title: Accidental hypothermia-an update : The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).
abstract: BACKGROUND
  This paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest.
  
  
  METHODS
  The authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review.
  
  
  RESULTS
  The hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature <28 °C, ventricular arrhythmia, systolic blood pressure <90 mmHg), and those who have already arrested, should be transferred directly to an ECLS-centre. Cardiac arrest patients should receive continuous cardiopulmonary resuscitation (CPR) during transfer. If prolonged transport is required or terrain is difficult, mechanical CPR can be helpful. Delayed or intermittent CPR may be appropriate in hypothermic arrest when continuous CPR is impossible. Modern post-resuscitation care should be implemented following hypothermic arrest. Structured protocols should be in place to optimise pre-hospital triage, transport and treatment as well as in-hospital management, including detailed criteria and protocols for the use of ECLS and post-resuscitation care.
  
  
  CONCLUSIONS
  Based on new evidence, additional clinical experience and clearer management guidelines and documentation, the treatment of accidental hypothermia has been refined. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck University Hospital, Anichstr. 35, 6020, Innsbruck, Austria. peter.paal@icloud.com.|Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, Barts Health NHS Trust, Queen Mary University of London, KGV Building, Office 10, 1st floor, West Smithfield, London, EC1A 7BE, UK. peter.paal@icloud.com.|International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland. peter.paal@icloud.com.
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0002-2939-4782
authors.initials: P
authors.lastname: Paal
authors.affiliation: Department of Anaesthesia, University hospitals, Morecambe Bay Trust, Lancaster, UK.|Langdale Ambleside Mountain Rescue Team, Ambleside, UK.
authors.forename: Les
authors.initials: L
authors.lastname: Gordon
authors.affiliation: International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland.|Institute of Mountain Emergency Medicine, EURAC research, Drususallee 1, Bozen/Bolzano, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Strapazzon
authors.affiliation: International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland.|Institute of Mountain Emergency Medicine, EURAC research, Drususallee 1, Bozen/Bolzano, Italy.|Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Monika
authors.initials: M
authors.lastname: Brodmann Maeder
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck University Hospital, Anichstr. 35, 6020, Innsbruck, Austria.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Putzer
authors.affiliation: Department of Surgery, Cardiovascular Research, Service of Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Walpoth
authors.affiliation: Department of Cardiothoracic Anaesthesia and Intensive Care 4142, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Wanscher
authors.affiliation: International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland.|Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Doug
authors.initials: D
authors.lastname: Brown
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Holzer
authors.affiliation: Department of Neurology, Neurologic Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Innsbruck University Hospital, Anichstr. 35, 6020, Innsbruck, Austria.|Institute of Mountain Emergency Medicine, EURAC research, Drususallee 1, Bozen/Bolzano, Italy.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brugger
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000628:therapy*; D017694:Rewarming / Q000379:methods*
keywords: Cardiopulmonary bypass; Cardiopulmonary resuscitation; Emergency medicine; Extracorporeal membrane oxygenation; Hypothermia; Resuscitation