Induced Hypothermia to 4.2°C with Neurologically Intact Survival: A Forgotten Case Series

Zafren, Ken; Paal, Peter; Brugger, Hermann; Lechner, Raimund

doi:10.1016/j.wem.2020.02.003

Cited by 6 publications

(4 citation statements)

References 10 publications

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Section: Discussionmentioning

confidence: 99%

“…The lowest recorded core temperatures for accidental hypothermia among individuals who have been successfully resuscitated were 13.7°C (56.7°F) in a 29-year-old female and 11.8°C (53.2°F) in a two-year-old male [ 13 , 14 ]. The lowest recorded core temperatures in induced reversible hypothermia with successful resuscitation were 9°C (48.2°F) and 4.2°C (39.6°F) [ 14 , 15 ]. There are numerous additional case reports of patients with severe hypothermia, <28°C (<82.4°F), and profound hypothermia, <24°C (<75.2°F), all of whom successfully recovered, many with full neurologic recovery [ 2 , 6 , 16 - 18 ].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of a Patient Being Alert and Communicative Despite Severe Hypothermia

Jeunesse,

O'Malley,

Petrus

et al. 2024

Cureus

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Hypothermia is defined as a significant drop in core body temperature below 35°C (95°F). It is traditionally staged as mild, moderate, severe, and profound at temperatures of 35°C to 32°C (95°F to 89.6°F), 32°C to 28°C (89.6°F to 82.4°F), <28°C (<82.4°F), and <24°C (75.2°F), respectively. It can also be classified into the same stages by clinical presentations. We present a patient that fits into two different stages based on core body temperature and clinical presentation. A 58-year-old homeless male with a history of seizures and alcohol use presented via emergency medical services after spending the night outside and uncovered with a core body temperature of 25.1°C (77.1°F) via a urinary bladder thermometer, meeting criteria for severe, near profound, hypothermia. However, he was alert and communicating, shivering, with tachycardia, tachypnea, normal oxygen saturation, and elevated blood pressure, suggestive of mild hypothermia clinically. Passive and active external and internal rewarming were utilized to treat, with the removal of wet clothing, forced air patient warming system, warm blankets, and warm lactated ringers given intravenously. He was soon transferred to the intensive care unit and first returned to normothermic levels after approximately 10 hours from presentation. An electrocardiogram was obtained after resolution of shivering and revealed atrial fibrillation without Osborn waves. He remained in the hospital for the following week to treat his atrial fibrillation, hypothermia-induced rhabdomyolysis, and alcohol withdrawal. He was discharged without neurologic deficits and medically stable with appropriate resources. This case demonstrates a unique presentation of severe hypothermia. To our knowledge, there has not been a reported case of severe hypothermia that does not involve severe central nervous system depression, severe slowing of vitals, and/or comatose status. These clinical symptoms normally begin during moderate hypothermic levels near 32°C (89.6°F), yet our patient presented without any central nervous system depression and with accelerated vitals that are more consistent with mild hypothermia yet had a core temperature of 25.1°C (77.1°F). Treatment was dictated by his core body temperature rather than clinical presentation. Because of this incongruence between symptoms and true severity of disease in hypothermia, we recommend diagnosis and treatment of hypothermia always be confirmed and based on core body temperature via a low-reading thermometer instead of clinical presentation alone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Rare Case of a Patient Being Alert and Communicative Despite Severe Hypothermia

Jeunesse,

O'Malley,

Petrus

et al. 2024

Cureus

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“…35,36 Core temperature should not, by itself, be used to determine death or withhold resuscitation. 37…”

Section: Discussionmentioning

confidence: 99%

“…35,36 Core temperature should not, by itself, be used to determine death or withhold resuscitation. 37 Absence of vital signs is not pathognomonic of death because signs may be absent although a person is still alive. In some situations, a person can have no vital signs but can be resuscitated.…”

Section: Core Temperaturementioning

confidence: 99%

Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom)

Schön

Gordon

Hölzl³

et al. 2020

Wilderness & Environmental Medicine

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Determination of death requires specific knowledge, training, and experience in most cases. It can be particularly difficult when external conditions, such as objective hazards in mountains, prevent close physical examination of an apparently lifeless person, or when examination cannot be accomplished by an authorized person. Guidelines exist, but proper use can be difficult. In addition to the absence of vital signs, definitive signs of death must be present. Recognition of definitive signs of death can be problematic due to the variability in time course and the possibility of mimics. Only clear criteria such as decapitation or detruncation should be used to determine death from a distance or by laypersons who are not medically trained. To present criteria that allow for accurate determination of death in mountain rescue situations, the International Commission for Mountain Emergency Medicine convened a panel of mountain rescue doctors and a forensic pathologist. These recommendations are based on a nonsystematic review of the literature including articles on determination of death and related topics.

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Kalte Klimazonen

Lechner,

Neitzel,

Unkelbach

et al. 2024

Taktische Medizin

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Induced Hypothermia to 4.2°C with Neurologically Intact Survival: A Forgotten Case Series

Cited by 6 publications

References 10 publications

A Rare Case of a Patient Being Alert and Communicative Despite Severe Hypothermia

A Rare Case of a Patient Being Alert and Communicative Despite Severe Hypothermia

Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom)

Kalte Klimazonen

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