exposed to an optokinetic stimulus (rotating drum). At 5-min intervals subjects rated their temperature perception, thermal comfort and MS discomfort. During immersion mean skin temperature, rectal temperature, the difference in temperature between the non-immersed right forearm and 3rd finger of the right hand (DeltaTff), oxygen uptake and heart rate were recorded. In the MS-trial, rectal temperature decreased substantially faster (33 P < 0.01). Also, the DeltaTff response, an index of peripheral vasomotor tone, as well as the oxygen uptake, indicative of the shivering response, were significantly attenuated (P < 0.01 and P < 0.001, respectively) by MS. Thus, MS may predispose individuals to hypothermia by enhancing heat loss and attenuating heat production. This might have significant implications for survival in maritime accidents. | |||||
| Norberg, W.J., Agnew, R.F., Brunsvold, R., Sivanna, P., Browdie, D.A. & Fisher, D. | Successful resuscitation of a cold water submersion victim with the use of cardiopulmonary bypass. [Abstract] |
1992 | Crit Care Med Vol. 20(9), pp. 1355-1357 |
article | |
| Abstract: [extract] This report details the use of cardiopulmonary by- pass in the resuscitation of a 7-yr-old boy alters 45-min period of cold water submersion. The use of cardiopulmonary bypass in accidental hypothermia victims has been documented (1). We found only one previous report (2) of cardiopulmonary bypass in the management of a cold water submersion victim. CASE REPORT An 11~yr-old boy fell through the ice of the local Red Riverand disappeared. With the heroic efforts ofthe rescue squad, the victim was found beneath the surface and removed from the water (estimated water temperature was 10°C) 46 mins later. Cardiopulmonary ... | |||||
| Nordrehaug, J.E. | Sustained ventricular fibrillation in deep accidental hypothermia. [Abstract] |
1982 | Br Med J (Clin Res Ed) Vol. 284(6319), pp. 867-868 |
article | |
| Abstract: [extract] We report a case of asthma due to occupational exposure to pigs. The cause of the symptoms was exposure to the urine of the animals. This was proved by provoking acute asthma with an inhalation challenge of an extract of pigs' urine at a concentration of 1 g/l. On a second occasion this asthmatic response was blocked by prior treatment with 40 mg sodium cromoglycate (Intal). The patient's serum contained specific IgE antibody to the urine extract which was not found in unexposed controls. Case report. The patient, a 21-year-old eczematous woman who enjoyed a vigorous sporting life, playing ... | |||||
| Nozaki, R., Ishibashi, K., Adachi, N., Nishihara, S. & Adachi, S. | Accidental profound hypothermia. | 1986 | N. Engl. J. Med. Vol. 315(26), pp. 1680 |
article | |
| O'keeffe, K.M. | Accidental hypothermia: a review of 62 cases. [Abstract] |
1977 | JACEP Vol. 6(11), pp. 491-496 |
article | |
| Abstract: A retrospective review of all patients seen in an urban city-county emergency department over a 32-month period with a primary or associated diagnosis of hypothermia was performed using the emergency department encounter form and the inpatient chart of 62 cases (59 patients) with core temperatures of 35 C (95 F) or below. With this relatively large population, a general conclusion was reached about the presentation and natural history of this interesting entity. This permitted a defensible treatment regimen which is currently employed a this institution and which is offered for institutions in similar settings. The variance in clinical signs, laboratory values, electrocardiographic findings and complications encountered in this study are detailed against the background of a review of the findings of the current literature. | |||||
| Oakley, E. & Francis, T. | Cold injury. [Abstract] |
1996 | A Textbook of Vascular Medicine., pp. 512 | incollection | URL |
| Abstract: [book] Until recently, the main treatment of vascular problems was surgery. Other therapies have now become available which are administered by a new generation of vascular physicians and angiologists. This book presents a comprehensive overview of this subject with emphasis on diagnosis and management. Vascular problems include such common disorders as thrombosis, leg ulcers, diabetes, Raynaud's syndrome, haemorrhage and lymphoedema. Until recently, the main treatment of these disorders was surgery. Now an increasing number of other therapies have become available which are administered by a new generation of vascular physicians and angiologists. This book presents a comprehensive overview of this subject with emphasis on diagnosis and management. | |||||
| Oakley, E.H.N. | The UK National Immersion Incident survey (UKNIIS). | 1997 | Institute of Naval Medicine | booklet | |
| Oakley, E.H.N. & Pethybridge, R.J. | The prediction of survival during cold immersion: results from the UK National Immersion Incident survey. INM Report No. 97011. | 1997 | Institute of Naval Medicine | booklet | |
| Oberhammer, R., Beikircher, W., Hörmann, C., Lorenz, I., Pycha, R., Adler-Kastner, L. & Brugger, H. | Full recovery of an avalanche victim with profound hypothermia and prolonged cardiac arrest treated by extracorporeal re-warming. [Abstract] |
2008 | Resuscitation Vol. 76(3), pp. 474-480 |
article | DOI |
| Abstract: Survival of hypothermic avalanche victims with cardiac arrest is rare. This report describes full recovery of a 29-year-old backcountry skier completely buried for 100 min at 3.0m (9.8 ft) depth. On extrication he was unconscious, but breathing spontaneously into an air pocket; core body temperature measured 22.0 degrees C (71.6 degrees F). He was intubated and ventilated on site. Ventricular fibrillation commenced during helicopter transportation, whereby chest compression was lacking for 15 min. At the nearest hospital continuous cardiopulmonary resuscitation was initiated, but defibrillation failed. Tympanic core body temperature measurement confirmed life-threatening hypothermia of 21.7 degrees C (71.1 degrees F) and serum K(+) was 4.3 mmol/l, necessitating transferral to a hospital with cardiopulmonary bypass facilities. Defibrillation finally succeeded following re-warming, by femoral veno-arterial bypass, to 34.5 degrees C (94.1 degrees F). Total duration of cardiac arrest was 150 min. The patient developed pulmonary oedema, treated by extracorporeal membrane oxygenation, but progressed well and was discharged from hospital on day 17, fit to resume professional and social activities. Follow-up cerebral magnetic resonance imaging 2 years after avalanche burial demonstrated only minimal changes attributable to unrelated, prior cranial trauma. Extensive neurological and psychological investigations gave excellent results. This report confirms previous literature that an air pocket with patent airways is essential for survival of a completely buried avalanche victim after 35 min and endorses the recommended management strategies of the International Commission for Mountain Emergency Medicine ICAR MEDCOM. In particular, all hypothermic victims extricated with an air pocket and free airways must be treated optimistically, even despite prolonged cardiac arrest. This remarkable case documents the fastest drop in core temperature ever recorded during snow burial, namely 9.0 degrees C (16.2 degrees F)/h, and the second-lowest reversible core temperature in avalanche literature. | |||||
| Oehmichen, M. | Hypothermia. Clinical, Pathomorphological and Forensic Features. | 2004 | Vol. 31, pp. 274 |
book | URL |
| Oesterhelweg, L., Klothbach, H. & Püschel, K. | Epidemiological and phenomonological aspects of death from hypothermia. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 105-113 | incollection | URL |
| Okada, M. | The cardiac rhythm in accidental hypothermia. [Abstract] |
1984 | J Electrocardiol Vol. 17(2), pp. 123-128 |
article | |
| Abstract: An analysis of the ECGs from 60 patients with accidental hypothermia reveals several facts concerning rhythmicity. Echocardiograms were useful to determine the precise rhythm in cases without discernible P waves. Atrial fibrillation (AF) was unusual in mild hypothermia (greater than 32.0 degrees C). AF was often observed in moderate (32.0-26.0 degrees C) and moderately deep (less than 26.0 degrees C) hypothermia. However, about half of the cases with moderately deep hypothermia remained in sinus, atrial, or junctional rhythm. AF was usually converted to sinus rhythm without any antiarrhythmic agents soon after normothermia was restored. There was no significant difference in the mortality rate between the AF and non-AF groups. Therefore, no aggressive treatment for this arrhythmia seems to be necessary. | |||||
| Okada, M., Nishimura, F., Yoshino, H., Kimura, M. & Ogino, T. | The J wave in accidental hypothermia. [Abstract] |
1983 | J Electrocardiol Vol. 16(1), pp. 23-28 |
article | |
| Abstract: Electrocardiograms of 50 patients with accidental hypothermia were reviewed with regard to the J wave with the following results: (1) J waves were observed in 40 of 50 cases. (2) J waves were recorded most frequently in leads II or V6 (34 of 40 cases, 85. However, in deep hypothermia, the J wave was often most prominent in leads V3 or V4. (3) The size of the J wave appeared to be related to body temperature. Below 30 degrees C, large J waves were often observed; above 30 degrees C, J waves were usually smaller. (4) J waves were not distinctive in the cases with clockwise rotation. (5) The appearance and the size of the J waves seemed not to be associated with the arterial pH. (6) The J wave decreased in size along with rise of the body temperature. However, a small J wave persisted in many cases even after normothermia was restored. It was also difficult to distinguish these small J waves from small notches at the QRS-ST junction which are sometimes observed in normal individuals not subjected to hypothermia. | |||||
| Oliveira-Filho, J., Ezzeddine, M.A., Segal, A.Z., Buonanno, F.S., Chang, Y., Ogilvy, C.S., Rordorf, G., Schwamm, L.H., Koroshetz, W.J. & McDonald, C.T. | Fever in subarachnoid hemorrhage: relationship to vasospasm and outcome. [Abstract] |
2001 | Neurology Vol. 56(10), pp. 1299-1304 |
article | |
| Abstract: OBJECTIVE: To investigate the causes of fever in subarachnoid hemorrhage (SAH) and examine its relationship to outcome. BACKGROUND: Fever adversely affects outcome in stroke. Patients with SAH are at risk for cerebral ischemia due to vasospasm (VSP). In these patients, fever may be both caused by, and potentiate, VSP-mediated brain injury. METHODS: The authors prospectively studied patients admitted to a neurologic intensive care unit with nontraumatic SAH, documenting Hunt-Hess grade, Fisher group, Glasgow Coma Score, bacterial culture data, daily transcranial Doppler mean velocities, and maximum daily temperatures. Patients were classified as febrile (temperature above 38.3 degrees C for at least 2 consecutive days) or afebrile (no fever or isolated episodes of temperature above 38.3 degrees C). VSP was verified by either transcranial Doppler or angiographic criteria. Rankin scale scores on discharge were dichotomized into good (0 to 2) or poor (3 to 6) outcomes. RESULTS: Ninety-two consecutive patients were studied. Thirty-eight patients were classified as febrile. No source for infection was found in 10 of 38 (26 patients. In a multivariate analysis, three variables independently predicted fever occurrence: ventriculostomy (OR, 8.5 [CI, 2.4 to 29.7]), symptomatic VSP (OR, 5.0 [CI, 1.03 to 24.5]), and older age (OR, 1.75 per 10 years [CI, 1.02 to 3.0]). Poor outcome was related to fever (OR, 1.4 per each day febrile [CI, 1.1 to 1.88]), older age (OR, 1.64 per 10 years [CI, 1.04 to 2.58]), and intubation (OR, 21.8 [CI, 5.6 to 84.5]). CONCLUSION: Fever in SAH is associated with vasospasm and poor outcome independently of hemorrhage severity or presence of infection. | |||||
