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Vol. 43. Issue 9.
Pages 556-568 (December 2019)
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Vol. 43. Issue 9.
Pages 556-568 (December 2019)
Review
DOI: 10.1016/j.medine.2018.11.006
Management of accidental hypothermia: A narrative review
Gestión de la hipotermia accidental: revisión narrativa
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M.L. Avellanas Chavalaa,b,c,
Corresponding author
mlavellanas@ono.com

Corresponding author.
, M. Ayala Gallardod, Í. Soteras Martíneze,f,g, E. Subirats Bayegof,g
a Unidad de Medicina Intensiva, Hospital General San Jorge, Huesca, Spain
b Unidad Funcional de Congelaciones y Patologías de Montaña, Hospital General San Jorge, Huesca, Spain
c Máster en Medicina de Urgencia y Rescate en Montaña, Universidad de Zaragoza, Zaragoza, Spain
d Servicio 061, Montaña Aragón, Spain
e Servicio de Urgencias, Spain
f Hospital de Cerdanya, Puigcerdà, Gerona, Spain
g Facultad de Medicina, Universidad de Girona, Gerona, Spain
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Table 1. Neurohumoral processes intervening in accidental hypothermia.1,3–11
Table 2. Most extreme published cases of accidental hypothermia and their neurological recovery.
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Abstract

A narrative review is presented on the diagnosis, treatment and management of accidental hypothermia. Although all these processes form a continuum, for descriptive purposes in this manuscript the recommendations are organized into the prehospital and in-hospital settings.

At prehospital level, it is advised to: (a) perform high-quality cardiopulmonary resuscitation for cardiac arrest patients, regardless of body temperature; (b) establish measures to minimize further cooling; (c) initiate rewarming; (d) prevent rescue collapse and continued cooling (afterdrop); and (e) select the appropriate hospital based on the clinical and hemodynamic situation of the patient.

Extracorporeal life support has revolutionized rewarming of the hemodynamically unstable victim or patients suffering cardiac arrest, with survival rates of up to 100%.

The new evidences indicate that the management of accidental hypothermia has evolved favorably, with substantial improvement of the final outcomes.

Keywords:
Accidental hypothermia
Rescue
Avalanche
Cardiopulmonary resuscitation
Rewarming
ECMO
Resumen

La presente revisión narrativa se centra en el diagnóstico, el tratamiento y la gestión de la hipotermia accidental. Si bien todos estos procesos son continuos, en el presente manuscrito las recomendaciones se organizan con fines descriptivos en prehospitalarias y hospitalarias.

En el ámbito prehospitalario se recomienda: a) reanimación de alta calidad de toda víctima en parada cardiaca, independientemente de la temperatura corporal; b) instaurar medidas para detener la pérdida de calor; c) iniciar el recalentamiento; d) prevenir el colapso del rescate y el efecto de recaída (afterdrop) y e) elegir adecuadamente el hospital de referencia de acuerdo con la situación clínica y hemodinámica de la víctima.

El soporte vital extracorpóreo ha revolucionado, con tasas de supervivencia que han llegado al 100%, el recalentamiento de víctimas con inestabilidad hemodinámica o paro cardiaco.

Las nuevas evidencias indican que la gestión de la hipotermia accidental ha evolucionado y ha conseguido mejorar sustancialmente el pronóstico final.

Palabras clave:
Hipotermia accidental
Rescate
Avalancha
Reanimación cardiopulmonar
Recalentamiento
ECMO

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