scholarly journals Clinical relevance of impaired consciousness in accidental hypothermia: A Japanese multicenter retrospective study

2021 ◽  
Author(s):  
Masahiro Fukuda ◽  
Masahiro Nozawa ◽  
Yohei Okada ◽  
Sachiko Morita ◽  
Naoki Ehara ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Core Body Temperature ◽  
Staging System ◽  
Accidental Hypothermia ◽  
Impaired Consciousness ◽  
Odds Ratios ◽  
Severe Hypothermia ◽  
Threatening Condition ◽  
Life Threatening ◽  
Core Body

Abstract Background This study aimed to investigate the association between level of impaired consciousness and severe hypothermia less than 28°C among accidental hypothermia. Severe accidental hypothermia (AH) is a life-threatening condition, and early identification can enable transport to an appropriate medical facility. The Swiss staging system has been used to classify patients with AH, but little is known regarding the association between the level of impaired consciousness and core body temperature (BT) in AH. This study aimed to clarify the association between level of impaired consciousness and core BT and determine whether the level of impaired consciousness could be used to predict severe hypothermia and in-hospital mortality among patients with AH. Results The study included 505 of 572 patients in the J-point registry. Relative to mildly impaired consciousness (Glasgow coma scale (GCS) 13–15), the adjusted odds ratios for severe hypothermia were moderate (GCS9-12) 3.26 (95% CI: 1.69–6.25) and severe (GCS < 9) 4.68 (95% CI: 2.40–9.14) for severely impaired consciousness. Relative to mildly impaired consciousness (GCS 13–15), the adjusted odds ratios for in-hospital mortality were moderate (GCS9-12) 1.65 (95% CI: 0.95–2.88) and severe (GCS < 9) 2.10 (95% CI: 1.17–3.78). Conclusions The level of impaired consciousness in patients with accidental hypothermia may predict severe hypothermia and in-hospital mortality.

scholarly journals Clinical Relevance of Impaired Consciousness in Accidental Hypothermia: A Japanese Multicenter Retrospective Study

2020 ◽  
Author(s):  
Masahiro Fukuda ◽  
Masahiro NOZAWA ◽  
Yohei OKADA ◽  
Sachiko MORITA ◽  
Naoki EHARA ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Likelihood Ratio ◽  
Clinical Relevance ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Accidental Hypothermia ◽  
Impaired Consciousness ◽  
Severe Hypothermia ◽  
Level Of Consciousness ◽  
The Relationship

Abstract Background: Severe accidental hypothermia (AH) is a life-threatening condition, and early identification can enable transport to an appropriate medical facility. The Swiss staging model has been used to classify patients with AH, but little is known regarding the relationship between the degree of impaired consciousness and core body temperature (BT) in AH. This study aimed to clarify the relationship between the level of consciousness and core BT and determine whether the level of consciousness could be used to predict severe hypothermia and in-hospital mortality among patients with AH.Methods: We retrospectively investigated the clinical relevance of impaired consciousness in AH. We included adult patients with AH and excluded patients with out-of-hospital cardiac arrest. The patients were identified from the J-point registry, which contains information regarding patients treated for AH between April 1, 2011 and March 31, 2016 in any of the 12 participating institutions in Japan. The primary exposure of interest was the level of consciousness at hospital arrival. Odds ratios were calculated for severe hypothermia and in-hospital mortality.Results: Overall, 505 of the 572 patients in the registry were included. Compared to mildly impaired consciousness, the adjusted odds ratio for severe hypothermia was 3.3 (95% confidence interval [CI]: 1.7–6.3) for moderately impaired consciousness and 4.7 (95% CI: 2.4–9.1) for severely impaired consciousness. Severely impaired consciousness as a predictor severe hypothermia had a sensitivity of 0.44 (95% CI: 0.34–0.54), specificity of 0.78 (95% CI: 0.74–0.82), positive likelihood ratio of 2.04, and negative likelihood ratio of 0.71. Compared to mildly impaired consciousness, the adjusted odds ratio for in-hospital mortality was 1.7 (95% CI: 0.95–2.9) for moderately impaired consciousness and 2.1 (95% CI: 1.2–3.8) for severely impaired consciousness.Conclusions: Severely impaired consciousness was a reliable predictor of severe hypothermia and in-hospital mortality in patients with AH. Thus, in an urban out-of-hospital emergency setting, the level of impaired consciousness may be helpful for triaging patients to the appropriate hospital.