| Orlowski, J.P. | How much resuscitation is enough resuscitation? | 1992 | Pediatrics Vol. 90(6), pp. 997-998 |
article | |
| Orlowski, J.P. | Drowning, near-drowning, and ice-water submersions. [Abstract] |
1987 | Pediatr Clin North Am Vol. 34(1), pp. 75-92 |
article | |
| Abstract: Drowning is the second most common cause of accidental death in children. Swimming pools and natural bodies of water close to home present the greatest risk to young children. The single most important step in the treatment of submersion accident victims is the immediate institution of resuscitative measures at the earliest possible opportunity. Ice-water submersion accidents are an important subgroup of near-drowning victims, who at times can defy predictions for outcome after profound anoxic-ischemic insults. Drowning accident prevention is an important public health measure. | |||||
| Orlowski, J.P. | Prognostic factors in pediatric cases of drowning and near-drowning. [Abstract] |
1979 | JACEP Vol. 8(5), pp. 176-179 |
article | |
| Abstract: Ninety-three cases of drowning or near-drowning in the pediatric age group between 1972 and 1976 were reviewed. A scoring system for prognostic factors was developed using one point for each of five unfavorable factors involved in the drowning or near-drowning of each patient. The prognostic factors were 1) age less than three years; 2) maximum submersion time estimated longer than five minutes; 3) resuscitation not attempted for at least ten minutes after rescue; 4) patient in coma on admission to hospital, and 5) arterial blood pH of less than or equal to 7.10. This scoring system significantly predicted the eventual outcome of patients who had experienced the postsubmersion syndrome. Patients with scores of less than or equal to 2 had a 90% chance of full recovery; those with scores of greater than or equal to 3 had only a 5% probability of survival. The early institution of resuscitative efforts was the single most important factor influencing survival. | |||||
| Ornato, J.P. | Special resuscitation situations: near drowning, traumatic injury, electric shock, and hypothermia. [Abstract] |
1986 | Circulation Vol. 74(6 Pt 2), pp. IV23-IV26 |
article | |
| Abstract: Special resuscitation situations are cardiopulmonary arrests requiring modification or extension of conventional life support techniques. Significant controversy exists with regard to several aspects of special resuscitation, including whether or not there is a need to clear the airway of a near-drowning victim with the Heimlich maneuver and whether CPR should be initiated in an unmonitored hypothermic patient showing no signs of life. The previous standards and guidelines almost entirely neglected the management of cardiac arrest due to traumatic injury. The conference panel on Special Situations recommended that: the Heimlich maneuver should only be performed on near-drowning victims when the rescuer suspects that foreign matter is obstructing the airway or the victim fails to respond appropriately to mouth-to-mouth ventilation, further investigation is needed to better define the need for, the risks of, and the timing of the Heimlich in the near-drowning victim, there should be an expanded section in the standards and guidelines describing the differences in the management of a victim whose cardiac arrest is due to traumatic injury, CPR is indicated and should be done on a pulseless, unmonitored hypothermic patient in the field, but that a longer time to check for a pulse (up to one minute) may be required, and guidelines that the panel proposed be used for management of the underwater submersion victim in cardiac arrest. | |||||
| Osborne, L., El-Din, A.S.K. & Smith, J.E. | Survival after prolonged cardiac arrest and accidental hypothermia. [Abstract] |
1984 | Br Med J (Clin Res Ed) Vol. 289(6449), pp. 881-882 |
article | |
| Abstract: [extract] In the conventional schedule of immunisation infants are given three doses of oral poliomyelitis vaccine starting at, or after, 6 to 8 weeks of age. In the new pulse immunisation strategy three doses of oral poliomyelitis vaccine are given in annual cycles to children under 24 months of age.' I carried out a study to see whether a lower age limit could be established in this program. Neonates were given one dose of oral poliomyelitis vaccine followed by second and third doses at intervals of four weeks. The seroconversion response in the neonates was as good as the ... | |||||
| Oung, C.M., English, M., Chiu, R.C. & Hinchey, E.J. | Effects of hypothermia on hemodynamic responses to dopamine and dobutamine. [Abstract] |
1992 | J Trauma Vol. 33(5), pp. 671-678 |
article | |
| Abstract: Hemodynamic characteristics, arrhythmogenicity, and dose-related hemodynamic responses to intravenous dopamine (group I) and dobutamine (group II) were examined in 16 swine at three different core body temperatures (38.5 degrees C, 35 degrees C, and 30 degrees C). The animals were anesthetized with isoflurane and mechanically ventilated. Cooling and re-warming were accomplished by a femoral-jugular A-V shunt. The animals were cooled down to 30 degrees C and stabilized for 1 hour before intravenous infusion of dopamine (group I, n = 8) or dobutamine (group II, n = 8) was started at 2, 5, 10, 15, 20, and 30 micrograms/kg/min. Hemodynamic responses to the two inotropes were continuously monitored with a bedside monitor equipped with a PC mode for customized data collection and analysis. Computerized arrhythmia detection was performed. Our findings were: (1) profound hypothermia (30 degrees C) causes significant depression of hemodynamic functions; (2) IV infusion of dopamine and dobutamine can be used safely and effectively for inotropic support during profound hypothermia, and the optimal dosage for improving cardiac output is 10-20 micrograms/kg/min; (3) no risk of inducing arrhythmia was noted with IV infusion of both inotropes up to a maximum dosage of 30 micrograms/kg/min, even though significant sinus tachycardia was consistently seen at 30 micrograms/kg/min. | |||||
| Paton, B.C. | Accidental hypothermia. [Abstract] |
1983 | Pharmacol Ther Vol. 22(3), pp. 331-377 |
article | |
| Abstract: Knowledge of the effects of hypothermia has increased greatly over the past 25 yr. Thousands of patients have been cooled intentionally in the operating room, and hundreds of thousands of living hearts have been temporarily stopped by cold cardioplegia and restarted without difficulty or apparent ill-effect. Yet in spite of the acquisition of this vast body of clinical experience an aura of mystery stills surrounds the patient who becomes hypothermic accidentally. The best treatment in any particular case is not always clear, and published accounts do not always give the impression that the hypothermic patient is treated with the same rational approach with which other sick and comatose patients are treated. In summarizing, therefore, conclusions that might be reached from reviewing past experience several important points emerge. The severely hypothermic patient should be treated in an intensive care unit where appropriate monitoring of temperature, cardiovascular function and respiratory function are available, and where full respiratory support including assisted ventilation can be given. The final outcome depends upon the etiology. The young healthy victim of exposure has a good chance of surviving. The patient poisoned by alcohol or barbiturates has a good chance of surviving provided the level of intoxication is not itself lethal. The elderly without severe underlying disease have a good chance of surviving. The patient with severe underlying disease of the endocrine, cardiovascular or neurologic system probably has, at best, a 50% chance of surviving and, at worst, a chance of only 10-20 depending upon the associated disease. There is no statistical evidence that any one method of rewarming is significantly better than any other. But there is anecdotal evidence that in the absence of full monitoring and support systems slow rewarming is safer than over-energetic external rewarming. Internal rewarming, peritoneal dialysis, hemodialysis, inhalation of warmed oxygen and extracorporeal circulation are effective in severe cases and can be used with safety. The causes of, and triggering mechanism for, ventricular fibrillation are still largely unknown but the onset of ventricular fibrillation in a very cold patient may often be an irreversible complication. The place of modern anti-arrhythmic drugs in the prevention and management of this complication has yet to be elucidated. Cardiopulmonary resuscitation is difficult in profoundly hypothermic patients but should be maintained until a body temperature of 30 degrees C has been achieved.(ABSTRACT TRUNCATED AT 400 WORDS) | |||||
| Pavlic, M., Grubwieser, P. & Rabl, W. | Death in snow avalanches: hypoxia - blunt trauma - hypothermia. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 141-152 | incollection | URL |
| Perry, G. | Wheel-well and cargo compartment temperatures of large aircraft in flight: implications for stowaways. [Abstract] |
2002 | Aviat Space Environ Med Vol. 73(7), pp. 673-676 |
article | |
| Abstract: BACKGROUND: Desperate people sometimes risk journeys as stowaways in aircraft wheel-wells. Some of them survive, despite the risks of being crushed by retracting landing gear, falling when the gear deploys for landing, or experiencing severe hypoxia and hypobaria in-flight. This study evaluates the level of hypothermia to which stowaways in aircraft may be exposed. METHODS: Miniature dataloggers were used to record in-flight temperatures in aircraft wheel-wells and cargo compartments. Temperatures were measured for front and side wheel-wells (FW and SW, respectively) on 36 flights by C-130 aircraft (mean duration 3.3 h, mean cruise altitude 5588 m (18,333 ft)) and 11 flights by C-141 aircraft (6.7 h and 10,744 m (35,250 ft)). RESULTS: Mean minimum temperatures for the C-130 remained above freezing and averaged 5.1 degrees C for FW and 11.9 degrees C for SW. The higher, longer C-141 flights produced temperatures below freezing with mean minimum temperatures of -18.0 degrees C for FW and -12.4 degrees C for SW. In general, temperatures in wheel-wells remained about 20 degrees C above outside air temperature (OAT) at all altitudes. This increase reflects the fact that wheel-wells are closed spaces within the aircraft body, in addition to which they contain sources of heat such as hydraulic lines and electrical equipment. Cargo compartment minimum temperature was relatively high (mean = 18.6 degrees C for commercial airline). A search of the medical literature and lay press produced information on 46 incidents of people found in wheel-wells after landing where there was no evidence of trauma. The 15 survivors had stowed away on relatively short flights (mean = 4.8 h, maximum = 10 h) compared with fatalities (mean = 7.5 h, range = 3-12 h). CONCLUSIONS: Temperatures in wheel-wells during short flights may sustain life. Long flights add severe hypothermia to acute hypoxia and hypobaria as potentially fatal environmental factors faced by wheel-well stowaways. | |||||
