What is the treatment for central hypothermia (central hypothermia tx)?

Treatment of Central Hypothermia

The treatment of central hypothermia should be guided by the severity level, with passive rewarming for mild cases (32-35°C), combined passive and active external rewarming for moderate cases (28-32°C), and aggressive active core rewarming techniques for severe cases (<28°C). 1

Assessment and Classification

Hypothermia severity is classified based on core temperature and clinical presentation:

Severity Level	Temperature	Clinical Signs
Cold stress	35-37°C	Alert, possibly shivering
Mild	32-35°C	Altered mental status, shivering
Moderate	28-32°C	Decreased responsiveness, ±shivering
Severe/profound	<28°C	Unresponsive, appears lifeless, slow vital signs

Treatment Algorithm

Immediate Actions for All Hypothermia Patients

1. Move patient to a warm environment
2. Remove wet clothing
3. Protect from further heat loss
4. Monitor core temperature regularly 2

Rewarming Strategies by Severity

Mild Hypothermia (32-35°C)

• Level 1 (Passive) Rewarming:
  • Dry blankets and clothing
  • Warm environment
  • Insulation from cold surfaces 2, 1
• Level 2 (Active External) Rewarming:
  • Warming blankets
  • Forced warm air systems
  • Heating pads 2
  • Monitor temperature every 15 minutes 1

Moderate Hypothermia (28-32°C)

• Combine Level 1 and 2 approaches
• Add:
  • Warmed IV fluids (37-40°C)
  • Warm humidified oxygen
  • Monitor temperature every 5 minutes 2, 1
• Handle patient gently to prevent arrhythmias 2
• Activate emergency response system 1

Severe/Profound Hypothermia (<28°C)

• Level 3 (Active Core) Rewarming:
  • All previous measures plus:
  • Body cavity lavage (peritoneal, pleural, gastric)
  • Extracorporeal blood warming (ECMO preferred for cardiac arrest)
  • Continuous cardiac monitoring 2, 1, 3
• Emergency intervention with all available methods 1
• Handle extremely gently to prevent arrhythmias 2

Special Considerations

Cardiac Considerations

• For patients in cardiac arrest with severe hypothermia:
  • Continue CPR
  • Limit defibrillation attempts until core temperature >30°C
  • Consider extracorporeal membrane oxygenation (ECMO) 2, 3
  • Endovascular rewarming catheters may be a less invasive alternative to ECMO in select cases 4, 5

Trauma Patients

• Hypothermia is an independent risk factor for mortality in trauma
• Associated with coagulopathy and increased bleeding
• Implement aggressive warming strategies early
• Avoid prolonged surgical exploration; consider damage control techniques 2

Safety Precautions

• Place insulation between heat sources and skin to prevent burns
• Follow manufacturer instructions for warming devices
• Monitor frequently for pressure injuries and burns 2, 1
• Continue warming until core temperature reaches 36°C
• Stop rewarming after reaching 37°C to avoid overheating 1

Effectiveness of Rewarming Methods

Direct blood warming and warm IV fluid infusion are among the most effective rewarming techniques based on thermodynamic analysis 6. For severe hypothermia, extracorporeal rewarming methods provide the fastest and most controlled rewarming rates 3.

The choice of rewarming method should be based on the severity of hypothermia, available resources, and the patient's clinical condition, with more aggressive techniques reserved for more severe cases.