title: Profound Accidental Hypothermia: Systematic Approach to Active Recognition and Treatment.
abstract: We sought to organize a functional system of recognition and advanced treatment of hypothermic patients with extracorporeal rewarming as a treatment option. All patients with suspected hypothermia are consulted with the hypothermia coordinator (HC), whose role is to provide expertise on hypothermia recognition and treatment to all rescue and medical services. Patients with Swiss staging system of hypothermia class III and IV are subjected to extracorporeal rewarming. Patients with class I and II are managed in local hospitals, after the HC provides instructions. From program initiation (July 29, 2013) to November 1, 2015, HC consulted 104 hypothermic patients; 21 in hypothermia class III and IV were subjected to extracorporeal rewarming in the John Paul II Hospital in Cracow, Poland. The remaining people were rewarmed in the referring hospitals. Cardiac arrest upon referral was present in 10 cases (resuscitation times from arrest to extracorporeal membrane oxygenation implantation ranged 107-345 minutes). Seven patients died, and the remaining 14 have been rewarmed with the restoration of hemodynamic stability. Systematic approach to active recognition and treatment of profound accidental hypothermia patients, on the basis of HC cooperation with emergency medical services, enables advanced management with good outcomes, especially in patients with cardiac arrest.
authors.affiliation: From the *Department of Anesthesiology and Intensive Care, The John Paul II Hospital, Krakow, Poland; †Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; ‡Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland; §Tatra Mountain Rescue Service, Zakopane, Poland; ¶Department of Emergency Medical Services, Medical University of Warsaw, Warsaw, Poland; ‖Polish Medical Air Rescue, Warsaw, Poland; and #Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, Krakow, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Jarosz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Darocha
authors.forename: Sylweriusz
authors.initials: S
authors.lastname: Kosiński
authors.forename: Robert
authors.initials: R
authors.lastname: Gałązkowski
authors.forename: Piotr
authors.initials: P
authors.lastname: Mazur
authors.forename: Jacek
authors.initials: J
authors.lastname: Piątek
authors.forename: Janusz
authors.initials: J
authors.lastname: Konstanty-Kalandyk
authors.forename: Hubert
authors.initials: H
authors.lastname: Hymczak
authors.forename: Rafał
authors.initials: R
authors.lastname: Drwiła
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017694:Rewarming