| Pickering, B.G., Bristow, G.K. & Craig, D.B. | Case history number 97: core rewarming by peritoneal irrigation in accidental hypothermia with cardiac arrest. [Abstract] |
1977 | Anesth Analg Vol. 56(4), pp. 574-577 |
article | |
| Abstract: [extract] At 0830 hours January 1, 1977 a 20-year- old, lightly clad woman was found outdoors, seemingly dead. Ambient temperature was -36° C. Duration of exposure to cold was unknown. Subsequent history only established the fact that the victim had been consuming alcohol several hours earlier. Shortly after discovery, she was conveyed by ambulance to the emergency unit of the Winnipeg Health Sciences Centre, several minutes away. Ambulance attendants noted several gasping respirations but no other signs of life. Upon arrival in hospital, the patient was clinically dead. She was apneic, had no detectable pulse or heart sounds, and had ... | |||||
| Pillgram-Larsen, J., Svennevig, J.L., Abdelnoor, M., Fjeld, N.B., Semb, G., Osterud, A. & Skulberg, A. | [Accidental hypothermia. Risk factors in 29 patients with body temperature of 30 degrees C and below] [Abstract] |
1991 | Tidsskr Nor Laegeforen Vol. 111(2), pp. 180-183 |
article | |
| Abstract: 29 patients with a body temperature below 30 degrees C (mean 26.4 degrees C) were treated during the period 1982-88, both years inclusive. Eight patients were severely hypotensive (systolic blood pressure less than 60 mm Hg) and two had ventricular fibrillation on admission. Bradycardia (less than 60 beats per minute) was noted in ten patients. 12 patients were rewarmed by surface warming, 17 by extracorporeal circulation with femoral cannulation. 22 patients (76 were discharged alive. Age, sex, body temperature, method and rate of rewarming, serum electrolytes, acidosis and the use of blood components did not influence the outcome. Renal failure was the only complication associated with a fatal outcome. Severe hypotension on admission tended to increase mortality, but logistic regression analysis identified the mode of cooling as the only independent risk factor for death. A patient cooled indoors had an odd risk of 10.6 of hospital mortality compared to one found outdoors. For the sake of convenience, in hospitals with the available resources rewarming by extracorporeal circulation may be used in patients with circulatory arrest, since this is the easiest way to control and support failing circulation. In all other cases carefully monitored surface rewarming should be used as this necessitates less use of hospital resources and produces equally good results. | |||||
| Plaisance, P., Adnet, F., Vicaut, E., Hennequin, B., Magne, P., Prudhomme, C., Lambert, Y., Cantineau, J.P., Léopold, C., Ferracci, C., Gizzi, M. & Payen, D. | Benefit of active compression-decompression cardiopulmonary resuscitation as a prehospital advanced cardiac life support. A randomized multicenter study. [Abstract] |
1997 | Circulation Vol. 95(4), pp. 955-961 |
article | |
| Abstract: BACKGROUND: We compared short-term prognosis of active compression-decompression (ACD) and standard (STD) cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests. METHODS AND RESULTS: We randomized advanced cardiac life support (ACLS) with ACD ACLS CPR on odd days and STD ACLS CPR on even days. We measured the rates of return of spontaneous circulation (ROSC), survival at 1 hour (H1), at 24 hours (H24), and at 1 month (D30): hospital discharge (HD); neurological outcome; and complications. Mean times from collapse to basic cardiac life support CPR was 9 minutes and from collapse to ACLS CPR was 21 minutes. Compared with the STD ACLS patients (n = 258), ACD ACLS patients (n = 254) had higher survival rates (ROSC, 44.9% versus 29.8 P = .0004; H1, 36.6% versus 24.8 P = .003; H24, 26% versus 13.6 P = .002; HD without neurological impairment, 5.5% versus 1.9 P = .03) and a trend for improvement in neurological outcome at D30 (Glasgow-Pittsburgh Outcome Categories = 1.6 +/- 0.8 versus 2.3 +/- 1.1. P = .09). Sternal dislodgements (2.9% versus 0.4 P = .03) and hemoptysis (5.4% versus 1.3 P = .01) were more frequent in the ACD ACLS group. CONCLUSIONS: Despite long time intervals, ACD significantly improved short-term survival rates in out-of-hospital cardiac arrests compared with STD CPR. | |||||
| Plaisance, P., Lurie, K.G. & Payen, D. | Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation: a randomized evaluation in patients in cardiac arrest. [Abstract] |
2000 | Circulation Vol. 101(9), pp. 989-994 |
article | |
| Abstract: BACKGROUND: Blood pressure is severely reduced in patients in cardiac arrest receiving standard cardiopulmonary resuscitation (CPR). Although active compression-decompression (ACD) CPR improves acute hemodynamic parameters, arterial pressures remain suboptimal with this technique. We performed ACD CPR in patients with a new inspiratory threshold valve (ITV) to determine whether lowering intrathoracic pressures during the "relaxation" phase of ACD CPR would enhance venous blood return and overall CPR efficiency. METHODS AND RESULTS: This prospective, randomized, blinded trial was performed in prehospital mobile intensive care units in Paris, France. Patients in nontraumatic cardiac arrest received ACD CPR plus the ITV or ACD CPR alone for 30 minutes during advanced cardiac life support. End tidal CO(2) (ETCO(2)), diastolic blood pressure (DAP) and coronary perfusion pressure, and time to return of spontaneous circulation (ROSC) were measured. Groups were similar with respect to age, gender, and initial rhythm. Mean maximal ETCO(2), coronary perfusion pressure, and DAP values, respectively (in mm Hg), were 13.1+/-0.9, 25.0+/-1.4, and 36.5+/-1.5 with ACD CPR alone versus 19.1+/-1.0, 43.3+/-1.6, and 56.4+/-1.7 with ACD plus valve (P<0.001 between groups). ROSC was observed in 2 of 10 patients with ACD CPR alone after 26.5+/-0.7 minutes versus 4 of 11 patients with ACD CPR plus ITV after 19.8+/-2.8 minutes (P<0.05 for time from intubation to ROSC). Conclusions-Use of an inspiratory resistance valve in patients in cardiac arrest receiving ACD CPR increases the efficiency of CPR, leading to diastolic arterial pressures of >50 mm Hg. The long-term benefits of this new CPR technology are under investigation. | |||||
| Plaisance, P., Lurie, K.G., Vicaut, E., Adnet, F., Petit, J.L., Epain, D., Ecollan, P., Gruat, R., Cavagna, P., Biens, J. & Payen, D. | A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. French Active Compression-Decompression Cardiopulmonary Resuscitation Study Group. [Abstract] |
1999 | N. Engl. J. Med. Vol. 341(8), pp. 569-575 |
article | |
| Abstract: BACKGROUND: We previously observed that short-term survival after out-of-hospital cardiac arrest was greater with active compression-decompression cardiopulmonary resuscitation (CPR) than with standard CPR. In the current study, we assessed the effects of the active compression-decompression method on one-year survival. METHODS: Patients who had cardiac arrest in the Paris metropolitan area or in Thionville, France, more than 80 percent of whom had asystole, were assigned to receive either standard CPR (377 patients) or active compression-decompression CPR (373 patients) according to whether their arrest occurred on an even or odd day of the month, respectively. The primary end point was survival at one year. The rate of survival to hospital discharge without neurologic impairment and the neurologic outcome were secondary end points. RESULTS: Both the rate of hospital discharge without neurologic impairment (6 percent vs. 2 percent, P=0.01) and the one-year survival rate (5 percent vs. 2 percent, P=0.03) were significantly higher among patients who received active compression-decompression CPR than among those who received standard CPR. All patients who survived to one year had cardiac arrests that were witnessed. Nine of 17 one-year survivors in the active compression-decompression group and 2 of 7 in the standard group, respectively, initially had asystole or pulseless electrical activity. In 12 of the 17 survivors who had received active compression-decompression CPR, neurologic status returned to base line, as compared with 3 of 7 survivors who had received standard CPR (P=0.34). CONCLUSIONS: Active compression-decompression CPR performed during advanced life support significantly improved long-term survival rates among patients who had cardiac arrest outside the hospital. | |||||
| Plaisier, B.R. | Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature. [Abstract] |
2005 | Resuscitation Vol. 66(1), pp. 99-104 |
article | DOI |
| Abstract: BACKGROUND: Accidental hypothermia resulting in cardiac arrest poses numerous therapeutic challenges. Cardiopulmonary bypass (CPB) should be used if feasible since it optimally provides both central rewarming and circulatory support. However, this modality may not be available or is contraindicated in certain cases. Thoracic lavage (TL) provides satisfactory heat transfer and may be performed by a variety of physicians. This paper presents the physiological rationale, technique, and role for TL in accidental hypothermia with cardiac arrest. METHODS: A patient with hypothermic cardiac arrest, treated by the author using TL, serves as the basis for this report. A search of the English language literature using PubMed (National Library of Medicine, Bethesda, Maryland) was conducted from 1966 to 2003 and 13 additional patients were identified. Demographic information, lavage method, rewarming rate, complications, and neurological outcome were analysed. RESULTS: There were numerous causes for hypothermia, with drug and alcohol intoxication being the most common (n = 4; 28.6. Patient age ranged from 8 to 72 years (median = 36 years). Mean core temperature was 24.5+/-0.60 degrees C. Most patients were without blood pressure or pulse upon presentation to the Emergency Department and the predominant cardiac rhythm was ventricular fibrillation (VF) (n = 9; 64.3. Thoracic lavage was accomplished by thoracotomy in seven patients and tube thoracotomy in the remaining seven. Median rewarming rate was 2.95 degrees C/h. Median time until sinus rhythm was restored was 120 min. Median length of hospital stay was 2 weeks. Four (28.6 patients died. Complications were seen in 12 (85.7 patients. Among survivors, neurological outcome was normal in 8 (80 while two were left with residual impairments. CONCLUSIONS: Patients presenting in cardiac arrest from accidental hypothermia may be rewarmed effectively using TL. Among survivors, normal neurological recovery is seen. Thoracic lavage should be strongly considered for these patients if CPB is not available or contraindicated. | |||||
