HYPOTHERMIA IN TRAUMA PATIENTS

Accidental hypothermia (AH) can be defined as an unintentional decreas e in core temperature below 35 degrees C during cold exposure by indiv iduals without intrinsic thermoregulatory dysfunction. Pathophysiologi cal changes can be attributed both to the severity of hypothermia and to co-morbid factors such as trauma, submersion, intoxication and unde rlying diseases. In trauma victims stratified according to the Injury Severity Score, the factor hypothermia is considered to be a poor prog nostic sign for survival. In these patients rewarming therapy should b e applied as soon as possible. In the Utrecht University Hospital, adu lt patients with AH are managed according to an algorithm based on the ir presenting hemodynamic conditions. Patients with perfusing cardiac rhythms and systolic pressures over 80 mmHg will receive continuous ar teriovenous rewarming (CAVR). Arrested and hemodynamically instable pa tients are treated with cardiopulmonary bypass (CPB). In a 3-year peri od, 22 patients with AH were admitted to the emergency department. Fou rteen patients had a trauma as the cause of hypothermia. Twenty patien ts were treated according to the algorithm (CAVR n = 18, CPB n = 2) an d two patients were alternatively managed. Mortality in the CAVR group was 28% and total mortality reached 32%. Complications of CAVR are re lated to placement and removal of vascular catheters and may be severe in these patients with impaired coagulation. CAVR permits a good acce ss to the (trauma-) patient and rewarming can be continued synchronous ly with diagnosis and treatment of various injuries.