Care at the Critical Care Medical Center is associated with improved outcomes in patients with accidental hypothermia: A report from the J-Point registry

Background: The recommendation that patients with accidental hypothermia (AH) should be transported to specialized centers which can provide extracorporeal life support has not been validated, and the efficacy still remains unclear.Methods: This was a multicenter retrospective cohort study of patients with a body temperature of ≤35°C presenting at the emergency department of 12 hospitals in Japan between April 2011 and March 2016. We divided the patients into the two groups based on the point of care delivery: Critical Care Medical Center (CCMC) or non-CCMC. The primary outcome of this study was in-hospital death. In-hospital death was compared between AH patients at the CCMC and non-CCMC via a multivariable logistic regression analysis. Subgroup analyses were conducted according to patients with severe hypothermia (<28°C) or systolic blood pressure of <90 mmHg.Results: A total of 537 patients were included; 413 patients (76.9%) in the CCMC and 124 patients (23.1%) in the non-CCMC group. The in-hospital death rate was lower in the CCMC group than in the non-CCMC group (22.3% versus 31.5%, p<0.001). The multivariable logistic regression analysis showed that the adjusted odds ratio (AOR) of the CCMC group was 0.54 (95% confidence interval: 0.32-0.90). In subgroup analyses, patients with systolic blood pressure <90 mmHg in the CCMC group were less likely to experience in-hospital death (AOR 0.36, 95% CI 0.23-0.56). However, no such association was observed among patients with severe hypothermia (AOR 1.08, 95% CI 0.63-1.85)Conclusions: Our multicenter study indicated that Care at CCMC was associated with improved outcomes in patients with AH. Optimizing the transport of patients with AH to specialized centers is likely to be beneficial.