Fig. 1

Management in Accidental Hypothermia. (*) Decapitation; truncal transection; whole body decomposed or whole body frozen solid (chest wall not compressible) [128]. (†) SBP <90 mmHg is a reasonable prehospital estimate of cardiac instability but for in-hospital decisions, the minimum sufficient circulation for a deeply hypothermic patient (e.g., <28 °C) has not been defined. (‡) Swiss staging of accidental hypothermia [73], see also Table 1. (§) In remote areas, transport decisions should balance the risk of increased transport time with the potential benefit of treatment in an ECLS centre. (||) Warm environment, chemical, electrical, or forced air heating packs or blankets, and warm IV fluids (38–42 °C). In case of cardiac instability refractory to medical management, consider rewarming with ECLS. (¶) If the decision is made to stop at an intermediate hospital to measure serum potassium, a hospital en route towards the ECLS centre should be chosen. (**) See Table 3. CPR denotes cardiopulmonary resuscitation, DNR do-not-resuscitate, ECLS extracorporeal life support, HT hypothermia, MD medical doctor, ROSC return of spontaneous circulation, SBP systolic blood pressure