Hypothermia (26.9°C) in a Polytrauma Patient: Case Report of Survival and Review of Science

Hypothermia is beneficial in certain circumstances; the single most advantageous aspect of hypothermia is the reduction in metabolic demand. However, induced hypothermia differs from post-traumatic hypothermia. It is acknowledged that hypothermic polytrauma patients have poorer outcomes than normothermic polytrauma patients. Post-traumatic hypothermia has worse outcomes, likely due to it being a sequel of hemorrhagic shock, and the attendant failure to meet metabolic demands. Hemorrhagic shock produces the “lethal triad” of trauma: hypothermia, acidosis and coagulopathy. Studies of post-traumatic hypothermia have shown that core body temperature of 32°C predicts fatality [1-4]. We present a case report of a trauma patient with documented presenting core temperature of 26.9°C in the context of treatable hemorrhagic shock along with a systematic literature review of post-traumatic hypothermia.

[1]  K. Hallows,et al.  Hemodialysis for the Treatment of Severe Accidental Hypothermia , 2014, Seminars in dialysis.

[2]  M. Czerny,et al.  Antegrade selective cerebral perfusion and moderate hypothermia in aortic arch surgery: clinical outcomes in elderly patients. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[3]  S. Talbot,et al.  Hypothermic cardiac arrest rescued with cardiopulmonary bypass and decompressive laparotomy , 2010, Emergency Medicine Journal.

[4]  T. Hemmen,et al.  Therapeutic Hypothermia for Brain Ischemia: Where Have We Come and Where Do We Go? , 2010, Stroke.

[5]  T. Debillon,et al.  [Hypothermia for hypoxic-ischemic encephalopathy in fullterm newborns]. , 2010, Archives de pediatrie : organe officiel de la Societe francaise de pediatrie.

[6]  Hui Lin,et al.  Donor heart preservation in an empty beating state under mild hypothermia. , 2010, The Annals of thoracic surgery.

[7]  T. Debillon,et al.  [Hypothermia for hypoxic-ischemic encephalopathy in fullterm newborns]. , 2010, Archives de pédiatrie.

[8]  P. Rhee,et al.  Mortality Impact of Hypothermia After Cavitary Explorations in Trauma , 2009, World Journal of Surgery.

[9]  P. Rhee,et al.  Management of an outbreak of multiresistant Acinetobacter baumanii infection in a surgical intensive care unit , 2007, Critical Care.

[10]  Umezawa Kazuo,et al.  The Efficacy of Rewarming With a Portable and Percutaneous Cardiopulmonary Bypass System in Accidental Deep Hypothermia Patients With Hemodynamic Instability , 2008 .

[11]  Hermann Brugger,et al.  Full recovery of an avalanche victim with profound hypothermia and prolonged cardiac arrest treated by extracorporeal re-warming. , 2008, Resuscitation.

[12]  R. Silbergleit,et al.  Rapid endovascular warming for profound hypothermia. , 2008, Annals of emergency medicine.

[13]  S. Inoue,et al.  The efficacy of rewarming with a portable and percutaneous cardiopulmonary bypass system in accidental deep hypothermia patients with hemodynamic instability. , 2008, The Journal of trauma.

[14]  K. Grathwohl,et al.  The impact of hypothermia on trauma care at the 31st combat support hospital. , 2006, American journal of surgery.

[15]  A. Elliott,et al.  Is hypothermia simply a marker of shock and injury severity or an independent risk factor for mortality in trauma patients? Analysis of a large national trauma registry. , 2005, The Journal of trauma.

[16]  P. Kilgo,et al.  INJURY-ASSOCIATED HYPOTHERMIA: AN ANALYSIS OF THE 2004 NATIONAL TRAUMA DATA BANK , 2005, Shock.

[17]  B. Plaisier Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature. , 2005, Resuscitation.

[18]  Henry E. Wang,et al.  Admission hypothermia and outcome after major trauma , 2005, Critical care medicine.

[19]  A. Wolberg,et al.  A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. , 2004, The Journal of trauma.

[20]  P. Safar,et al.  After spontaneous hypothermia during hemorrhagic shock, continuing mild hypothermia (34 degrees C) improves early but not late survival in rats. , 2003, The Journal of trauma.

[21]  M H Weil,et al.  Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. , 2003, Circulation.

[22]  D. Pierson,et al.  Trauma critical care. , 2001, American journal of respiratory and critical care medicine.

[23]  P. A. Nilsen,et al.  Resuscitation from accidental hypothermia of 13·7°C with circulatory arrest , 2000, The Lancet.

[24]  P. A. Nilsen,et al.  Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. , 2000, Lancet.

[25]  F. Lewis,et al.  Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. , 1997, Annals of surgery.

[26]  J. Parrott,et al.  Cardiopulmonary bypass resuscitation for accidental hypothermia. , 1994, The Annals of thoracic surgery.

[27]  R. Barish,et al.  Accidental hypothermia with cardiac arrest: recovery following rewarming by cardiopulmonary bypass. , 1992, The Journal of emergency medicine.

[28]  R. Soderberg,et al.  Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill patients. , 1992, The Journal of trauma.

[29]  D. Wittmann,et al.  Comparison of three methods of rewarming from hypothermia: advantages of extracorporeal blood warming. , 1990, The Journal of trauma.

[30]  B. Walpoth,et al.  Accidental deep hypothermia with cardiopulmonary arrest: extracorporeal blood rewarming in 11 patients. , 1990, European Journal of Cardio-Thoracic Surgery.

[31]  P. Marcus The treatment of acute accidental hypothermia: proceedings of a symposium held at the RAF Institute of Aviation Medicine. , 1979, Aviation, space, and environmental medicine.

[32]  A. Beran,et al.  Hypothermia and rewarming by peritoneal dialysis and temperature-controlled inhalate. , 1976, The Annals of thoracic surgery.

[33]  E. Lloyd Accidental hypothermia treated by central rewarming through the airway. , 1973, British journal of anaesthesia.