scholarly journals Hypothermia and cardiac electrophysiology: a systematic review of clinical and experimental data

2018 ◽  
Vol 115 (3) ◽  
pp. 501-509 ◽  
Author(s):  
Erik Sveberg Dietrichs ◽  
Torkjel Tveita ◽  
Godfrey Smith
Keyword(s):  
Experimental Data ◽  
Ventricular Arrhythmias ◽  
Cardiac Electrophysiology ◽  
Clinical Evidence ◽  
Core Body Temperature ◽  
Accidental Hypothermia ◽  
Class Iii ◽  
Severe Hypothermia ◽  
Pubmed Database ◽  
Core Body

Abstract Moderate therapeutic hypothermia procedures are used in post-cardiac arrest care, while in surgical procedures, lower core temperatures are often utilized to provide cerebral protection. Involuntary reduction of core body temperature takes place in accidental hypothermia and ventricular arrhythmias are recognized as a principal cause for a high mortality rate in these patients. We assessed both clinical and experimental literature through a systematic literature search in the PubMed database, to review the effect of hypothermia on cardiac electrophysiology. From included studies, there is common experimental and clinical evidence that progressive cooling will induce changes in cardiac electrophysiology. The QT interval is prolonged and appears more sensitive to decreases in temperature than the QRS interval. Severe hypothermia is associated with more pronounced changes, some of which are proarrhythmic. This is supported clinically where severe accidental hypothermia is commonly associated with ventricular fibrillation or asystole. J-waves in human electrocardiogram recordings are regularly but not always observed in hypothermia. Its relation to ventricular repolarization and arrhythmias is not obvious. Little clinical data exist on efficacy of anti-arrhythmic drugs in hypothermia, while experimental data show the potential of some agents, such as the class III antiarrhythmic bretylium. It is apparent that QT-prolonging drugs should be avoided.

scholarly journals IS AN EMERGENCY DEPARTMENT A SAFER PLACE FOR HYPOTHERMIC VICTIMS THAN AN AMBULANCE? A COMPARISON OF THE KNOWLEDGE OF MEDICAL PERSONNEL CONCERNING HYPOTHERMIA

2019 ◽  
Vol 72 (2) ◽  
pp. 209-215
Author(s):  
Paweł Podsiadło ◽  
Adam Nogalski ◽  
Sylweriusz Kosiński ◽  
Tomasz Sanak ◽  
Kinga Sałapa ◽  
...  
Keyword(s):  
Independent Risk Factor ◽  
Core Body Temperature ◽  
Medical Personnel ◽  
Initial Management ◽  
Severe Hypothermia ◽  
Post Test ◽  
E Learning ◽  
Level Of Knowledge ◽  
Post Traumatic ◽  
Core Body

Introduction: Improper initial management of a victim in severe hypothermia is associated with a risk of cardiac arrest. At the same time, an uncontrolled drop in core body temperature in trauma victims is an independent risk factor for mortality. Medical personnel require a thorough understanding of the pathophysiology and treatment of hypothermia. Gaps in this understanding can lead to serious complications for patients. The aim: To compare knowledge concerning hypothermia between medical personnel working in emergency departments (ED) and emergency medical services (EMS). Materials and methods: A total of 5,362 participants were included in the study. In this study, EMS and ED personnel were encouraged to participate in an e-learning course on hypothermia. Subsequently, the scores of a pre-test, lesson tests and post-test completed by participants of this course were compared. Results: Pre-test scores were significantly higher among personnel working in EMS compared with those working in EDs. Nurses employed in EDs had significantly more failures in completing the course than EMS nurses. The most difficult topics for all practitioners were post-traumatic hypothermia and hypothermia-related clotting disorders. Conclusions: EMS personnel have a higher level of knowledge of hypothermia than ED personnel. Moreover, an e-learning course is an effective tool for improving medical personnel’s knowledge of hypothermia.

