Multicenter hypothermia survey

Daniel F. Danzl, Robert S. Pozos, Paul S. Auerbach, Sheldon Glazer, William Goetz, Eric Johnson, Jon Jui, Patrick Lilja, John A. Marx, Jon Miller, William Mills, Richard Nowak, Richard Shields, Salvator Vicario, Marvin Wayne

Research output: Contribution to journalArticle

185 Scopus citations

Abstract

A multicenter survey evaluated the clinical presentation, treatment, and outcome of accidental hypothermia. Data were collected from 13 emergency departments, with 401 of the 428 cases presenting during a two-year study period. Core temperatures ranged from 35 C to 15.6 C (mean, 30.57 C ± 3.53) with 272 cases (63.6%) ≤ 32.2 C. There were no significant differences by age in presenting temperature, rewarming strategies, or mortality. The first hour rewarming rate was significantly (P < .05) faster in the population ≤ 59 years (1.08 ± 1.39 C/hr) than in those ≥ 60 years (0.75 ± 1.16 C/hr). Male core temperatures averaged 30.27 ± 3.44 C versus female temperatures of 31.1 ± 3.61 C. There were no clinically significant differences in male (N = 296) versus female (N = 132) profiles. High ethanol levels (315 to 800 mg %) did not affect outcome. Nine of 27 (33%) patients who received CPR initiated in the field survived, versus six of 14 (43%) with CPR begun in the ED. The profile of the CPR versus non-CPR population differed significantly (P < .05) in location (outdoors), initial temperature (24.8 ± 3.77 C vs 30.94 ± 3.12 C), third-hour rewarming rate (2.28 ± 1.53 C vs 1.17 ± 1.18 C/hr), and numerous laboratory parameters. Tracheal intubation was performed without incident in 117 cases, of which 97 were ≤ 32.2 C. There were 73 fatalities (17.1%). Of these, 84.9% (N = 62) were ≤ 32.2 C. Predisposing conditions in this group included "serious" illness (30), systemic infection (28), trauma (15), immersion (ten), frostbite (seven), and overdose (two). The initial pulse, hemoglobin, and first-hour rewarming rate was lower in the deceased population, while the potassium, urea nitrogen, creatinine, and phosphorus were elevated. Excluding treatment combinations, outcome with exclusive use of a single rewarming strategy was passive external rewarming, 14 deaths below 32.2 C, 13 above; active external rewarming, six deaths below 32.2 C, two above; active core rewarming, 38 deaths below 32.2 C, none above. Refinements of the American Heart Association's CPR standards in hypothermia and a Hypothermia Survival Index are proposed.

Original languageEnglish (US)
Pages (from-to)1042-1055
Number of pages14
JournalAnnals of emergency medicine
Volume16
Issue number9
DOIs
StatePublished - Sep 1987
Externally publishedYes

Keywords

  • hypothermia
  • multicenter study of

ASJC Scopus subject areas

  • Emergency Medicine

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  • Cite this

    Danzl, D. F., Pozos, R. S., Auerbach, P. S., Glazer, S., Goetz, W., Johnson, E., Jui, J., Lilja, P., Marx, J. A., Miller, J., Mills, W., Nowak, R., Shields, R., Vicario, S., & Wayne, M. (1987). Multicenter hypothermia survey. Annals of emergency medicine, 16(9), 1042-1055. https://doi.org/10.1016/S0196-0644(87)80757-6