| Platzer, M., Trampitsch, E., Likar, R., Breschan, C. & Schalk, H.-V. | [Cardiopulmonary resuscitation after heroin intoxication and hypothermia] [Abstract] |
2007 | Anaesthesist Vol. 56(2), pp. 141-144 |
article | DOI |
| Abstract: We present the case of a 21-year-old female drug addict with severe accidental hypothermia (core body temperature 27.5 degrees C) and cardiorespiratory arrest. After successful cardiopulmonary resuscitation the patient was actively internally rewarmed without the use of extracorporal circulation. Although at the first clinical presentation the patient appeared to be dead, an excellent neurological outcome was achieved. This case report reviews the epidemiology, pathophysiology, prognostic markers and the therapeutic approaches of severe hypothermia. | |||||
| Polderman, K.H., Joe, R.T.T., Peerdeman, S.M., Vandertop, W.P. & Girbes, A.R.J. | Effects of therapeutic hypothermia on intracranial pressure and outcome in patients with severe head injury. [Abstract] |
2002 | Intensive Care Med Vol. 28(11), pp. 1563-1573 |
article | DOI |
| Abstract: OBJECTIVE: Therapeutic hypothermia may improve outcome in patients with severe head injury, but clinical studies have produced conflicting results. We hypothesised that the severe side effects of artificial cooling might have masked the positive effects in earlier studies, and we treated a large group of patients with severe head injury with hypothermia using a strict protocol to prevent the occurrence of cooling-induced side effects. DESIGN: Prospective clinical trial. SETTING: University teaching hospital. PATIENTS: Hundred thirty-six consecutive patients admitted to our hospital with severe head injury (Glasgow Coma Scale (GCS) < or =8). MEASUREMENTS AND RESULTS: Patients included are the 136 patients with a GCS of 8 or less on admission in whom intracranial pressure (ICP) remained above 20 mmHg in spite of therapy according to a step-up protocol. Those who responded to the last step of our protocol (barbiturate coma) constituted the control group (n=72). Those who did not respond to barbiturate coma (n=64) were treated with moderate hypothermia (32-34 degrees C). Average APACHE II scores were higher (28.9+/-14.4 vs 25.2+/-12.1, p<0.01) and average GCS at admission slightly lower (5.37+/-1.8 vs 5.9+/-2.1, p<0.05) in the hypothermia group, indicating greater severity of illness and more severe neurological injury. Predicted mortality was 86% for the hypothermia group versus 80% in controls (p<0.01). Actual mortality rates were significantly lower: 62% versus 72 the difference in mortality between hypothermic patients and controls was significant (p<0.05). The number of patients with good neurological outcome was also higher in the hypothermia group: 15.7% versus 9.7% for hypothermic patients versus controls, respectively (p<0.02). These differences were explained almost entirely by the subgroup of patients with GCS of 5 or 6 at admission (mortality 52% vs 76 p<0.01; good neurological outcome 29% vs 8 p<0.01). CONCLUSIONS: Artificial cooling can significantly improve survival and neurological outcome in patients with severe head injury when used in a protocol with great attention to the prevention of side effects. Because there is likely to have been bias against the hypothermia group in this study, the positive effects of hypothermia might even have been underestimated. In addition, our results confirm the value of therapeutic hypothermia in treating refractory intracranial hypertension. | |||||
| Preuss, J., Dettmeyer, R., Lignitz, E. & Madea, B. | Fatty degeneration in renal tubule epithelium in accidental hypothermia victims. [Abstract] |
2004 | Forensic Sci Int Vol. 141(2-3), pp. 131-135 |
article | DOI |
| Abstract: The diagnosis "death due to hypothermia" is mainly based on circumstances and gross autopsy findings like frost erythema and gastric erosions. Up to now, there are no reliable histologic criteria available to confirm the diagnosis "death due to hypothermia." However, fatty changes of organs have been reported already in the literature as a histological finding contributing to the diagnosis "death due to hypothermia." To evaluate these reports, cases with well-documented hypothermia (study-group; n=83), cases with other causes of death (control-group; n=25) and additionally also seven cases with a past medical history of diabetes mellitus were investigated. Renal tissue autopsy samples were taken from both the left and the right kidney and investigated for signs of fatty degeneration within the renal tubule epithelium. The results were compared with regard to macroscopic signs of hypothermia (Wischnewski-ulcers, erythema), as reported in the autopsy protocols. The results lead to the conclusion, that fatty degeneration is a very reliable histologic diagnostic criterium in cases of hypothermia, comparable to the significance of Wischnewski-ulcers. | |||||
| Preuss, J., Lignitz, E., Dettmeyer, R. & Madea, B. | Pancreatic changes in cases of death due to hypothermia. [Abstract] |
2007 | Forensic Sci Int Vol. 166(2-3), pp. 194-198 |
article | DOI |
| Abstract: Several morphological alterations of the pancreatic tissue have been described as common findings in hypothermia (e.g. bleedings, pancreatitis, vacuoles). The frequency of these findings varies a lot. It was the aim of this study to clarify the kind and frequency of pancreatic changes in cases of death due to hypothermia. The autopsy reports of 143 cases of fatal hypothermia were, retrospectively, evaluated with regard to describe macroscopic findings in the pancreas. Additionally, microscopic investigations of tissue samples of the pancreas were carried out in 62 cases. As a control group, pancreatic samples of 25 autopsy cases without hypothermia and without alcoholism were collected. Additionally, pancreatic samples of 25 further autopsy cases with an alcoholic disease in the case history were investigated. In only 5 out of 143 cases of the study group, macroscopic bleedings in the pancreas were described. One case of acute and one of chronic pancreatitis was found in the autopsy reports. In 11 (17.7 out of 62 cases, microscopic investigations yielded bleedings in the pancreatic tissue and in 24 (38.7 out of 62 cases, optically empty vacuoles in the adenoid cells were found. In 15 out of 62 cases (24.2, autolysis was too pronounced to gain utilisable results. In the control group without alcoholism, 12 out of 25 cases (48 were diagnosed without pathological findings, five cases showed bleedings, one case an acute pancreatitis, one case a chronic pancreatitis and in six cases, the pancreatic tissue was autolytic. Vacuoles in the adenoid cells were not found. In the additional collective with alcoholism in the case history, 13 cases presented signs of an acute or a chronic pancreatitis. In 3 out of these 13 cases, vacuoles in the adenoid cells were found, but no case with vacuoles and without signs of a chronic pancreatitis was observed. The high frequency of pancreatic bleedings in cases of fatal hypothermia as described in the literature cannot be confirmed by our investigations. Only the vacuoles in the adenoid cells of the pancreas seem to be an additional sign of death due to hypothermia or associated with hypothermia. | |||||
| Preuss, J., Thierauf, A., Dettmeyer, R. & Madea, B. | Wischnewsky's spots in an ectopic stomach. [Abstract] |
2007 | Forensic Sci Int Vol. 169(2-3), pp. 220-222 |
article | DOI |
| Abstract: Wischnewsky's spots in the mucosa of the stomach have been a well-known sign of death due to hypothermia for many years. Furthermore it is reported that those spots can rarely be found in the esophagus as well. We now report on a case concerning a 93-year-old woman who presented an ectopic stomach with erosions of the mucosa in the intrathoracic part of the stomach that were assessed as Wischnewsky's spots. When she was found dead in her flat, she was completely undressed and showed an injury to the head. The autopsy findings are presented and discussed in view of a possible genesis and pathophysiology of Wischnewsky's spots. | |||||
| Püschel, K. & Türk, E. | Determination of the rectal temperature as an important tool for establishing the diagnosis of vital hypothermia. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 175-180 | incollection | URL |
| Quan, L. & Kinder, D. | Pediatric submersions: prehospital predictors of outcome. [Abstract] |
1992 | Pediatrics Vol. 90(6), pp. 909-913 |
article | |
| Abstract: This retrospective cohort study was conducted to test prehospital prognostic indicators in pediatric submersion victims. The authors studied all less than 20 years old victims submerged in the non-icy waters of King County, WA who were treated by Seattle or King County Emergency Medical Services between 1985 and 1989 and were hospitalized or died. Seventy-seven victims were identified from emergency medical services incident logs, hospital discharge records, and medical examiner's registries. Outcome predictors were correlated with the victim's condition at hospital discharge. Of 29 victims in cardiac arrest, 13 had return of spontaneous circulation following field resuscitation. Of these, 6 (21 survived, with mild (n = 2) and severe (n = 4) neurologic impairment at hospital discharge. The best outcome predictors were obtained in the field. These were, for death or severe neurologic impairment, submersion durations > 10 minutes (6/6) and resuscitation durations > 25 minutes (17/17), and for good outcome, sinus rhythm (37/37), reactive pupils (43/43), and neurologic responsiveness (40/40) at the scene. Field-determined factors were reproducibly good outcome predictors. Aggressive emergency medical services may save the lives of pediatric victims in cardiac arrest following short submersion durations. The data support pronouncing dead in the field those pediatric victims of non-icy submersions who do not respond to advanced life support within 25 minutes. | |||||
| Radke, O., Bräuer, A., Mielck, F., Hanekop, G.G., Baryalei, M., Kettler, D. & Quintel, M. | [Spontaneous breathing and stable hemodynamics during severe accidental hypothermia (22 degrees C)] [Abstract] |
2005 | Anasthesiol Intensivmed Notfallmed Schmerzther Vol. 40(1), pp. 32-37 |
article | DOI |
| Abstract: We present a case of severe accidental hypothermia (core temperature 22 degrees C) after a suicide attempt. The initial symptoms and the pre-hospital and hospital treatment are discussed. Additionally, different rewarming strategies for patients with severe accidental hypothermia are compared. | |||||
| Raedler, C., Voelckel, W.G., Wenzel, V., Bahlmann, L., Baumeier, W., Schmittinger, C.A., Herff, H., Krismer, A.C., Lindner, K.H. & Lurie, K.G. | Vasopressor response in a porcine model of hypothermic cardiac arrest is improved with active compression-decompression cardiopulmonary resuscitation using the inspiratory impedance threshold valve. [Abstract] |
2002 | Anesth Analg Vol. 95(6), pp. 1496-502, table of contents |
article | |
