References | Accidental Hypothermia

<< Evidence-Based Management Of Accidental Hypothermia In The Emergency Department


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study are included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, will be noted by an asterisk (*) next to the number of the reference.

  1. Davis PR, Byers M. Accidental hypothermia. J R Army Med Corps. 2005;151(4):223-233. (Review article)
  2. Brandstrom H, Johansson G, Giesbrecht GG, et al. Accidental cold-related injury leading to hospitalization in northern Sweden: an eight-year retrospective analysis. Scand J Trauma Resusc Emerg Med. 2014;22:6. (Retrospective review; 326 patients)
  3. Vassal T, Benoit-Gonin B, Carrat F, et al. Severe accidental hypothermia treated in an ICU: prognosis and outcome. Chest. 2001;120(6):1998-2003. (Retrospective review; 47 patients)
  4. No author listed. Number of hypothermia-related deaths, by sex--National Vital Statistics System, United States, 1999- 2011. MMWR Morb Mortal Wkly Rep. 2013;61(51 & 52):1050. (Retrospective review)
  5. Gilbert M, Busund R, Skagseth A, et al. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet. 2000;355(9201):375-376. (Case report; 1 case)
  6. Meyer M, Pelurson N, Khabiri E, et al. Sequela-free long-term survival of a 65-year-old woman after 8 hours and 40 minutes of cardiac arrest from deep accidental hypothermia. J Thorac Cardiovasc Surg. 2014;147(1):e1-e2. (Case report; 1 case)
  7. * Dunne B, Christou E, Duff O, et al. Extracorporeal-assisted rewarming in the management of accidental deep hypothermic cardiac arrest: a systematic review of the literature. Heart Lung Circ. 2014;23(11):1029-1035. (Systematic review; 13 papers)
  8. Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council guidelines for resuscitation 2010, section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81(10):1400-1433. (Guidelines; consensus paper)
  9. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 Suppl 3):S829-S861. (Guidelines; consensus paper)
  10. Zafren K, Giesbrecht GG. State of Alaska cold injuries guidelines. Juneau, AK: Department of Health and Social Services, Division of Public Health; 2014:5-17. (Guidelines)
  11. Durrer B, Brugger H, Syme D, et al. The medical on-site treatment of hypothermia: ICAR-MEDCOM recommendation. High Alt Med Biol. 2003;4(1):99-103. (Guideline)
  12. * Zafren K, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia. Wilderness Environ Med. 2014;25(4):425-445. (Guidelines)
  13. * Danzl DF, Pozos RS. Accidental hypothermia. N Engl J Med. 1994;331(26):1756-1760. (Review article)
  14. * Danzl DF. Accidental hypothermia. Tintinalli JE, Stapczynski JS, Cline DM, et al, eds. In: Rosen’s Emergency Medicine: Concepts and Clinical Practice. New York: McGraw Hill Medical; 2010:1868-1881. (Textbook)
  15. Bristow GK, Giesbrecht GG. Contribution of exercise and shivering to recovery from induced hypothermia (31.2 degrees C) in one subject. Aviat Space Environ Med. 1988;59(6):549-552. (Observational study; 1 patient)
  16. Pasquier M, Zurron N, Weith B, et al. Deep accidental hypothermia with core temperature below 24 degrees C presenting with vital signs. High Alt Med Biol. 2014;15(1):58-63. (Systematic review; 23 cases)
  17. Lee CH, Van Gelder C, Burns K, et al. Advanced cardiac life support and defibrillation in severe hypothermic cardiac arrest. Prehosp Emerg Care. 2009;13(1):85-89. (Case report; 1 case)
  18. Gordon L, Paal P, Ellerton JA, et al. Delayed and intermittent CPR for severe accidental hypothermia. Resuscitation. 2015;90:46-49. (Review article)
