Delayed and intermittent CPR for severe accidental hypothermia.
BACKGROUND
Cardiac arrest (CA) in patients with severe accidental hypothermia (core temperature <28 °C) differs from CA in normothermic patients. Maintaining CPR throughout the prehospital period may be impossible, particularly during difficult evacuations. We have developed guidelines for rescuers who are evacuating and treating severely hypothermic CA patients.


METHODS
A literature search was performed. The authors used the findings to develop guidelines.


RESULTS
Full neurological recovery is possible even with prolonged CA if the brain was already severely hypothermic before CA occurred. Data from surgery during deep hypothermic CA and prehospital case reports underline the feasibility of delayed and intermittent CPR in patients who have arrested due to severe hypothermia.


CONCLUSIONS
Continuous CPR is recommended for CA due to primary severe hypothermia. Mechanical chest-compression devices should be used when available and CPR-interruptions avoided. Only if this is not possible should CPR be delayed or performed intermittently. Based on the available data, a patient with a core temperature <28 °C or unknown with unequivocal hypothermic CA, evidence supports alternating 5 min CPR and ≤5 min without CPR. With core temperature <20 °C, evidence supports alternating 5 min CPR and ≤10 min without CPR.
University Hospitals of Morecambe Bay Trust, Royal Lancaster Infirmary, LA1 4RP, United Kingdom; Langdale Ambleside Mountain Rescue Team, United Kingdom.
Les
L
Gordon
Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria; International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Austria. Electronic address: peter.paal@uki.at.
Peter
P
Paal
Birbeck Medical Group, Penrith, Cumbria, United Kingdom; International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Austria.
John A
JA
Ellerton
Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy; Medical University Innsbruck, Austria; International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Austria.
Hermann
H
Brugger
East Midlands Congenital Heart Centre, United Kingdom; Glenfield Hospital, Leicester LE3 9QP, United Kingdom; EuroELSO Steering Committee, United Kingdom.
Giles J
GJ
Peek
Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Medical Director, Alaska Mountain Rescue Group, USA; International Commission for Mountain Emergency Medicine (ICAR MEDCOM), Austria.
Ken
K
Zafren
D000367:Age Factors; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services; D006801:Humans; D007035:Hypothermia / Q000150:complications / Q000628:therapy*; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000628:therapy*; D020521:Stroke / Q000517:prevention & control
Cardiac arrest; Cardiopulmonary resuscitation; Emergency medical services; Hypothermia; Mountain rescue; Transportation