The International Hypothermia Registry (IHR): Dieter's ESAO Winter Schools and Beat's International Hypothermia Registry

2017 ◽  
Vol 40 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Beat H. Walpoth ◽  
Marie Meyer ◽  
Christophe Gaudet-Blavignac ◽  
Philippe Baumann ◽  
Pierre Gilquin ◽  
...  
Keyword(s):  
Mild Hypothermia ◽  
Statistical Significance ◽  
Orphan Disease ◽  
Accidental Hypothermia ◽  
Evidence Based ◽  
Outcome Predictors ◽  
Severe Hypothermia ◽  
Life Threatening

Accidental hypothermia could be listed as an ‘orphan disease,’ since mild hypothermia is common but has no severe medical consequences, whereas severe hypothermia is rare and life-threatening. In order to increase our knowledge, find new outcome predictors, and propose better guidelines for the treatment of deep accidental hypothermia victims, we created the International Hypothermia Registry (IHR: https://www.hypothermia-registry.org ), which will allow us to gather a large number of cases in order to achieve statistical significance and issue evidence-based recommendations.

scholarly journals A Bayesian Study of the Dynamic Effect of Comorbidities on Hospital Outcomes of Care for CHF Patients

2019 ◽  
Author(s):  
Dimitrios Zikos ◽  
Stelios Zimeras ◽  
Neli Ragina
Keyword(s):  
Hospital Mortality ◽  
Clinical Decision Making ◽  
Cumulative Effect ◽  
Dynamic Effect ◽  
Clinical Decision ◽  
Hospital Outcomes ◽  
Variable Effect ◽  
Outcomes Of Care ◽  
Threatening Condition ◽  
Life Threatening

Comorbidities can have a cumulative effect on hospital outcomes of care, such as the length of stay (LOS), and hospital mortality. This study examines patients hospitalized with Congestive Heart Failure (CHF), a life-threatening condition, which, when it coexists with a burdened disease profile, the risk for negative hospital outcomes increases. Since coexisting conditions co-interact, with a variable effect on outcomes, clinicians should be able to recognize these joint effects. In order to study CHF comorbidities, we used medical claims data from CMS. After extracting the most frequent cluster of CHF comorbidities, we: (i) Calculated, step-by-step, the conditional probabilities for each disease combination inside this cluster (ii) Estimated the cumulative effect of each comorbidity combination on the LOS and hospital mortality (iii) Constructed (a) Bayesian, scenario-based graphs and (b) Bayes-networks to visualize results. Results show that, for CHF patients, different comorbidity constructs have variable effect on the LOS and hospital mortality. Therefore, dynamic comorbidity risk assessment methods should be implemented for informed clinical decision making in any ongoing effort for quality of care improvements.

scholarly journals Environmental Injuries: Hyperthermia and Hypothermia

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Amanda McDonald ◽  
Rebekah Stubbs ◽  
Prince Lartey ◽  
Shaeleigh Kokot
Keyword(s):  
Risk Factors ◽  
Body Temperature ◽  
Sport Injury ◽  
Core Body Temperature ◽  
Research Paper ◽  
The Body ◽  
Important Type ◽  
Preventative Measures ◽  
Life Threatening ◽  
Core Body

Environmental injuries are an important type of sport  injury to study as they can occur year-round, through a variety of activities, and occur to a broad range of athletic populations. Hyperthermia (a core body temperature above 38.5°C) and hypothermia (a core body temperature below 35°C) are two common environmental injuries that can be life threatening. This research paper examines the mechanisms of how and why these injuries occur and the effect they have on the body. This paper also outlines preventative measures to take, including identifying internal and external predisposing risk factors, as well as ways to treat hyperthermia and hypothermia to return an athlete back to play.