  19. Niazi SA, Lewis FJ. Profound hypothermia in man; report of a case. Ann Surg. 1958;147(2):264-266. (Case report; 1 case)
  20. Paal P, Milani M, Brown D, et al. Termination of cardiopulmonary resuscitation in mountain rescue. High Alt Med Biol. 2012;13(3):200-208. (Guidelines; consesus article)
  21. * Danzl DF, Pozos RS, Auerbach PS, et al. Multicenter hypothermia survey. Ann Emerg Med. 1987;16(9):1042-1055. (Retrospective review; 428 patients)
  22. Markota A, Palfy M, Stozer A, et al. Difference between bladder and esophageal temperatures in mild induced hypothermia. J Emerg Med. 2015. (Prospective study; 8 patients)
  23. Rittenhouse EA, Mori H, Dillard DH, et al. Deep hypothermia in cardiovascular surgery. Ann Thorac Surg. 1974;17(1):63-98. (Retrospective review)
  24. MacLeod DB, Cortinez LI, Keifer JC, et al. The desaturation response time of finger pulse oximeters during mild hypothermia. Anaesthesia. 2005;60(1):65-71. (Prospective cross-over; 10 patients)
  25. Mallet ML. Pathophysiology of accidental hypothermia. QJM. 2002;95(12):775-785. (Review article)
  26. Kuriyama S, Tomonari H, Numata M, et al. [Clinical characteristics of renal damage in patients with accidental hypothermia]. Nihon Jinzo Gakkai Shi. 1999;41(5):493-498. (Prospective cross-over; 10 patients)
  27. Mattu A, Brady WJ, Perron AD. Electrocardiographic manifestations of hypothermia. Am J Emerg Med. 2002;20(4):314-326. (Case series; 6 cases)
  28. Vella MA, Jenner C, Betteridge DJ, et al. Hypothermia-induced thrombocytopenia. J R Soc Med. 1988;81(4):228-229. (Case series; 2 cases)
  29. Reed RL 2nd, Johnson TD, Hudson JD, et al. The disparity between hypothermic coagulopathy and clotting studies. J Trauma. 1992;33(3):465-470. (Prospective observational trial)
  30. Vassallo SU, Delaney KA, Hoffman RS, et al. A prospective evaluation of the electrocardiographic manifestations of hypothermia. Acad Emerg Med. 1999;6(11):1121-1126. (Prospective study; 43 patients, 100 ECGs)
  31. Baumgartner FJ, Janusz MT, Jamieson WR, et al. Cardiopulmonary bypass for resuscitation of patients with accidental hypothermia and cardiac arrest. Can J Surg. 1992;35(2):184- 187. (Case series; 5 cases)
  32. Osborne L, Kamal El-Din AS, Smith JE. Survival after prolonged cardiac arrest and accidental hypothermia. Br Med J (Clin Res Ed). 1984;289(6449):881-882. (Case report; 1 case)
  33. Diefenbach C, Abel M, Buzello W. Greater neuromuscular blocking potency of atracurium during hypothermic than during normothermic cardiopulmonary bypass. Anesth Analg. 1992;75(5):675-678. (Prospective cohort; 15 patients)
  34. Leslie K, Sessler DI, Bjorksten AR, et al. Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg. 1995;80(5):1007-1014. (Prospective cohort; 6 subjects)
  35. Heier T, Caldwell JE. Impact of hypothermia on the response to neuromuscular blocking drugs. Anesthesiology. 2006;104(5):1070-1080. (Review article)
  36. Petrone P, Asensio JA, Marini CP. Management of accidental hypothermia and cold injury. Curr Probl Surg. 2014;51(10):417-431. (Review article)
  37. * Brunette DD, McVaney K. Hypothermic cardiac arrest: an 11 year review of ED management and outcome. Am J Emerg Med. 2000;18(4):418-422. (Retrospective review; 11 patients)
  38. Lienhart HG, John W, Wenzel V. Cardiopulmonary resuscitation of a near-drowned child with a combination of epinephrine and vasopressin. Pediatr Crit Care Med. 2005;6(4):486-488. (Case report; 1 case)
  39. Splittgerber FH, Talbert JG, Sweezer WP, et al. Partial cardiopulmonary bypass for core rewarming in profound accidental hypothermia. Am Surg. 1986;52(8):407-412. (Case series and retrospective review)
