title: Outcome after severe accidental hypothermia in the French Alps: A 10-year review.
abstract: OBJECTIVE
  To describe the factors associated with outcome after accidental deep hypothermia.
  
  
  METHODS
  We conducted a retrospective cohort study on patients with accidental hypothermia (core temperature <28 °C) admitted to a Level I emergency room over a 10-year period.
  
  
  RESULTS
  Forty-eight patients were included with a median temperature of 26 °C (range, 16.3-28 °C) on admission. The etiology of hypothermia was exposure to a cold environment (n = 27), avalanche (n = 13) or immersion in cold water (n = 8). Mean age was 47 ± 22 years, and 58% were males. Thirty-two patients had a cardiac arrest (CA): 15 patients presented unwitnessed cardiac arrest (UCA) and 17 patients presented rescue collapse (RC). Extracorporeal life support (ECLS) was implemented in 21 patients with refractory cardiac arrest and in two patients with hemodynamic instability. Overall mortality was 50%. For cardiac arrest patients, only three out of 15 patients with UCA survived at day 28, whereas eight out of 17 patients with RC survived. The cerebral performance category score was 4 for all the survivors of UCA and 1 [range, 1-2] for survivors of RC. Patients with poor outcome presented more UCA, a lower pH, a higher serum potassium, creatinine, serum sodium or lactate level as well as more severe coagulation disorders.
  
  
  CONCLUSIONS
  Cardiac arrest related to rescue collapse was associated with favorable outcome. On-scene rescue collapse should prompt prolonged resuscitation and ECLS rewarming in all CA patients with deep hypothermia. Conversely, unwitnessed cardiac arrest was associated with unfavorable outcome and will likely not benefit from ECLS.
authors.affiliation: UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525/Equipe PRETA, Grenoble F-38041, France; Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France. Electronic address: gdebaty@chu-grenoble.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.affiliation: Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Moustapha
authors.affiliation: Department of Anesthesiology and Critical Care, Grenoble University Hospital, Grenoble, France; INSERM U836, Grenoble F-38042, France; Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble F-38042, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
authors.affiliation: UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525/Equipe PRETA, Grenoble F-38041, France; Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Maignan
authors.affiliation: Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Blancher
authors.affiliation: Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Rallo
authors.affiliation: Department of Anesthesiology and Critical Care, Grenoble University Hospital, Grenoble, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Brun
authors.affiliation: Department of Cardiac Surgery, Grenoble University Hospital, Grenoble, France; HP2 Laboratory, INSERM U 1042, Grenoble, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chavanon
authors.affiliation: Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Danel
authors.affiliation: Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Carpentier
authors.affiliation: Department of Anesthesiology and Critical Care, Grenoble University Hospital, Grenoble, France; INSERM U836, Grenoble F-38042, France; Université Grenoble Alpes, Grenoble Institut des Neurosciences, Grenoble F-38042, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Payen
authors.affiliation: UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525/Equipe PRETA, Grenoble F-38041, France; Department of Emergency Medicine, Grenoble University Hospital, CS 10217, 38043 Grenoble Cedex 09, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Briot
mesh_terms: D000328:Adult; D000368:Aged; D055875:Avalanches; D001831:Body Temperature; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D003080:Cold Temperature / Q000009:adverse effects*; D004777:Environment; D005112:Extracorporeal Circulation / Q000379:methods; D005260:Female; D005602:France / Q000453:epidemiology; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D007035:Hypothermia / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D017694:Rewarming / Q000379:methods; D012769:Shock / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis
keywords: Accidental hypothermia; Cardiac arrest; Extracorporeal rewarming; Rescue collapse