Treatment recommendations for rewarming patients in severe accidental hypothermia with preserved spontaneous circulation have a weak evidence due to the absence of randomized clinical trials. We aimed to compare the outcomes of extracorporeal versus less-invasive rewarming of severely hypothermic patients with preserved spontaneous circulation. We conducted a multicenter retrospective study. The patient population was compiled based on data from the HELP Registry, the International Hypothermia Registry, and a literature review. Adult patients with a core temperature <28°C and preserved spontaneous circulation were included. Patients who underwent extracorporeal rewarming were compared with patients rewarmed with less-invasive methods, using a matched-pair analysis. The study population consisted of 50 patients rewarmed extracorporeally and 85 patients rewarmed with other, less-invasive methods. Variables significantly associated with survival included: lower age; outdoor cooling circumstances; higher blood pressure; higher PaCO 2 ; higher BE; higher HCO 3 ; and the absence of comorbidities. The survival rate was higher in patients rewarmed extracorporeally ( p = 0.049). The relative risk of death was twice as high in patients rewarmed less invasively. Based on our data, we conclude that patients in severe accidental hypothermia with circulatory instability can benefit from extracorporeal rewarming without an increased risk of complications.

Department of Acute Medicine Division of Anaesthesiology University Hospitals Geneva Switzerland

Department of Anaesthesiology and Intensive Care 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Anaesthesiology and Intensive Care Medical University of Lublin Poland

Department of Anaesthesiology and Intensive Care Medical University of Silesia Katowice Poland

Department of Anaesthesiology and Intensive Care University Hospital Łódź Poland

Department of Cardiac Surgery Provincial Specialist Hospital Olsztyn Poland

Department of Cardiosurgery Pomeranian Medical University in Szczecin Poland

Department of Emergency Medicine Faculty of Health Sciences University of Bielsko Biała Poland

Department of Epidemiology and Clinical Research Methodology Medical University of Lublin Poland

Department of Medical Education Jagiellonian University Medical College Kraków Poland

Emergency Department University Hospital Pomeranian Medical University Szczecin Poland

Emeritus Department of Cardiovascular Surgery University Hospitals of Geneva Switzerland

Faculty of Health Sciences Jagiellonian University Medical College Kraków Poland

Faculty of Medicine and Health Sciences Andrzej Frycz Modrzewski Kraków University Kraków Poland

From the Department of Emergency Medicine Jan Kochanowski University Kielce Poland

Institute of Health Sciences Jan Kochanowski University Kielce Poland

Univ Grenoble Alpes CNRS UMR 5525 VetAgro Sup Grenoble INP CHU Grenoble Alpes TIMC Grenoble France

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