Pre-Hospital Core Temperature Measurement in Accidental and Therapeutic Hypothermia

Abstract

Core temperature (T core) measurement is the only diagnostic tool to accurately assess the severity of hypothermia. International recommendations for management of accidental hypothermia encourage T core measurement for triage, treatment, and transport decisions, but they also recognize that lack of equipment may be a limiting factor, particularly in the field. The aim of this nonsystematic review is to highlight the importance of field measurement of T core and to provide practical guidance for clinicians on pre-hospital temperature measurement in accidental and therapeutic hypothermia. Clinicians should recognize the difference between alternative measurement locations and available thermometers, tailoring their decision to the purpose of the measurement (i.e., intermittent vs. continual measurement), and the impact on management decisions. The importance of T core measurement in therapeutic hypothermia protocols during early cooling and monitoring of target temperature is discussed.

Indoor accidental hypothermia in the elderly: an emerging lethal entity in the 21st century

“…Last, pre-hospital and in-hospital staff should be aware of the potential occurrence of accidental hypothermia indoors and outdoors. In this regard, a role model has been set by the Severe Accidental Hypothermia centre in Cracow, Poland, where low reading thermometers were promoted pre-hospitally9 and specific training for accidental hypothermia diagnosis, hospital triage and treatment was provided to pre-hospital and in-hospital staff. After taking up work, a four times higher than reported rate for accidental hypothermia was noted 10.…”

The prehospital management of avalanche victims

“…Core body temperature is most reliably obtained by oesophageal probe measurement in the lower third of the oesophagus and should be used in intubated patients 57. In non-intubated patients, thermistor-based tympanic thermometers are recommended 58 59. If temperature measurements cannot reliably be obtained, one should assume a worst-case cooling rate and accept the potential for severe hypothermia despite short duration of burial 7…”

Managing accidental hypothermia: a UK-wide survey of prehospital and search and rescue providers

“…Most services reported using thermometers, but also commented that this can be unreliable, and stressed the importance of clinical signs. Skin and oral temperature measurements are used by a quarter of providers, but evidence suggests it will not reflect core temperatures in hypothermia 24. The disadvantages of rectal measurement, used by five services, include risk of significant lag time behind core temperature and exposing the casualty to the cold environment 7–9.…”

“…The disadvantages of rectal measurement, used by five services, include risk of significant lag time behind core temperature and exposing the casualty to the cold environment 7–9. While oesophageal probes are the more reliable method of recording core temperature,24 they are invasive and generally require the patient to be unresponsive. It is therefore unsurprising that this method is used mainly on air ambulances.…”