| Abstract: During normothermic cardiac arrest, a combination of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) with the inspiratory threshold valve (ITV) significantly improves vital organ blood flow, but this technique has not been studied during hypothermic cardiac arrest. Accordingly, we evaluated the hemodynamic effects of ACD + ITV CPR before, and after, the administration of vasopressin in a porcine model of hypothermic cardiac arrest. Pigs were surface-cooled until their body core temperature was 26 degrees C. After 10 min of untreated ventricular fibrillation, 14 animals were randomly assigned to either ACD CPR with the ITV (n = 7) or to standard (STD) CPR (n = 7). After 8 min of CPR, all animals received 0.4 U/kg vasopressin IV, and CPR was maintained for an additional 10 min in each group; defibrillation was attempted after 28 min of cardiac arrest, including 18 min of CPR. Before the administration of vasopressin, mean +/- SEM common carotid blood flow was significantly higher in the ACD + ITV group compared with STD CPR (67 +/- 13 versus 26 +/- 5 mL/min, respectively; P < 0.025). After vasopressin was given at minute 8 during CPR, mean +/- SEM coronary perfusion pressure was significantly higher in the ACD + ITV group, but did not increase in the STD group (29 +/- 3 versus 15 +/- 2 mm Hg, and 25 +/- 1 versus 14 +/- 1 mm Hg at minute 12 and 18, respectively; P < 0.001); mean +/- SEM common carotid blood flow remained higher at respective time points (33 +/- 8 versus 10 +/- 3 mL/min, and 31 +/- 7 versus 7 +/- 3 mL/min, respectively; P < 0.01). Without active rewarming, spontaneous circulation was restored and maintained for 1 h in three of seven animals in the ACD + ITV group versus none of seven animals in the STD CPR group (not significant). During hypothermic cardiac arrest, ACD CPR with the ITV improved common carotid blood flow compared with STD CPR alone. Moreover, after the administration of vasopressin, coronary perfusion pressure was significantly higher during ACD + ITV CPR, but not during STD CPR. IMPLICATIONS: New strategies are needed to improve the efficiency of cardiopulmonary resuscitation (CPR) in hypothermic cardiac arrest. Active compression-decompression CPR with the inspiratory threshold valve improved carotid blood flow (and coronary perfusion pressure with vasopressin) compared with standard CPR. | |||||
| Rahmad, K., Riddell, I. & Armstrong, A. | Hypothermia. [Abstract] |
1991 | BMJ Vol. 302(6772), pp. 352 |
article | |
| Abstract: [extract] SIR,-Professor W R Keatinge discussed the management of hypothermia and made a plea that some patients deserve heroic measures, including extracorporeal rewarming of the blood. It must be understood that these patients will require a cardiopulmonary bypass, a technique not usually available at district general hospitals. When it is impossible to arrange a rapid transfer to an appropriate facility peritoneal dialysis could be used as an alternative method of treating hypothermia. This not only will raise the core temperature by rewarming the blood but should also normalise plasma potassium concentrations. The technique of peritoneal dialysis is simple and can ... | |||||
| Rankin, A.C. & Rae, A.P. | Cardiac arrhythmias during rewarming of patients with accidental hypothermia. [Abstract] |
1984 | Br Med J (Clin Res Ed) Vol. 289(6449), pp. 874-877 |
article | |
| Abstract: Accidental hypothermia has a high mortality and is associated with cardiac arrhythmias. To determine the incidence of arrhythmias and their importance 22 patients with accidental hypothermia (core temperature less than 35 degrees C) were studied by 12 lead electrocardiography and continuous recording of cardiac rhythm. Although 14 of the patients died (64, only six died while hypothermic. Prolongation of the Q-T interval and the presence of J waves were related to the severity of the hypothermia. Supraventricular arrhythmias, including atrial fibrillation, were common (nine cases) and benign. Ventricular extrasystoles were also common (10 cases), but ventricular tachycardia or fibrillation did not occur during rewarming. In eight patients who died while being monitored the terminal rhythm was asystole. There was no correlation between the severity of hypothermia or the rate of rewarming and the clinical outcome. In the absence of malignant arrhythmias there is no indication for using prophylactic antiarrhythmic treatment in patients with accidental hypothermia. The presence or absence of severe underlying disease is the main determinant of prognosis. | |||||
| Rathgeber, J., Weyland, W., Bettka, T., Züchner, K. & Kettler, D. | [Is reduction of intraoperative heat loss and management of hypothermic patients with anesthetic gas climate control advisable? Heat and humidity exchangers vs. active humidifiers ina functional lung model] [Abstract] |
1996 | Anaesthesist Vol. 45(9), pp. 807-813 |
article | |
| Abstract: Heated humidifiers (HH) as well as heat and moisture exchangers (HME) are commonly used in intubated patients as air-conditioning devices to raise the moisture content of the air, thus preventing mucosal damage and heat loss resulting from ventilation with dry inspired gases. In contrary to HME, HH are able to add heat and moisture to the inspired air in surplus, which is often stressed as an advantage in warming hypothermic patients or reducing major heat losses, e.g., during long operations. The impact of air conditioning on the energy balance of man was calculated comparing HME and HH. METHODS: The efficiency of a HME (Medisize Hygrovent) and a HH (Fisher & Paykel MR 730) was evaluated in a mechanically ventilated lung model simulating the physiological heat and humidity conditions of the upper airways. The gas flow from the central supply was dry; the model temperature varied between 32 and 40 degrees C. By using a HH in the inspiratory limb, a circle system was simulated with water-saturated inspired air at room temperature. The water content of the ventilated air was determined at the tracheal tube connection using a fast, high-resolution humidity meter and was compared with the moisture return of the HME. The energy balance was calculated according to thermodynamic laws. RESULTS: Both HME and HH were able to create physiological heat and humidity conditions in the airways. With the normothermic patient model, the moisture return of the HME was equal to that of the HH set at 34 degrees C. Increasing the heating temperature resulted only in reduced water loss from the lung; heat and water input in the normothermic model was not possible. This was only effective with almost negligible amounts under hypothermic patient model conditions. DISCUSSION: The water content in the inspired and expired air is the most important parameter for estimating pulmonary heat loss in mechanically ventilated patients. In adults (minute volume approximately 71/min) the main fraction of pulmonary heat loss results from water evaporation from the airways (approximately 6 kcal/h), whereas the heat loss due to convection is negligible (approximately 1.2 kcal/h). In intubated patients ventilated with dry air, the heat loss increases to approximately 8 kcal/h due to greater water evaporation from the airways. Both HME and HH are able to reduce the pulmonary heat loss to 1-2 kcal/h. In normothermic as well as hypothermic patients, HH do not offer significant advantages in heat balance compared to effective HME. In conclusion, air conditioning in intubated patients is neither a powerful too for maintaining body temperature during long-lasting anaesthesia nor a sufficient method of warming hypothermic patients in intensive care units. | |||||
| Reed, R.L., Bracey, A.W., Hudson, J.D., Miller, T.A. & Fischer, R.P. | Hypothermia and blood coagulation: dissociation between enzyme activity and clotting factor levels. [Abstract] |
1990 | Circ Shock Vol. 32(2), pp. 141-152 |
article | |
| Abstract: Previous studies of hypothermia and blood coagulation have focused on alterations in the levels of blood clotting elements using coagulation tests performed under normothermic conditions. However, because of the enzymatic nature of activated clotting factors, hypothermia should also be expected to affect clotting factor activities. Multiple determinations of activated partial thromboplastin times (APTT), prothrombin times (PT), and thrombin times (TT) were performed on commercially available normal human plasma at assay temperatures similar to those encountered clinically (25-37 degrees C). Both the APTT and the PT were significantly prolonged at temperatures below 35 degrees C (P less than 0.05). Clotting time correlated significantly with assay temperature in a negative exponential fashion for all three tests (r = -0.97 for APTT, -0.93 for PT, -0.71 for TT, P less than 0.001 for all regressions). Clotting time prolongation appears proportional to the number of enzymatic steps involved. These data indicate that the coagulopathy observed during hypothermia is, in part, independent of clotting factor levels. | |||||
| Reed, R.L., Johnson, T.D., Hudson, J.D. & Fischer, R.P. | The disparity between hypothermic coagulopathy and clotting studies. [Abstract] |
1992 | J Trauma Vol. 33(3), pp. 465-470 |
article | |
| Abstract: Hypothermic patients commonly develop coagulopathy, but the effects of hypothermia on coagulation remain unclear because clinical laboratories routinely perform clotting tests only at 37 degrees C. Measurements of activated partial thromboplastin times (APTT), prothrombin times (PT), and thrombin times (TT) were performed on plasma from normothermic and hypothermic rats at a range of temperatures (25 degrees-37 degrees C) to assess the effects of hypothermia on apparent clotting factor levels and clotting factor activities. In general, clotting times were more severely prolonged when test temperatures were hypothermic than when body temperatures were hypothermic. Indeed, little to no prolongation resulted from body hypothermia alone. These findings reveal the observed disparity between clinically evident hypothermic coagulopathy and near-normal clotting studies. Clotting studies performed at 37 degrees C will not confirm hypothermic coagulopathy. These results indicate that the appropriate treatment for hypothermia-induced coagulopathy is rewarming rather than administration of clotting factors. | |||||
| Rekand, T., Sulg, I.A., Bjaertnes, L. & Jolin, A. | Neuromonitoring in hypothermia and in hypothermic hypoxia. [Abstract] |
1991 | Arctic Med Res Vol. 50 Suppl 6, pp. 32-36 |
article | |