  40. Ireland AJ, Pathi VL, Crawford R, et al. Back from the dead: extracorporeal rewarming of severe accidental hypothermia victims in accident and emergency. J Accid Emerg Med. 1997;14(4):255-257. (Case series; 3 cases)
  41. Ujhelyi MR, Sims JJ, Dubin SA, et al. Defibrillation energy requirements and electrical heterogeneity during total body hypothermia. Crit Care Med. 2001;29(5):1006-1011. (Randomized controlled trial in pigs)
  42. Okada M. The cardiac rhythm in accidental hypothermia. J Electrocardiol. 1984;17(2):123-128. (Retrospective review; 50 patients)
  43. Ho JD, Heegaard WG, Brunette DD. Successful transcutaneous pacing in 2 severely hypothermic patients. Ann Emerg Med. 2007;49(5):678-681. (Case series; 2 cases)
  44. Steele MT, Nelson MJ, Sessler DI, et al. Forced air speeds rewarming in accidental hypothermia. Ann Emerg Med. 1996;27(4):479-484. (Prospective randomized study; 16 patients)
  45. * Delaney KA, Vassallo SU, Larkin GL, et al. Rewarming rates in urban patients with hypothermia: prediction of underlying infection. Acad Emerg Med. 2006;13(9):913-921. (Prospective observational study; 96 patients)
  46. Greif R, Rajek A, Laciny S, et al. Resistive heating is more effective than metallic-foil insulation in an experimental model of accidental hypothermia: A randomized controlled trial. Ann Emerg Med. 2000;35(4):337-345. (Randomized controlled prospective cross-over study; 8 patients)
  47. Truell KD, Bakerman PR, Teodori MF, et al. Third-degree burns due to intraoperative use of a Bair Hugger warming device. Ann Thorac Surg. 2000;69(6):1933-1934. (Case report; 1 case)
  48. Goheen MS, Ducharme MB, Kenny GP, et al. Efficacy of forced-air and inhalation rewarming by using a human model for severe hypothermia. J Appl Physiol. 1997;83(5):1635-1640. (Prospective cross-over study; 8 patients)
  49. Ittner KP, Bachfischer M, Zimmermann M, et al. Convective air warming is more effective than resistive heating in an experimental model with a water dummy. Eur J Emerg Med. 2004;11(3):151-153. (Experimental model)
  50. Koller R, Schnider TW, Neidhart P. Deep accidental hypothermia and cardiac arrest--rewarming with forced air. Acta Anaesthesiol Scand. 1997;41(10):1359-1364. (Case series; 5 cases)
  51. Roggla M, Frossard M, Wagner A, et al. Severe accidental hypothermia with or without hemodynamic instability: rewarming without the use of extracorporeal circulation. Wien Klin Wochenschr. 2002;114(8-9):315-320. (Cohort study; 36 patients)
  52. Cocchi MN, Giberson B, Donnino MW. Rapid rewarming of hypothermic patient using Arctic Sun device. J Intensive Care Med. 2012;27(2):128-130. (Case report; 1 case)
  53. Franczuk P, Krawczyk P. [Arctic Sun System for hypothermia treatment after near-drowning]. Anestezjol Intens Ter. 2008;40(1):32-34. (Case report; 1 case)
  54. Vince SC, Flint NJ, Hall AP. A novel non-invasive warming technique in severe accidental hypothermia. Resuscitation. 2008;77(1):144-145. (Case report; 1 case)
  55. Grocott HP, Mathew JP, Carver EH, et al. A randomized controlled trial of the Arctic Sun Temperature Management System versus conventional methods for preventing hypothermia during off-pump cardiac surgery. Anesth Analg. 2004;98(2):298-302. (Randomized controlled trial; 29 patients)
  56. Weinberg AD. The role of inhalation rewarming in the early management of hypothermia. Resuscitation. 1998;36(2):101- 104. (Review article)
  57. Kempainen RR, Brunette DD. The evaluation and management of accidental hypothermia. Respir Care. 2004;49(2):192- 205. (Review article)
