Elsevier

Annals of Emergency Medicine

Volume 16, Issue 9, September 1987, Pages 1042-1055
Annals of Emergency Medicine

Special contribution
Multicenter hypothermia survey

https://doi.org/10.1016/S0196-0644(87)80757-6Get rights and content

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%) ⩽ 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 < .05) faster in the population ⩽ 59 years (1.08 ± 1.39 C/hr) than in those ⩾ 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 < .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 ⩽ 32.2 C. There were 73 fatalities (17.1%). Of these, 84.9% (N = 62) were ⩽ 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.

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    Presented at the UAEM/IRIEM Research Symposium on Environmental Emergencies in Clearwater Beach, Florida, February 1987.

    This study was supported by the Office of Naval Research and the Undersea Medical Society.

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