| Abstract: Severe accidental hypothermia is often associated with global ischaemia due to cardiac arrest. The purpose of the present study was to evaluate whether rewarming on cardiopulmonary bypass (CPB) should be slow or as fast as possible. Pigs were cooled to 23 degrees C (rectum), subsequently followed by 1 h period of circulatory arrest, whereupon rewarming was started. Pigs were randomly allocated to 3 groups: slowly rewarmed (2 h), rapidly rewarmed (0.5 h) and a control group on CPB maintaining normothermia. EEG was continuously analyzed by means of Anesthesia-Brain-Monitor (ABM-system), which allows simultaneous monitoring of EEG, blood- and intracranial pressures, heart rate and capnogram as trend graphs. The ABM-system thus delivers a continuous on-line printout of all measured variables. Cooling resulted after about 30 min in electrocerebral inactivity (ECI) in all pigs. EEG reappeared in all animals regardless of the considerable long cardiocirculatory arrest, followed by nearly 3 hours of ECI! It would appear tempting to rewarm an accidentally cooled organism as fast as possible. The present study, however, indicate that the brain during rewarming seems to have its own speed for regeneration of the EEG. This speed showed to be slower than the steeply rising temperature during rapid rewarming. Furthermore, a too vigorous rewarming may jeopardize cerebral metabolism; 90 min after the start of rewarming the EEG had reappeared in 5 out of 8 pigs in slow group, but only in 2 out of 7 in rapidly rewarmed animals. In controls the EEG was continuously present throughout the experiments. | |||||
| Reuler, J.B. | Hypothermia: pathophysiology, clinical settings, and management. [Abstract] |
1978 | Ann Intern Med Vol. 89(4), pp. 519-527 |
article | |
| Abstract: Hypothermia, defined as a core temperature less than 35 degrees C, is frequently not recognized, in part because of the inadequacy of standard thermometers. This entity has multiple causes and unique pathophysiologic consequences that complicate diagnosis and treatment. Understanding of the physiology of thermoregulation is important in light of recent advances in therapy using core rewarming. Pathophysiology, etiology and management of the hypothermia syndrome are reviewed. | |||||
| Reutens, D.C., Dunne, J.W. & Gubbay, S.S. | Triphasic waves in accidental hypothermia. [Abstract] |
1990 | Electroencephalogr Clin Neurophysiol Vol. 76(4), pp. 370-372 |
article | |
| Abstract: Triphasic waves occur in a variety of metabolic, toxic and diffuse encephalopathies. We describe an elderly patient in whom triphasic waves accompanied moderately severe accidental hypothermia and disappeared on rewarming. | |||||
| Rimailho, A. & Teboul, J.L. | [Accidental hypothermia in the adult] | 1983 | Rev Prat Vol. 33(51), pp. 2797-2803 |
article | |
| Roeggla, G., Roeggla, M., Wagner, A. & Hoedl, W. | Prognostic markers in patients with severe accidental hypothermia. | 1994 | Resuscitation Vol. 28(1), pp. 72-73 |
article | |
| Roeggla, G., Wagner, A., Roeggla, M. & Hoedl, W. | Immediate use of cardiopulmonary bypass in patients with severe accidental hypothermia in the emergency department. | 1994 | Eur J Emerg Med Vol. 1(3), pp. 155 |
article | |
| Roggero, E., Stricker, H. & Biegger, P. | [Severe accidental hypothermia with cardiopulmonary arrest: prolonged resuscitation without extracorporeal circulation] [Abstract] |
1992 | Schweiz Med Wochenschr Vol. 122(5), pp. 161-164 |
article | |
| Abstract: We describe a case of severe hypothermia in a 32-year-old patient who fell into a crevasse. Three hours later he was rescued and flown to a district hospital. On arrival he was apparently dead, with cadaveric skin, dilated and fixed pupils, pulseless and in respiratory arrest. His rectal temperature was 26 degrees C. On the ECG monitor there was first ventricular fibrillation, then, after several unsuccessful attempts at defibrillation, the heart became asystolic. Cardiopulmonary resuscitation was begun with orotracheal intubation and external cardiac compression, which eventually lasted 4 hours and continuously required a team of 6 persons. Only at a temperature of 32.5 degrees C could the patient be defibrillated with success. In the absence of extracorporeal circulation (ECC) the victim was rewarmed by warm-air breathing and by instillation of warm saline in peritoneum, stomach and bladder. In this way the rewarming velocity was 1.8 degrees C/hour. The postacute course was characterized by severe rhabdomyolysis (CK of 100,000 U/L) with non-oliguric renal failure, which necessitated several sessions of hemodialysis. Four months later the asymptomatic patient returned to work. Our case shows that a severely hypothermic patient can successfully be treated in a primary hospital not equipped with an ECC, provided that there is a sufficiently large team. Further, uninterrupted external cardiac compression guarantees efficient circulation even over several hours. Electric defibrillation in a hypothermic patient is ineffective unless normal body temperature has been reached. Lastly, every effort to continue resuscitation must be made in the still hypothermic patient whose absence of clinical response may obscure the real possibility of complete recovery. | |||||
| Rohrer, M.J. & Natale, A.M. | Effect of hypothermia on the coagulation cascade. [Abstract] |
1992 | Crit Care Med Vol. 20(10), pp. 1402-1405 |
article | |
| Abstract: BACKGROUND AND METHODS: The development of a multifactorial coagulopathy after massive transfusion is a well-recognized clinical problem that is almost always accompanied by hypothermia. The purpose of this study was to investigate the isolated effect of alterations of temperature on the integrity of the coagulation cascade. Prothrombin times and partial thromboplastin times were each performed 15 times on samples of pooled normal plasma at the temperatures of 37 degrees C, 34 degrees C, 31 degrees C, and 28 degrees C, as well as 39 degrees C and 41 degrees C. RESULTS: Mean prothrombin time results increased from 11.8 +/- 0.3 (SD) secs at 37 degrees C to 12.9 +/- 0.5, 14.2 +/- 0.5, and 16.6 +/- 0.2 secs at 34 degrees C, 31 degrees C, and 28 degrees C, respectively (p < or = .001 for each). Partial thromboplastin time determinations increased from 36.0 +/- 0.7 (SD) secs at 37 degrees C to 39.4 +/- 1.0, 46.1 +/- 1.1, and 57.2 +/- 0.6 secs at 34 degrees C, 31 degrees C, and 28 degrees C, respectively (p < or = .001 for each). Both prothrombin time and partial thromboplastin time determinations were only minimally shortened at hyperthermic temperatures. CONCLUSIONS: The series of enzymatic reactions of the coagulation cascade are strongly inhibited by hypothermia, as demonstrated by the dramatic prolongation of prothrombin time and partial thromboplastin time tests at hypothermic deviations from normal temperature in a situation where factor levels were all known to be normal. Clinicians who deal with critically ill massively transfused hypothermic patients all recognize the inevitable appearance of a coagulopathy that has a multifactorial origin. Unless specifically considered, the contribution of hypothermia to the hemorrhagic diathesis may be overlooked since coagulation testing is performed at 37 degrees C, rather than at the patient's actual in vivo temperature. | |||||
| Rollnik, J.D., Witt, K., Hänert, W., Rix, W. & Schwindt, M. | Rescue lifting system (RLS) might help to prevent death after rescue from immersion in cold water. [Abstract] |
2001 | Int J Sports Med Vol. 22(1), pp. 17-20 |
article | |
| Abstract: OBJECTIVE: In order to prevent sudden death after rescue from immersion in cold water, victims should be handled carefully avoiding additional cardiovascular stress. In this study we investigated if a new double-sling rescue system ("Rescue Lifting System-RLS) was superior to conventional single-sling techniques. METHODS: We studied 14 healthy male subjects in good physical condition aged 21 to 40 years. They were lifted up from the ground with the new RLS and two conventional techniques ("Lifesling" and a navy rescue system used in SAR helicopters). Heart rate was determined by QRS detection (Polar Precision Performance device; Polar Electro Oy, Kempele, Finland) and blood pressure by sphygmomanometry. RLS and "Lifesling" were tested under conditions of dry land and immersion in 18 degrees C water. RESULTS: Rescue with RLS induced only moderate heart rate changes which were significantly lower (about 30 bpm) than with conventional techniques. These findings could be reproduced under "wet" condition. DISCUSSION: RLS enables rescue in a supine position avoiding extensive orthostatic stress. It might therefore be favourable in preventing sudden death after rescue from immersion in cold water. | |||||
| Rothschild, M.A., Mülling, C. & Luzar, O. | Lethal hypothermia: the phenomena of paradoxical undressing and Hide-and-Die-Syndrome. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 167-173 | incollection | URL |
| Rundgren, M., Rosén, I. & Friberg, H. | Amplitude-integrated EEG (aEEG) predicts outcome after cardiac arrest and induced hypothermia. [Abstract] |
2006 | Intensive Care Med Vol. 32(6), pp. 836-842 |
article | DOI |
| Abstract: OBJECTIVE: To evaluate the use of continuous amplitude-integrated EEG (aEEG) as a prognostic tool for survival and neurological outcome in cardiac arrest patients treated with hypothermia. DESIGN: Prospective, observational study. SETTING: Multidisciplinary intensive care unit in a university hospital. INTERVENTION: Comatose survivors of cardiac arrest were treated with induced hypothermia for 24 h. An aEEG recording was initiated upon arrival at the ICU and continued until the patient regained consciousness or, if the patient remained in coma, no longer than 120 h. The aEEG recording was not available to the ICU physician, and the aEEG tracings were interpreted by a neurophysiologist with no knowledge of the patient's clinical status. Only clinically visible seizures were treated. MEASUREMENTS AND RESULTS: Thirty-four consecutive hypothermia-treated cardiac arrest survivors were included. At normothermia (mean 37 h after cardiac arrest), the aEEG pattern was discriminative for outcome. All 20 patients with a continuous aEEG at this time regained consciousness, whereas 14 patients with pathological aEEG patterns (flat, suppression-burst or status epilepticus) did not regain consciousness and died in hospital. Patients were evaluated neurologically upon discharge from the ICU and after 6 months, using the Cerebral Performance Category (CPC) scale. Eighteen patients were alive with a good cerebral outcome (CPC 1--2) at 6-month follow-up. CONCLUSION: A continuous aEEG pattern at the time of normothermia was discriminative for regaining consciousness. aEEG is an easily applied method in the ICU setting. | |||||
| Russo, S., Timmermann, A., Radke, O., Kerren, T. & Bräuer, A. | [Accidental hypothermia in the household environment. Importance of preclinical temperature measurement] [Abstract] |
2005 | Anaesthesist Vol. 54(12), pp. 1209-1214 |
article | DOI |
| Abstract: In emergency medicine accidental hypothermia in non-traumatized patients is a rare situation. To emphasize the need for a precise preclinical temperature measurement, two cases of accidental hypothermia (28.2 degrees C and 29.3 degrees C core temperature) are presented which occurred under conditions that did not give a direct suspicion of hypothermia. In one case the immediate diagnosis lead to complete convalescence, the other patient died of multiple organ failure. The primary diagnosis, diagnostic methods and therapy as well as the primary treatment are discussed. | |||||
| Ruttmann, E., Weissenbacher, A., Ulmer, H., Müller, L., Höfer, D., Kilo, J., Rabl, W., Schwarz, B., Laufer, G., Antretter, H. & Mair, P. | Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. [Abstract] |