Lowest core body temperature and adverse outcomes associated with coronary artery bypass surgery

Perfusion ◽  
2003 ◽  
Vol 18 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Gordon R DeFoe ◽  
Charles F Krumholz ◽  
Christian P DioDato ◽  
Cathy S Ross ◽  
Elaine M Olmstead ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Body Temperature ◽  
Hospital Mortality ◽  
Coronary Artery Bypass ◽  
Core Temperature ◽  
Core Body Temperature ◽  
Artery Bypass ◽  
Mortality Rates ◽  
Adverse Outcomes ◽  
Core Body

To examine the effect of lowest core body temperature on adverse outcomes associated with coronary artery bypass graft (CABG) surgery, data were collected on 7134 isolated CABG procedures carried out in New England from 1997 to 2000. Excluded from the analysis were patients with pump times <60 and >120 min and those operated upon using continuous warm cardioplegia. Data for lowest core temperature were divided into quartiles for analysis (≤31.4°C, 31.5-33.1°C, 33.2-34.3°C, and ≥34.4°C). Patients with lower core body temperature on cardio-pulmonary bypass (CPB) had higher in-hospital mortality rates. Crude mortality rates were 2.9% in the ≤31.4°C group, 2.1% in the 31.5 - 33.1°C group, 1.3% in the 33.2 - 34.3°C group and 1.2% in the ≥34.4°C group. The trend toward higher mortality as core temperature decreased was statistically significant (ptrend<0.001). Adjustment for differences in patient and disease characteristics did not significantly change the results and the test of trend remained significant ( p<0.001). Rates of perioperative stroke were somewhat lower in the colder groups. Rates in the two colder groups were0.9% compared with 1.6% and 1.4% in the warmer groups (ptrend = 0.082). This remained a marginal but significant trend after adjustment for possible confounding factors (p=0.044). Low core body temperatures on CPB are associated with higher rates of in-hospital mortality among isolated CABG patients. Rates of intra- or postoperative use of an intra-aortic balloon pump are also higher with lower core temperatures. We concluded that temperature management strategy during CABG surgery has an important effect on patient outcomes.

scholarly journals Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Makoto Watanabe ◽  
Tasuku Matsuyama ◽  
Sachiko Morita ◽  
Naoki Ehara ◽  
Nobuyoshi Miyamae ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Body Temperature ◽  
Hospital Mortality ◽  
Core Body Temperature ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Regression Analysis ◽  
International Classification Of Diseases ◽  
The Body ◽  
Accidental Hypothermia ◽  
Time Of Arrival

Abstract Background Accidental hypothermia (AH) is defined as an involuntary decrease in core body temperature to < 35 °C. The management of AH has been progressing over the last few decades, and numerous techniques for rewarming have been validated. However, little is known about the association between rewarming rate (RR) and mortality in patients with AH. Method This was a multicentre chart review study of patients with AH visiting the emergency department of 12 institutions in Japan from April 2011 to March 2016 (Japanese accidental hypothermia network registry, J-Point registry). We retrospectively registered patients using the International Classification of Diseases, Tenth Revision code T68: ‘hypothermia’. We excluded patients whose body temperatures were unknown or ≥ 35 °C, who could not be rewarmed, whose rewarmed temperature or rewarming time was unknown, those aged < 18 years, or who or whose family members had refused to join the registry. RR was calculated based on the body temperature on arrival at the hospital, time of arrival at the hospital, the documented temperature during rewarming, and time of the temperature documentation. RR was classified into the following five groups: ≥2.0 °C/h, 1.5–< 2.0 °C/h, 1.0–< 1.5 °C/h, 0.5–< 1.0 °C/h, and < 0.5 °C/h. The primary outcome of this study was in-hospital mortality. The association between RR and in-hospital mortality was evaluated using multivariate logistic regression analysis. Result During the study, 572 patients were registered in the J-Point registry, and 481 patients were included in the analysis. The median body temperature on arrival to the hospital was 30.7 °C (interquartile range [IQR], 28.2 °C–32.4 °C), and the median RR was 0.85 °C/h (IQR, 0.53 °C/h–1.31 °C/h). The in-hospital mortality rates were 19.3% (11/57), 11.1% (4/36), 14.4% (15/104), 20.1% (35/175), and 34.9% (38/109) in the ≥2.0 °C/h, 1.5–< 2.0 °C/h, 1.0–< 1.5 °C/h, 0.5–< 1.0 °C/h, and < 0.5 °C/h groups, respectively. Multivariate regression analysis revealed that in-hospital mortality rate increased with each 0.5 °C/h decrease in RR (adjusted odds ratio, 1.49; 95% confidence interval, 1.15–1.94; Ptrend < 0.01). Conclusion This study showed that slower RR is independently associated with in-hospital mortality.