  58. Kjaergaard B, Bach P. Warming of patients with accidental hypothermia using warm water pleural lavage. Resuscitation. 2006;68(2):203-207. (Case series; 5 cases)
  59. Plaisier BR. Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature. Resuscitation. 2005;66(1):99-104. (Case report; 1 case)
  60. Laniewicz M, Lyn-Kew K, Silbergleit R. Rapid endovascular warming for profound hypothermia. Ann Emerg Med. 2008;51(2):160-163. (Case report; 1 case)
  61. Rollstin AD, Seifert SA. Acetaminophen/diphenhydramine overdose in profound hypothermia. Clin Toxicol (Phila). 2013;51(1):50-53. (Case report; 1 case)
  62. Willekes T, Naunheim R, Lasater M. A novel method of intravascular temperature modulation to treat severe hypothermia. Emerg Med J. 2006;23(10):e56. (Case report; 1 case)
  63. Rahman S, Rubinstein S, Singh J, et al. Early use of hemodialysis for active rewarming in severe hypothermia: a case report and review of literature. Ren Fail. 2012;34(6):784-788. (Case report; 1 case)
  64. Gentilello LM, Cobean RA, Offner PJ, et al. Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill patients. J Trauma. 1992;32(3):316-325. (Prospective observational trial; 34 patients)
  65. Ruttmann E, Weissenbacher A, Ulmer H, et al. Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. J Thorac Cardiovasc Surg. 2007;134(3):594-600. (Retrospective review; 59 patients)
  66. * Morita S, Inokuchi S, Yamagiwa T, et al. Efficacy of portable and percutaneous cardiopulmonary bypass rewarming versus that of conventional internal rewarming for patients with accidental deep hypothermia. Crit Care Med. 2011;39(5):1064- 1068. (Retrospective review; 68 patients)
  67. Sawamoto K, Bird SB, Katayama Y, et al. Outcome from severe accidental hypothermia with cardiac arrest resuscitated with extracorporeal cardiopulmonary resuscitation. Am J Emerg Med. 2014;32(4):320-324. (Retrospective review; 26 patients)
  68. Schaller MD, Fischer AP, Perret CH. Hyperkalemia. A prognostic factor during acute severe hypothermia. JAMA. 1990;264(14):1842-1845. (Retrospective review; 24 patients)
  69. Martin RS, Kilgo PD, Miller PR, et al. Injury-associated hypothermia: an analysis of the 2004 National Trauma Data Bank. Shock. 2005;24(2):114-118. (Retrospective review of National Trauma Data Bank data; 1.1 million patients)
  70. Mitra B, Tullio F, Cameron PA, et al. Trauma patients with the ‘triad of death’. Emerg Med J. 2012;29(8):622-625. (Retrospective review; 90 patients)
  71. Gentilello LM, Jurkovich GJ, Stark MS, et al. Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg. 1997;226(4):439-447. (Randomized prospective study; 57 patients)
  72. Johnson JW, Gracias VH, Schwab CW, et al. Evolution in damage control for exsanguinating penetrating abdominal injury. J Trauma. 2001;51(2):261-269. (Retrospective review; 24 patients)
  73. Brown D, Ellerton J, Paal P, et al. Hypothermia evidence, afterdrop, and practical experience. Wilderness Environ Med. 2015;26(3):437-439. (Guideline; consensus article)
  74. * van der Ploeg GJ, Goslings JC, Walpoth BH, et al. Accidental hypothermia: rewarming treatments, complications and outcomes from one university medical centre. Resuscitation. 2010;81(11):1550-1555. (Retrospective cohort; 84 patients)
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Megan L. Rischall, MD; Andrea Rowland-Fisher, MD

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January 1, 2016

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January 31, 2019

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