Scand J Trauma Resus
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Scand J Trauma Resus · Aug 2020
ReviewIs prehospital use of active external warming dangerous for patients with accidental hypothermia: a systematic review.
Optimal prehospital management and treatment of patients with accidental hypothermia is a matter of frequent debate, with controversies usually revolving around the subject of rewarming. The rule of thumb in primary emergency care and first aid for patients with accidental hypothermia has traditionally been to be refrain from prehospital active rewarming and to focus on preventing further heat loss. The potential danger of active external rewarming in a prehospital setting has previously been generally accepted among the emergency medicine community based on a fear of potential complications, such as "afterdrop", "rewarming syndrome", and "circum-rescue collapse". This has led to a reluctancy from health care providers to provide patients with active external rewarming outside the hospital. Different theories and hypotheses exist for these physiological phenomena, but the scientific evidence is limited. The research question is whether the prehospital use of active external rewarming is dangerous for patients with accidental hypothermia. This systematic review intends to describe the acute unfavourable adverse effects of active external rewarming on patients with accidental hypothermia. ⋯ One of the main findings in this article was the poor scientific quality and the low number of articles meeting our inclusion criteria. When conducting this review, we found no scientific evidence of acceptable quality to prove that the use of active external rewarming is dangerous for patients with accidental hypothermia in a prehospital setting. We found several articles claiming that active external rewarming is dangerous, but most of them do not cite references or provide evidence.
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Scand J Trauma Resus · Aug 2020
Observational StudyPredictive accuracy of biomarkers for survival among cardiac arrest patients with hypothermia: a prospective observational cohort study in Japan.
There is limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. This study aimed to identify the predictive accuracy of these biomarkers for survival among OHCA patients with hypothermia. ⋯ This study indicated the predictive accuracy of serum lactate, pH, and potassium for 1-month survival among adult OHCA patients with hypothermia. These biomarkers may help define a more appropriate resuscitation strategy.
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Scand J Trauma Resus · Aug 2020
Comment LetterRe-assessment of re-warming for out-of-hospital births.
Therapeutic controlled cooling is routinely practiced on neonates with core temperatures of 33-34 °C attained during cooling for birth related hypoxic-ischaemia encephalopathy (HIE). Rewarming after therapeutic cooling in clinical trials for HIE takes place at 0.25-0.5 °C/h over 6-12 h. ⋯ In contrast, the group plastic bag+skin-to-skin+cap had a median temperature rise of 0.2 °C (median transport time 43 min [IQR-33-61 min]); equating to 0.28 °C/h, which is closer to therapeutic controlled methods. Javaudin et al. proposed incubator re-warming for out-of-hopital births whereas we consider that an alternative interpretation of the article's results leads to the different conclusion that plastic bag+skin-to-skin+cap, rather than an incubator, is the preferable method due to the more progressive re-warming and lower frequency of hyperthermia.