title: The Bernese Hypothermia Algorithm: a consensus paper on in-hospital decision-making and treatment of patients in hypothermic cardiac arrest at an alpine level 1 trauma centre.
abstract: BACKGROUND
  Guidelines for the treatment of patients in severe hypothermia and mainly in hypothermic cardiac arrest recommend the rewarming using the extracorporeal circulation (ECC). However,guidelines for the further in-hospital diagnostic and therapeutic approach of these patients, who often suffer from additional injuries—especially in avalanche casualties, are lacking. Lack of such algorithms may relevantly delay treatment and put patients at further risk. Together with a multidisciplinary team, the Emergency Department at the University Hospital in Bern, a level I trauma centre, created an algorithm for the in-hospital treatment of patients with hypothermic cardiac arrest. This algorithm primarily focuses on the decision-making process for the administration of ECC.
  The major difference between the traditional approach, where all hypothermic patients are primarily admitted to the emergency centre, and our new algorithm is that hypothermic cardiac arrest patients without obvious signs of severe trauma are taken to the operating theatre without delay. Subsequently, the interdisciplinary team decides whether to rewarm the patient using ECC based on a standard clinical trauma assessment, serum potassium levels, core body temperature, sonographic examinations of the abdomen, pleural space, and pericardium, as well as a pelvic X-ray, if needed. During ECC, sonography is repeated and haemodynamic function as well as haemoglobin levels are regularly monitored. Standard radiological investigations according to the local multiple trauma protocol are performed only after ECC. Transfer to the intensive care unit, where mild therapeutic hypothermia is maintained for another 12 h, should not be delayed by additional X-rays for minor injuries.
  
  
  CONCLUSIONS
  The presented algorithm is intended to facilitate in-hospital decision-making and shorten the door-to-reperfusion time for patients with hypothermic cardiac arrest. It was the result of intensive collaboration between different specialties and highlights the importance of high-quality teamwork for rare cases of severe accidental hypothermia. Information derived from the new International Hypothermia Registry will help to answer open questions and further optimize the algorithm.
authors.affiliation: University Centre for Emergency, Inselspital, Bern University Hospital, Switzerland. Monika.Brodmann@insel.ch
authors.forename: Brodmann Maeder
authors.initials: BM
authors.lastname: Monika
authors.forename: Dünser
authors.initials: D
authors.lastname: Martin
authors.forename: Eberle
authors.initials: E
authors.lastname: Balthasar
authors.forename: Loetscher
authors.initials: L
authors.lastname: Stefan
authors.forename: Dietler
authors.initials: D
authors.lastname: Roland
authors.forename: Englberger
authors.initials: E
authors.lastname: Lars
authors.forename: Martinolli
authors.initials: M
authors.lastname: Luca
authors.forename: Neumann
authors.initials: N
authors.lastname: Markus
authors.forename: Stalder
authors.initials: S
authors.lastname: Mario
authors.forename: Roost-Krähenbühl
authors.initials: RK
authors.lastname: Eva
authors.forename: Zimmermann
authors.initials: Z
authors.lastname: Heinz
authors.forename: Exadaktylos K
authors.initials: EK
authors.lastname: Aristomenis
mesh_terms: D000465:Algorithms; D055875:Avalanches; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003657:Decision Making; D004190:Disasters; D004632:Emergency Medical Services / Q000592:standards*; D005112:Extracorporeal Circulation / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000628:therapy*; D017410:Practice Guidelines as Topic; D017694:Rewarming / Q000379:methods*; D014193:Trauma Centers