Physiological Impact of Hypothermia: The Good, the Bad and the Ugly

Physiology ◽  
2021 ◽  
Author(s):  
Torkjel Tveita ◽  
Gary C. Sieck
Keyword(s):  
Body Temperature ◽  
Therapeutic Hypothermia ◽  
Clinical Medicine ◽  
Core Body Temperature ◽  
Accidental Hypothermia ◽  
Striking Difference ◽  
Neurosurgical Procedures ◽  
Protective Agent ◽  
Core Body ◽  
The Impact

Hypothermia is defined as a core body temperature of < 35°C, and as body temperature is reduced the impact on physiological processes can be beneficial or detrimental. The beneficial effect of hypothermia enables circulation of cooled experimental animals to be interrupted for 1-2 h without creating harmful effects, while tolerance of circulation arrest in normothermia is between 4 and 5 min. This striking difference has attracted so many investigators, experimental as well as clinical, to this field, and this discovery was fundamental for introducing therapeutic hypothermia in modern clinical medicine in the 1950's. Together with the introduction of cardiopulmonary bypass, therapeutic hypothermia has been the cornerstone in the development of modern cardiac surgery. Therapeutic hypothermia also has an undisputed role as a protective agent in organ transplantation and as a therapeutic adjuvant for cerebral protection in neonatal encephalopathy. However, the introduction of therapeutic hypothermia for organ protection during neurosurgical procedures or as a scavenger after brain and spinal trauma has been less successful. In general, the best neuroprotection seems to be obtained by avoiding hyperthermia in injured patients. Accidental hypothermia occurs when endogenous temperature control mechanisms are incapable of maintaining core body temperature within physiologic limits and core temperature becomes dependent on ambient temperature. During hypothermia spontaneous circulation is considerably reduced and with deep and/or prolonged cooling, circulatory failure may occur, which may limit safe survival of the cooled patient. Challenges that limit safe rewarming of accidental hypothermia patients include cardiac arrhythmias, uncontrolled bleeding, and "rewarming shock".

scholarly journals Novel Measurement Approaches Are Needed In The Pre-Hospital Setting To Prevent Accidental Hypothermia.

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Timothy Binyon ◽  
BENJAMIN MACKIE
Keyword(s):  
Body Temperature ◽  
Best Practice ◽  
Core Body Temperature ◽  
Hospital Setting ◽  
Accidental Hypothermia ◽  
Effective Management ◽  
Reliable Measurement ◽  
Practice Approach ◽  
Unconscious Patients ◽  
Core Body

Accidental hypothermia can be fatal if not recognised early, and effective management relies on the accurate recording of core body temperature. The focus of this critique - a recent study by Podsiado et al. (2019) – highlighted the need for reliable measurement of core body temperature in the pre-hospital and austere setting. An esophageal temperature probe may prove to be a reliable, and best practice approach for measuring core body temperature in critically unwell, unconscious patients suffering accidental hypothermia.

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