Accidental hypothermia in Poland : estimation of prevalence, diagnostic methods and treatment

BACKGROUND: The incidence of hypothermia is difficult to evaluate, and the data concerning the morbidity and mortality rates do not seem to fully represent the problem. The aim of the study was to estimate the actual prevalence of accidental hypothermia in Poland, as well as the methods of diagnosis and management procedures used in emergency rooms (ERs). METHODS: A specially designed questionnaire, consisting of 14 questions, was mailed to all the 223 emergency rooms (ER) in Poland. The questions concerned the incidence, methods of diagnosis and risk factors, as well as the rewarming methods used and available measurement instruments. RESULTS: The analysis involved data from 42 ERs providing emergency healthcare for the population of 5 305 000. The prevalence of accidental hypothermia may have been 5.05 cases per 100.000 residents per year. Among the 268 cases listed 25% were diagnosed with codes T68, T69 or X31, and in 75% hypothermia was neither included nor assigned a code in the final diagnosis. The most frequent cause of hypothermia was exposure to cold air alongside ethanol abuse (68%). Peripheral temperature was measured in 57%, core temperature measurement was taken in 29% of the patients. Peripheral temperature was measured most often at the axilla, while core temperature measurement was predominantly taken rectally. Mild hypothermia was diagnosed in 75.5% of the patients, moderate (32-28°C) in 16.5%, while severe hypothermia (less than 28°C) in 8% of the cases. Cardiopulmonary resuscitation was carried out in 7.5% of the patients. The treatment involved mainly warmed intravenous fluids (83.5%) and active external rewarming measures (70%). In no case was extracorporeal rewarming put to use. CONCLUSIONS: The actual incidence of accidental hypothermia in Polish emergency departments may exceed up to four times the official data. Core temperature is taken only in one third of the patients, the treatment of hypothermic patients is rarely conducted in intensive care wards and extracorporeal rewarming techniques are not used. It may be expected that personnel education and the development of management procedures will brighten the prognosis and increase the survival rate in accidental hypothermia

Extracorporeal rewarming from accidental hypothermia of patient with suspected trauma

The use of extracorporeal membrane oxygenation is a new approach to rewarming patients with severe hypothermia and hemodynamic instability. There are, however, many questions regarding qualification for this technique in case of suspected or confirmed trauma. A male with confirmed accidental hypothermia (25°C) and after successful cardiopulmonary resuscitation from in-hospital cardiac arrest was subjected to a protocol of extracorporeal rewarming from profound hypothermia. Because of unclear history, a full trauma computed tomography was performed that showed pericerebral hematoma and signs of previously undergone right craniotomy, multiple right-sided rib fractures and the presence of intraperitoneal fluid. Based on repeated imaging and specialist consultation, no life-threatening injuries were identified and rewarming with extracorporeal membrane oxygenation was safely performed. In a year follow-up, the patient was found to be alive, with no neurologic deficits. Although this case highlights the first successful utilization of extracorporeal rewarming in a trauma patient at our center there are several limitations to its widespread us

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