2007 | J Thorac Cardiovasc Surg Vol. 134(3), pp. 594-600 |
article | DOI |
| Abstract: OBJECTIVE: Extracorporeal circulation is considered the gold standard in the treatment of hypothermic cardiocirculatory arrest; however, few centers use extracorporeal membrane oxygenation instead of standard extracorporeal circulation for this indication. The aim of this study was to evaluate whether extracorporeal membrane oxygenation-assisted resuscitation improves survival in patients with hypothermic cardiac arrest. METHODS: A consecutive series of 59 patients with accidental hypothermia in cardiocirculatory arrest between 1987 and 2006 were included. Thirty-four patients (57.6 were resuscitated by standard extracorporeal circulation, and 25 patients (42.4 were resuscitated by extracorporeal membrane oxygenation. Accidental hypothermia was caused by avalanche in 22 patients (37.3, drowning in 22 patients (37.3, exposure to cold in 8 patients (13.5, and falling into a crevasse in 7 patients (11.9. Multivariate logistic regression analysis was used to compare extracorporeal membrane oxygenation with extracorporeal circulation resuscitation, with adjustment for relevant parameters. RESULTS: Restoration of spontaneous circulation was achieved in 32 patients (54.2. A total of 12 patients (20.3 survived hypothermia. In the extracorporeal circulation group, 64% of the nonsurviving patients who underwent restoration of spontaneous circulation died of severe pulmonary edema, but none died in the extracorporeal membrane oxygenation group. In multivariate analysis, extracorporeal membrane oxygenation-assisted resuscitation showed a 6.6-fold higher chance for survival (relative risk: 6.6, 95% confidence interval: 1.2-49.3, P = .042). Asphyxia-related hypothermia (avalanche or drowning) was the most predictive adverse factor for survival (relative risk: 0.09, 95% confidence interval: 0.01-0.60, P = .013). Potassium and pH failed to show statistical significance in the multivariate analysis. CONCLUSIONS: Extracorporeal rewarming with an extracorporeal membrane oxygenation system allows prolonged cardiorespiratory support after initial resuscitation. Our data indicate that prolonged extracorporeal membrane oxygenation support reduces the risk of intractable cardiorespiratory failure commonly observed after rewarming. | |||||
| Sabapathi, R., Ridley, C. & Yen, M.C. | Complete recovery from profound hypothermia associated with DIC. | 1986 | Md Med J Vol. 35(3), pp. 203-204 |
article | |
| consumer Safety Institute & Drowning, S.F. | Book of abstracts. World Congress on Drowning 2002. held in Amsterdam on 26-28 June 2002. | 2002 | book | ||
| Sakurai, A., Kinoshita, K., Moriya, T., Utagawa, A., Ebihara, T., Furukawa, M. & Tanjoh, K. | Reduced effectiveness of hypothermia in patients lacking the wave V in auditory brainstem responses immediately following resuscitation from cardiac arrest. [Abstract] |
2006 | Resuscitation Vol. 70(1), pp. 52-58 |
article | DOI |
| Abstract: AIMS: Therapeutic hypothermia appears to improve the outcome of pre-hospital cardio-pulmonary arrest (CPA) in patients with an initial cardiac rhythm of ventricular fibrillation or nonperfusing ventricular tachycardia (VF/VT). Notwithstanding, the outcome of this procedure is certainly difficult to predict based solely on the initial rhythm. The aim of the present study was to predict the outcome using auditory brainstem responses (ABRs) in CPA patients treated with therapeutic hypothermia. DESIGN AND SETTING: A prospective observational study in the intensive care unit of a university hospital. PATIENTS: The study included 26 patients resuscitated from out-of-hospital CPA. INTERVENTIONS: Basic and advanced cardiac life support, intensive care and post-resuscitative hypothermia. MEASUREMENT AND RESULTS: ABRs were recorded immediately after the return of spontaneous circulation (ROSC). An ABR wave V was recorded in 16 patients. Among 8 patients with a favourable outcome, the initial rhythms were VF/VT in 6 patients and other rhythms in 2. All 10 patients without a detectable ABR wave V had an unfavourable outcome. The VF/VT as the initial arrest rhythm and the presence of wave V were significantly (p = 0.0095) correlated with a favourable outcome. The presence of wave V had a 100% sensitivity to a favourable outcome. CONCLUSION: The absence of the ABR wave V in the early phase after ROSC wave indicated a reduced effect of therapeutic hypothermia, even in cases that underwent hypothermia promptly after out-of-hospital CPA. Measurement of ABRs appears to be useful as a predictor of effectiveness and as a criterion for determining the indication for therapeutic hypothermia. | |||||
| Saltiel, A., Kopf, G.S., Elefteriades, J., Hammond, G.L., Shaffer, W., Farrell, D., Ponn, R. & Lister, G. | Resuscitation of cold water immersion victims with cardiopulmonary bypass. | 1989 | J Crit Care Vol. 4(1), pp. 54-57 |
article | |
| Samuelson, H., Nekludov, M. & Levander, M. | Neuropsychological outcome following near-drowning in ice water: two adult case studies. [Abstract] |
2008 | J Int Neuropsychol Soc Vol. 14(4), pp. 660-666 |
article | DOI |
| Abstract: Two men, 56 and 33 years old, (case 1 and case 2) were examined neuropsychologically after successful resuscitation from circulatory arrest following extreme accidental hypothermia and near drowning. After submersion in ice water for at least 20 minutes they received CPR for 45 to 60 minutes. Body-core temperature at start of CPB was 24 degrees C and 22 degrees C, respectively. A neuropsychological examination was performed within two months after the accident and 1 year later. An additional follow-up interview was made 3 years after the accidents. Both had severe problems with memory, visuospatial performance, executive function, and verbal fluency. The follow-up demonstrated improvement in the visuospatial test in both and in the verbal learning, recall, and logical reasoning tests in case 2. Both still had problems with executive function, and case 2 also in verbal fluency. Case 1 also had problems with flexibility, planning and abstract ability. Despite the protective effects of hypothermia and gradual improvement of symptoms over time, some of the deficits were permanent. A thorough neuropsychological examination of patients suffered from anoxia is advisable, because gross neurological examination and MRI scans may not always reveal underlying brain dysfunction. | |||||
| Sarnaik, A.P. & Vohra, M.P. | Near-drowning: fresh, salt, and cold water immersion. [Abstract] |
1986 | Clin Sports Med Vol. 5(1), pp. 33-46 |
article | |
| Abstract: Near-drowning and immersion hypothermia are important, preventable causes of mortality and morbidity. The most important consequences of an immersion accident are hypoxia and its effects on the cardiovascular system and the CNS. The mammalian diving reflex and hypothermia may offer some protection to the CNS despite prolonged hypoxia. The initial management of a nearly drowned victim must be focused on reversal of hypoxemia and acidosis. Prompt and effective on-site CPR is of paramount importance in ensuring optimal survival. The presence of immersion hypothermia must be recognized. Hypothermic patients should be managed according to the severity and the duration of hypothermia. Active external rewarming is adequate for acute and mild hypothermia, whereas active core rewarming may be necessary for chronic and severe hypothermia. | |||||
| Sasaki, H., Yukioka, T., Ohta, S., Fujikawa, T., Noda, M., Homma, H. & Mishima, S. | Is there a self-preserving hypothermic mechanism in shock? [Abstract] |
2007 | Shock Vol. 27(4), pp. 354-357 |
article | DOI |
| Abstract: Hypoxia-induced hypothermia (HIH) is regarded as an adaptive response to hypoxia in a variety of creatures, but no details of the mechanism have yet been elucidated in the clinical setting. This study was designed to analyze alteration of core body temperature with hemorrhagic shock and to clarify HIH in the clinical setting. Patients were categorized in the hemorrhage shock (S, n = 15) or cardiopulmonary arrest (C, n = 88) group. The tympanic membrane temperature (TMT) was measured, and the length of the interval of call-to-arrival (CTA) at a hospital was set as the time-course parameter. There was a significant negative linear relationship between CTA interval and TMT (S group: TMT = -0.055 degrees C, CTA = +36.1 min, r = -0.833, P < 0.001; C group: TMT = -0.046 degrees C, CTA = +36.3 min, r = -0.548, P < 0.001). Analysis of variance revealed no significant difference in the slope of the regression lines of both groups. However, when the CTA interval was used as a covariate, there was a significant difference in the TMT (P = 0.014), which means that the regression line of the S group was significantly lower than that of the C group with time. Furthermore, in the S group, all patients were hypothermic (<35 degrees C) when their CTA interval was more than 20 min; on the other hand, in the C group, only 64 (75 of 85 were hypothermic. Patients in S group were more likely to become hypothermic (P < 0.05). In humans with cellular hypoxia, HIH takes place, as seen in other animals. This result emphasizes the necessity for studies of analysis of the mechanisms of temperature control and determination of optimal body temperature during acute critical care. | |||||
| Savourey, G., Barnavol, B., Caravel, J.P., Feuerstein, C. & Bittel, J.H. | Hypothermic general cold adaptation induced by local cold acclimation. [Abstract] |
1996 | Eur J Appl Physiol Occup Physiol Vol. 73(3-4), pp. 237-244 |
article | |
| Abstract: To study relationships between local cold adaptation of the lower limbs and general cold adaptation, eight subjects were submitted both to a cold foot test (CFT, 5 degrees C water immersion, 5 min) and to a whole-body standard cold air test (SCAT, 1 degree C, 2 h, nude at rest) before and after a local cold acclimation (LCA) of the lower limbs effected by repeated cold water immersions. The LCA induced a local cold adaptation confirmed by higher skin temperatures of the lower limbs during CFT and a hypothermic insulative general cold adaptation (decreased rectal temperature and mean skin temperature P < 0.05) without a change either in metabolic heat production or in lower limb skin temperatures during SCAT after LCA. It was concluded that local cold adaptation was related to the habituation process confirmed by decreased plasma concentrations of noradrenaline (NA) during LCA (P < 0.05). However, the hypothermic insulative general cold adaptation was unrelated either to local cold adaptation or to the habituation process, because an increased NA during SCAT after LCA (P < 0.05) was observed but was rather related to a "T3 polar syndrome" occurring during LCA. | |||||
| Schaller, M.D., Fischer, A.P. & Perret, C.H. | Hyperkalemia. A prognostic factor during acute severe hypothermia. [Abstract] |
1990 | JAMA Vol. 264(14), pp. 1842-1845 |
article | |
