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Letter to the Editor
DOI: 10.1016/j.medin.2020.01.010
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Disponible online el 27 de Febrero de 2020
In reply to “Management of accidental hypothermia: Narrative review”
En respuesta a “Gestión de la hipotermia accidental: revisión narrativa”
Visitas
...
M.L. Avellanas Chavalaa,b,c,
Autor para correspondencia
mlavellanas@gmail.com

Corresponding author.
, M. Ayala Gallardod, I. 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 Profesor del Master en Medicina de Urgencia y Rescate en Montaña, Universidad de Zaragoza, Spain
d Servicio 061 – Montaña Aragón, Spain
e Servicio de Urgencias, Spain
f Hospital de Cerdanya, Puigcerdá (Girona), Spain
g Facultad de Medicina, Universidad de Girona, Spain
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Dear Editor:

First of all, we thank Dr. Ferrer Marrero for his interest in our article, which demonstrates the concern and growing interest of professionals involved in the management of accidental hypothermic victims, including cold water immersion and drowning.

We agree with the author the requirement of a good coordination between the rescue teams, pre-hospital emergency systems, and useful hospitals. In fact, in 1991, we already expressed this desire.1 Since then, the criteria have changed a lot and, in the recent years, survival has been revolutionized with excellent neurological results.2

Further progress must be made in the development of structured protocols that plan rescue coordination, problem prediction, triage optimization, pre-hospital management including immediate and high quality CPR, transportation and treatment. These protocols should include; hospital choice, hospital management, detailed criteria for the use of ECMO and cardiorespiratory support and subsequent resuscitation care.3 An example of this coordination has recently been published in non-scientific press.4 A severe hypothermic victim in cardiac arrest in the Gerona's Pyrenees was resuscitated after 6h without neurological sequela. The victim was transported to The Vall d’Hebron Hospital in Barcelona for extracorporeal life support rewarming. This achievement originated a press release from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC).5

Furthermore, we believe that, due to the low frequency of this pathology and the difficulty to make the good decision at the accident site, the advice of an expert in hypothermia (called coordinator in other countries) could be useful. Its effectiveness improving survival and final neurological prognosis has been reported.6

Funding source

The authors declare that the article has not received any funding.

Conflict of interest

The authors declare that none of the signatories has a conflict of interest.

References
[1]
M.L. Avellanas, J. Laplaza, J. Cegoñino, J.M. Montón, C. Serón.
Hipotermia accidental en los accidentes de montaña: importancia de la rapidez en el rescate y traslado.
Med Intensiva, 15 (1991), pp. 147-153
[2]
T. Darocha, S. Kosiński, A. Jarosz, D. Sobczyk, R. Gałązkowski, J. Piątek, et al.
The chain of survival in hypothermic circulatory arrest: encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming.
Scand J Trauma Resusc Emerg Med, 24 (2016),
[3]
P. Paal, H. Brugger, G. Strapazzon.
Accidental hypothermia.
Handb Clin Neurol, 157 (2018), pp. 547-563
[4]
Una mujer sobrevive 6 horas en parada cardiaca por una hipotermia; 2019. Available from: https://elpais.com/sociedad/2019/12/05/actualidad/1575540215_906914.html?ssm=whatsapp [accessed 15.01.20].
[5]
La hipotermia: una situación compleja que supone un gran reto; 2019. Available from: https://semicyuc.org/2019/12/la-hipotermia-una-situacion-compleja-que-supone-un-gran-reto/ [accessed 15.01.20].
[6]
T. Darocha, S. Kosinski, M. Moskwa, A. Jarosz, D. Sobczyk, R. Galazkowski, et al.
The role of hypothermia coordinator: a case of hypothermic cardiac arrest treated with ECMO.
High Alt. Med. Biol., 16 (2015), pp. 352-355
Copyright © 2020. Elsevier España, S.L.U. y SEMICYUC
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