What are the complications of hypothermia?

From the Guidelines

Hypothermia can lead to severe complications, including cardiac arrhythmias, respiratory depression, and coagulopathy, which can significantly increase morbidity and mortality, and therefore, prompt recognition and treatment are crucial to prevent these complications and improve patient outcomes. The most immediate complications of hypothermia include:

• Cardiac arrhythmias, particularly bradycardia and atrial fibrillation, which can progress to ventricular fibrillation and cardiac arrest as body temperature drops below 28°C 1
• Respiratory complications, such as decreased respiratory rate, bronchospasm, and pulmonary edema
• Neurological complications, including progressive depression of brain function, leading to confusion, poor coordination, slurred speech, and eventually coma
• Metabolic complications, such as coagulopathy with increased bleeding risk, acidosis, hyperglycemia followed by hypoglycemia, and electrolyte disturbances
• Renal complications, including cold diuresis and acute kidney injury
• Gastrointestinal complications, such as ileus, pancreatitis, and hepatic dysfunction
• Immunosuppression, increasing infection risk, particularly pneumonia
• Reperfusion injury, which can cause multiorgan dysfunction after rewarming

These complications result from decreased enzymatic activity, altered cellular metabolism, vasoconstriction, and fluid shifts that occur as body temperature falls 1. Treatment focuses on careful rewarming while managing these potential complications with supportive care. According to the most recent guidelines, normothermia with core temperatures between 36 and 37 °C should be targeted to create optimal pre-conditions for coagulation 1. Additionally, removing wet clothing, avoiding additional heat loss, and increasing the ambient temperature can help reduce the risk of hypothermia and hypothermia-induced coagulopathy 1. Forced air warming, warm fluid therapy, and extracorporeal re-warming devices may also be used to manage hypothermia 1.

From the Research

Complications of Hypothermia

• Cardiac arrest is a common complication of severe hypothermia, and it can be challenging to treat due to the patient's unstable condition and the need for specialized care 2.
• Other complications of hypothermia include:
  • Dysrhythmias
  • Decreased cardiac output
  • Decreased central nervous system electrical activity
  • Cold diuresis
  • Noncardiogenic pulmonary edema
• In severe cases, hypothermia can lead to multiple organ dysfunction and refractory vasoplegia 2.
• Hypothermic patients who experience cardiac arrest may require prolonged cardiopulmonary resuscitation (CPR) and rewarming, which can be done using various methods, including extracorporeal life support (ECLS) or non-ECLS methods such as heated blankets, forced warmed air, and warmed IV fluids 3, 4.

Treatment and Management

• The treatment of hypothermic patients requires a multidisciplinary approach, including awareness, logistics, and proper planning 2.
• ECLS can be an effective treatment option for severely hypothermic patients with cardiac arrest, but it may not always be available or feasible 2, 3.
• Non-ECLS methods, such as continuous and prolonged CPR and conventional rewarming methods, can also lead to successful outcomes in patients with hypothermia in cardiac arrest 3, 4.
• Other treatment options, such as therapeutic peritoneal lavage with warm saline solution, can be used in critical hypothermic trauma patients 4.
• Ultrarapid induction of hypothermia using continuous automated peritoneal lavage with ice-cold fluids has been shown to be a safe and effective method for rapidly inducing and maintaining hypothermia in comatose patients after cardiac arrest and awake patients with acute myocardial infarction 5.
• Vasopressin has been used to restore spontaneous circulation in hypothermic cardiac arrest patients, and it may be a useful adjunct to epinephrine in these cases 6.