| Abstract: When hypothermic patients appear to be dead, the decision to resuscitate may be difficult due to lack of reliable criteria of death. To discover useful prognostic indicators, we reviewed the hospital charts of nine hypothermic victims of snow avalanches (group A: median value of rectal temperature, 29.6 degrees C; range, less than 12 degrees C to 34 degrees C) and of 15 patients with hypothermia following acute drug intoxication and/or cold exposure (group B: 28.8 degrees C; range, 25.5 degrees C to 32 degrees C. In group A, plasma potassium level on admission was extremely high (14.5 mmol/L; range, 6.8 to 24.5 mmol/L) compared with that obtained in group B (3.5 mmol/L; range, 2.7 to 5.3 mmol/L). All patients in group A were in cardiorespiratory arrest. None could be successfully resuscitated despite effective rewarming by cardiopulmonary bypass or peritoneal lavage. In contrast, all of the patients in group B recovered from hypothermia, including two in cardiorespiratory arrest. Thus, extreme hyperkalemia during acute hypothermia appears to be a reliable marker of death. It might be used to select those patients in whom heroic resuscitation efforts can be useful. | |||||
| Schewe, J.-C., Heister, U., Fischer, M. & Hoeft, A. | [Accidental urban hypothermia. Severe hypothermia of 20.7 degrees C] [Abstract] |
2005 | Anaesthesist Vol. 54(10), pp. 1005-1011 |
article | DOI |
| Abstract: In emergency medicine accidental hypothermia (<35 degrees C) is a common epiphenomenon of many medical conditions. In contrast, severe hypothermia (<28 degrees C) occurs very seldom and presents a difficult medical situation. Here we present a female patient with severe urban hypothermia (core temperature of 20.7 degrees C) and circulatory arrest. An overview of the emergency treatment, rewarming strategy with extracorporeal circulation and the clinical course will be given. The survival of the patient and the favorable neurological outcome will be discussed considering the current literature. Due to the paucity of treatment guidelines or clear prognostic criteria of withholding or withdrawing treatment in severe hypothermia, the decision of prolonged resuscitation and rewarming strategy is solely dependent on the individual judgement and medical experience of the physician. The positive clinical outcome which can be gleaned from case reports or single retrospective studies should encourage the emergency physician to selectively rewarm a severe hypothermic patient with extracorporeal circulation under prolonged CPR. | |||||
| Schmicke, P. | [Rewarming of humans in deep hypothermia using a short-wave therapy apparatus. Report of 3 cases] [Abstract] |
1984 | Anasth Intensivther Notfallmed Vol. 19(1), pp. 27-29 |
article | |
| Abstract: Three cases of successful "rewarming" of low hypothermic patients (below 30 degrees C = 86 degrees F) with a short-wave therapy apparatus (operating frequency 27.12 MHz) and eddy-current electrodes (Diplode) are described. The patients survived without any visible complications such as afterdrop, ventricular fibrillation or burns. This method is simple and not restricted to special hospitals. | |||||
| Schmidt, U., Fritz, K.W., Kasperczyk, W. & Tscherne, H. | Successful resuscitation of a child with severe hypothermia after cardiac arrest of 88 minutes. [Abstract] |
1995 | Prehosp Disaster Med Vol. 10(1), pp. 60-62 |
article | |
| Abstract: A 4-year-old boy broke through the ice of a frozen lake and drowned. The boy was extricated from the icy water by a rescue helicopter that was dispatched shortly after the incident. Although the boy was severely hypothermic, no cardiac response could be induced with field resuscitation measures, including intubation, ventilation, suction, and cardiopulmonary resuscitation. On admission, the primary findings included fixed, nonreacting pupils and asystole. The first core temperature measured was 19.8 degrees C (67.6 degrees F). During active, external warming, the first ventricular beats were observed 20 minutes after admission, and changed 10 minutes later to a sinus rhythm. Continuous monitoring included repeated arterial blood gas and electrolyte tests; prophylaxis for cerebral edema was performed with hyperventilation and administration of sodium Brevimytal and dexamethasone. Seventy minutes after admission, hemodynamics stabilized and the boy was transferred to the pediatric intensive care unit (PICU), where active external warming was continued to raise the core temperature at a rate of 1 degree C/hour. Adult respiratory distress syndrome developed, and the boy had to be ventilated in the PICU for 10 days. He was discharged home after another two weeks. He recovered fully. The rapid heat loss with the induction of severe hypothermia (< 20 degrees C; 68 degrees F) was the main reason for survival in this rare event of a patient with cardiac arrest lasting 88 minutes after accidental hypothermia. | |||||
| Schneider, J. | [Accidental hypothermia] [Abstract] |
1983 | Aktuelle Gerontol Vol. 13(4), pp. 156-158 |
article | |
| Abstract: Accidental hypothermia in the elderly is a rather unknown clinical syndrome in Germany. Manifestations are those of a generalized disease without striking symptoms or signs. To assure the clinical diagnosis, a low graded thermometer is necessary. Treatment consists of slow and passive rewarming and of correction of the accompanying disturbances. As important as correct diagnosis and treatment are preventive efforts against exogenous and endogenous risk factors. | |||||
| Schrijver, G. & van der Maten, J. | Severe accidental hypothermia: pathophysiology and therapeutic options for hospitals without cardiopulmonary bypass equipment. | 1996 | Neth J Med Vol. 49(4), pp. 167-176 |
article | DOI |
| Schulze-Osthoff, K. & Wesselborg, S. | [Oxygen radicals as second messengers of gene expression] | 1996 | Dtsch Med Wochenschr Vol. 121(42), pp. 1301-1302 |
article | |
| Schwaitzberg, S.D., Allen, M.J., Connolly, R.J., Grabowy, R.S., Carr, K.L. & Cleveland, R.J. | Rapid in-line blood warming using microwave energy: preliminary studies. [Abstract] |
1991 | J Invest Surg Vol. 4(4), pp. 505-510 |
article | |
| Abstract: The management of massive blood loss resulting from trauma or surgery necessitates rapid transfusion capability. Hypothermia secondary to shock, transfusion, and prolonged surgical procedures significantly increases morbidity and mortality in these patients. Transfusion at high flow rates frequently exceeds the warming capacity of conventional blood-warming devices, whose inherent resistance also limits the maximal flow rates. Microwave ovens are capable of blood warming, but have been associated with unacceptable hemolysis. We have investigated the possibility of using microwave energy to provide rapid in-line blood warming. Fresh blood from 10 human subjects was warmed from an average of 18 degrees C to temperatures ranging from 37 to 39 degrees C at flow rates from 250 to 500 mL/min. Laboratory analysis of free plasma hemoglobin, haptoglobin, hematocrit, hemoglobin, and electrolytes showed no difference between heated and control samples. LDH was elevated in those samples warmed repeatedly, but remained within the normal range. These data indicate the potential for further investigation utilizing properly controlled microwave energy for in-line blood and fluid warming. | |||||
| Schwarz, S., Häfner, K., Aschoff, A. & Schwab, S. | Incidence and prognostic significance of fever following intracerebral hemorrhage. [Abstract] |
2000 | Neurology Vol. 54(2), pp. 354-361 |
article | |
| Abstract: OBJECTIVE: To investigate the incidence and prognostic significance of fever on presentation and during the subsequent 72 hours in patients with spontaneous supratentorial intracerebral hemorrhage (ICH). METHODS: We analyzed 251 patients. On admission, body temperature, Glasgow Coma Scale (GCS) score, age, sex, blood pressure, blood glucose level, and presumed origin of hemorrhage were analyzed. From the initial CT scan, hematoma volume, location, and presence of intraventricular hemorrhage were determined. From the first 72 hours, hematoma enlargement, duration of increased temperatures, blood pressure, and blood glucose level were determined. Outcome was classified on discharge with the Glasgow Outcome Scale (GOS) score. RESULTS: Outcomes included no symptoms in 23 (9, moderate disability in 64 (26, severe disability in 104 (41, vegetative state in 5 (2, and death in 55 (22 patients. Prognostic factors retained from a logistic regression model with a dichotomized GOS scale (GOS score of 1 or 2 versus GOS score of 3 to 5) as response variables were GCS score of 7 or less, age older than 75 years, hematoma volume of more than 60 cm3, ventricular hemorrhage, and presence of a coagulation disorder (p < 0.05). Fever was associated with intraventricular hemorrhage. From 196 patients, data from the first 72 hours were analyzed. A total of 18 patients (9 had normal temperatures throughout the study. The duration of fever (> or =37.5 degrees C) was less than 24 hours in 66 (34, 24 to 48 hours in 70 (36, and more than 48 hours in 42 patients (21. Independent prognostic factors during the first 72 hours were duration of fever, secondary hemorrhage, GCS score of 7 or less, ventricular hemorrhage, hematoma volume of more than 60 cm3, duration of increased blood pressure of more than 48 hours, and duration of increased blood glucose of more than 48 hours. CONCLUSIONS: The incidence of fever after supratentorial ICH is high, especially in patients with ventricular hemorrhage. In patients surviving the first 72 hours after hospital admission, the duration of fever is associated with poor outcome and seems to be an independent prognostic factor in these patients. | |||||
| Schäfer, A.T. | Tissue damage caused by freezing. | 2004 | Hypothermia. Clinical, Pathomorphological and Forensic Features., pp. 69-103 | incollection | URL |
| Schöchl, H., Brunauer, A. & Chmelizek, F. | Versorgung tief hypothermer Patienten nach akzidenteller Kälteexposition. | 1994 | Notarzt Vol. 10, pp. 165-169 |
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| Sefrin, P. | Thermische Notfälle. Allgemeine Unterkühlung. [Abstract] |
1998 | Vol. 6(XIV)Notfalltherapie. Erstversorgung im Rettungsdienst nach den Empfehlungen der DIVI., pp. 351-358 |
incollection | URL |
| Abstract: Autorenporträt: Professor Dr. med. Peter Sefrin, Institut für Anästhesiologie der Universität Würzburg, Vorsitzender der Bundesvereinigung der Arbeitsgemeinschaft Notärzte in Deutschland (BAND) sowie Vorsitzender der Arbeitsgemeinschaft der in Bayern tätigen Notärzte (AGBN). | |||||
| Segantini, P. & Horn, R. | [Cold-induced pathology at high altitude] [Abstract] |
1991 | Schweiz Rundsch Med Prax Vol. 80(46), pp. 1283-1286 |
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| Abstract: Cold injury is an objective danger in mountain climbing as well as in many outdoor and recreational sports such as skiing, fishing, etc. Symptoms are easily recognizable by the experienced, and prevention is mostly possible. Cold injury should be divided by pathological means in general hypothermia and local frostbite injuries. Life-threatening deep hypothermia with coma and insufficient circulation or cardiac arrest is reversible under t | |||||