{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T01:33:18Z","timestamp":1792891998543,"version":"4.5.0"},"reference-count":155,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T00:00:00Z","timestamp":1641168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Accidental hypothermia is an unintentional drop of core temperature below 35 \u00b0C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature &lt; 30 \u00b0C in young and healthy patients and &lt;32 \u00b0C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure &lt; 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.<\/jats:p>","DOI":"10.3390\/ijerph19010501","type":"journal-article","created":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T03:41:32Z","timestamp":1641440492000},"page":"501","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":207,"title":["Accidental Hypothermia: 2021 Update"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2939-4782","authenticated-orcid":false,"given":"Peter","family":"Paal","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0042-5909","authenticated-orcid":false,"given":"Mathieu","family":"Pasquier","sequence":"additional","affiliation":[{"name":"International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland"},{"name":"Department of Emergency Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Darocha","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Medical University of Silesia, 40-001 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5961-335X","authenticated-orcid":false,"given":"Raimund","family":"Lechner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Military Hospital, 89081 Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylweriusz","family":"Kosinski","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Jagiellonian University Medical College, 34-500 Krakow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3746-9537","authenticated-orcid":false,"given":"Bernd","family":"Wallner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4928-840X","authenticated-orcid":false,"given":"Ken","family":"Zafren","sequence":"additional","affiliation":[{"name":"International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland"},{"name":"Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK 99508, USA"},{"name":"Department of Emergency Medicine, Stanford University Medical Center, Stanford University, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2752-6929","authenticated-orcid":false,"given":"Hermann","family":"Brugger","sequence":"additional","affiliation":[{"name":"International Commission for Mountain Emergency Medicine (ICAR MedCom), 8302 Kloten, Switzerland"},{"name":"Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy"},{"name":"Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/B978-0-444-64074-1.00033-1","article-title":"Accidental hypothermia","volume":"157","author":"Paal","year":"2018","journal-title":"Handb. 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