The Internet Book of Critical Care Podcast IBCC Episode 65 - Hypothermia
Nov 21, 2019
Dive into the chilling world of hypothermia as experts break down clinical clues and severity categories. Discover the surprising ECG changes, paradoxical undressing, and unique metabolic triggers. Learn about modified resuscitation techniques, including the innovative use of ECMO for rapid warming. They even explore active rewarming methods like thoracic lavage and heated humidity. Plus, understand the critical importance of treating underlying causes and managing complications, ensuring no one is left out in the cold!
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Spectrum And Severity Of Hypothermia
- Hypothermia is defined as core temperature <35°C and ranges from mild (32–35°C) to severe (<28°C).
- Severe hypothermia may mimic death with fixed pupils and arrhythmias, so treat aggressively before declaring death.
Modify ACLS And Prioritize ECMO
- For hypothermic cardiac arrest, preferentially transfer to an ECMO or cardiopulmonary bypass center when possible.
- Limit repeated drug doses and defibrillation attempts until the core is rewarmed by ~1–2°C.
Use Central Rewarming Strategically
- Use VA-ECMO or cardiopulmonary bypass for hypothermic arrest to provide perfusion and rapid core warming.
- Rewarm gradually to intermediate temperatures (eg, to ~34°C) rather than immediate normalization.