What is the protocol for treating hypothermia?

From the Guidelines

Hypothermia protocol should prioritize rewarming techniques based on the severity of hypothermia, with passive rewarming for mild cases, external warming for moderate cases, and core rewarming for severe cases. The initial care for victims of accidental hypothermia involves preventing further heat loss and beginning rewarming immediately 1. For patients with mild hypothermia (temperature >34°C), passive rewarming is generally adequate, while those with moderate hypothermia (30°C to 34°C) require external warming techniques 1. Severe hypothermia (<30°C) often requires core rewarming, which can be achieved through cardiopulmonary bypass, warm-water lavage of the thoracic cavity, or extracorporeal blood warming with partial bypass 1.

Some key points to consider in hypothermia management include:

• Preventing additional evaporative heat loss by removing wet garments and insulating the victim from further environmental exposures
• Using adjunctive core rewarming techniques such as warmed IV or intraosseous (IO) fluids and warm humidified oxygen
• Not delaying urgent procedures such as airway management and insertion of vascular catheters
• Considering the use of active external rewarming methods, such as forced-air warmers or heating pads, for patients with moderate to severe hypothermia

It's also important to note that hypothermia is a significant risk factor for morbidity and mortality in trauma patients, and early goal-directed management can help prevent hypothermia-related complications 1. A systematic approach to managing hypothermia in trauma patients, including prevention and treatment, can help reduce morbidity and mortality 1.

In terms of specific rewarming techniques, active internal rewarming methods, such as ventilation with humidified oxygen, warmed intravenous fluids, and extracorporeal modalities, can be effective for moderate to severe hypothermia 1. However, the choice of rewarming technique should be based on the individual patient's needs and the severity of their hypothermia. Overall, a goal-directed approach to hypothermia management, prioritizing rewarming techniques based on severity, is crucial for improving outcomes in patients with hypothermia.

From the Research

Hypothermia Protocol

• Hypothermia is a life-threatening condition that can lead to cardiac arrest, and its treatment depends on the severity of the condition 2.
• Severe accidental hypothermia can be treated with extracorporeal membrane oxygenation (ECMO) as a first-line strategy for rewarming, especially in cases complicated by cardiac arrest 3, 4, 5, 6.
• ECMO has been shown to be effective in rewarming patients with severe hypothermia, with faster rewarming rates and higher hospital survival rates compared to conventional rewarming methods 4.
• Veno-venous ECMO (VV ECMO) and veno-arterial ECMO (VA ECMO) are two types of ECMO that can be used for rewarming, each with its own advantages and potential benefits 3, 6.
• The use of ECMO in severe hypothermia associated with cardiac arrest has become more frequent in specialized centers, with better survival outcomes compared to traditional rewarming methods 5.
• Advanced rewarming techniques such as ECMO are important in the outcome of patients with severe accidental hypothermia, even after prolonged and refractory out-of-hospital cardiac arrest 5.
• Accidental hypothermia treatment algorithms, especially in hospitals capable of ECMO rewarming, are necessary to enable more rapid decision-making 5, 6.

Rewarming Methods

• ECMO is a preferred technique for rewarming due to its lower anticoagulation requirements and potential to prolong circulatory support 6.
• Conventional rewarming methods, such as intravascular rewarming catheters or warm fluid lavage, can also be used, but may have slower rewarming rates and lower hospital survival rates compared to ECMO 4.
• The choice of rewarming method depends on the severity of the hypothermia, the presence of cardiac arrest, and the availability of ECMO facilities 3, 4, 5, 6.

Nursing Care

• Nursing management of a patient with hypothermia depends on the severity of the condition, with the primary concern being to treat the symptoms and re-warm the patient appropriately 2.
• Nurses should be aware of the risk factors for hypothermia, including underlying conditions that increase a person's susceptibility to cold, and take steps to prevent heat loss and promote heat gain 2.