Forced air surface rewarming in patients with severe accidental hypothermia

Methods of rewarming patients with severe accidental hypothermia remain con troversial. This paper reports our experience with the use of forced air re warming in patients with severe accidental hypothermia and a body core temp erature below 30 degrees C. Fifteen hypothermic patients (body core tempera ture 24-30 degrees C) were successfully treated with forced air rewarming t o a body core temperature above 35 degrees C (mean rewarming rate 1.7 degre es C/h, range from 0.7 to 3.4 degrees C/h). An afterdrop phenomenon was not observed in any of the patients. Nine hypothermic patients (group I) had n o prehospital cardiac arrest, all nine were long-term survivors and made a full recovery. Six patients (group 2) had prehospital cardio circulatory ar rest with restoration of spontaneous circulation. None of the group 2 patie nts survived long-term. Group I and group 2 patients did not differ in core temperature (26.6 +/- 1.6 degrees C group 1 and 27.0 +/- 1.8 degrees C gro up 2). Group 2 patients needed catecholamine support during rewarming more frequently (83 versus 22%) and had higher lactate levels and lower pH value s at all points of observation. In conclusion our preliminary data indicate that forced air rewarming is an efficient and safe method of managing pati ents with severe accidental hypothermia. The poor outcome of patients with a history of prehospital cardiopulmonary resuscitation is probably due to i rreversible ischaemic brain damage in primarily asphyxiated avalanche and n ear-drowning victims, rather than the consequence of the rewarming method u sed. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.