今日の臨床サポート

低体温

著者: 石丸直人 明石医療センター総合内科

監修: 前野哲博 筑波大学医学医療系 地域医療教育学

著者校正/監修レビュー済:2021/06/30
参考ガイドライン:
  1. 欧州蘇生協議(ERC):ERC蘇生ガイドライン 2021
  1. 山岳救助国際委員会(ICAR):ICAR-MEDCOM勧告 2021
  1. 米国野外救急学会(WMS):WMS診療ガイドライン 2019
  1. 日本蘇生協議会JRC蘇生ガイドライン 2015
患者向け説明資料

概要・推奨   

  1. 低体温が疑われる患者には、直腸温や膀胱温などにより中心体温を確認し、死亡率の高いHT以上の低体温を同定することが勧められる(推奨度1)
  1. 高齢者は低体温になりやすく低体温に弱いため、寒冷環境を避けることが勧められる(推奨度2)
  1. 徐脈や呼吸数低下を認める患者には、HT以上の低体温が疑われ、中心体温を確認することが勧められる(推奨度1)
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  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧には
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
石丸直人 : 特に申告事項無し[2021年]
監修:前野哲博 : 特に申告事項無し[2021年]

改訂のポイント:
  1. ERC蘇生ガイドライン 2021、ICAR-MEDCOM勧告 2021、WMS診療ガイドライン 2019 、JRC蘇生ガイドライン 2015に基づきステージング、予後予測モデル、中心温評価法、蘇生処置、体外循環の適応について改訂を行った。

病態・疫学・診察

疫学情報・病態・注意事項  
  1. 低体温は、中心体温が35℃未満と定義される。
  1. 低体温は、従来軽症(32~35℃)、中等症(28~32℃)、重症(28℃未満)に分類されていたが、現在ではSwiss staging system(stage HTI-HTⅤ)で分類される。HTⅡ以上の低体温の死亡率は約40%と高い。
  1. 循環動能が安定した低体温患者の神経学的治療予後は100%回復するが、体外加温で加療された心停止患者の神経学的治療予後回復率は約50%である。
  1. 低体温により細胞膜機能が傷害されることで、細胞内液が貯留し、酵素機能障害、電解質異常が生じる。
  1. 寒冷ストレスに対し、視床下部は震えや甲状腺、交感神経、副腎の活性を増加することで、熱産生を刺激する。
  1. 高齢者は低体温になりやすく低体温に弱いため、寒冷環境を避けることが必要である。
  1. Swiss staging system
  1. HTIは中心温度32~35℃で意識清明、振戦がある。
  1. HTⅡは中心温度28~32℃で意識障害を認め、振戦はない。
  1. HTⅢは中心温度24~28℃で意識はなし、振戦はないが、バイタルサインは認める。
  1. HTⅣは中心温度13.7~24℃でバイタルサインは認めない。
  1. HTⅤは中心温度9~13.7℃で不可逆性の低体温による死亡している。
  1. Swiss staging systemを用いたステージングには、中心温の過大評価、32℃未満でも振戦が存在し得る、といった課題があり、Revised Swiss Systemが提唱されている[1]。 Revised Swiss Systemでは、AVPU(Alert、Verbal、Painful、Unconscious)スケールによる重症度評価を行い、今後は同指標に改訂される予定である。
  1. わが国での後ろ向き観察研究では、75歳以上、日常生活活動度(ADL)要支援、血行動態不安定、高カリウム血症が入院死亡率と関連しており、5Aスコアリングモデルが提唱されている[2]。一方で、SOFAスコアが5Aスコアリングモデルよりも入院死亡を予測する点で優れた弁別能を有するという報告もある[3]
  1. イスラエルでの後ろ向き観察研究では、70歳以上、収縮期血圧90mmHg未満、pH7.35未満、Cre1.5mg/dL以上、最近の意識障害が30日死亡率と関連しており[4]、わが国でもその妥当性が検証された[5]。わが国では、女性、収縮期血圧81mmHg未満、Cre1.5mg/dL以上が30日死亡率と関連していた。
 
低体温中等症患者の手足における重症凍傷

手足に腫れや水疱が見られる症例

 
  1. 高齢者は低体温になりやすく低体温に弱いため、寒冷環境を避けることが勧められる(推奨度2)
  1. まとめ:高齢者は低体温を起こしやすく、特に認知症がある場合には寒冷環境を避けることが必要である。
  1. 代表事例:例えば、65歳以上が低体温による死者の半数を占めると報告されている[6]。また、17名の高齢者と13名の若年者を比較した研究では、高齢者では若年者と比べ温冷覚の低下を認めたと報告されている[7]。さらに、47名の高齢患者を5年間追跡した研究では、高齢者では寒冷刺激に対する温度調節機能低下が年齢とともに進行したことが報告されている[8]。特に、認知症患者は、寒冷環境において不適応行動をとってしまうと報告されている[9]
  1. 結論:このことから、高齢者、特に認知症がある場合には、寒冷環境を避けることが推奨される。
問診・診察のポイント  
  1. 以下の低体温でみられる所見とともに、並行して低血糖、脱水、薬物中毒、外傷、感染症などの所見を確認する。

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文献 

著者: Martin E Musi, Alison Sheets, Ken Zafren, Hermann Brugger, Peter Paal, Natalie Hölzl, Mathieu Pasquier
雑誌名: Resuscitation. 2021 May;162:182-187. doi: 10.1016/j.resuscitation.2021.02.038. Epub 2021 Mar 3.
Abstract/Text Clinical staging of accidental hypothermia is used to guide out-of-hospital treatment and transport decisions. Most clinical systems utilize core temperature, by measurement or estimation, to stage hypothermia, despite the challenge of obtaining accurate field measurements. Recent studies have demonstrated that field estimation of core temperature is imprecise. We propose a revision of the original Swiss Staging system. The revised system uses the risk of cardiac arrest, instead of core temperature, to determine the staging level. Our revised system simplifies assessment by using the level of responsiveness, based on the AVPU scale, and by removing shivering as a stage-defining sign.

Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.
PMID 33675869  Resuscitation. 2021 May;162:182-187. doi: 10.1016/j.res・・・
著者: Yohei Okada, Tasuku Matsuyama, Sachiko Morita, Naoki Ehara, Nobuhiro Miyamae, Takaaki Jo, Yasuyuki Sumida, Nobunaga Okada, Tetsuhisa Kitamura, Ryoji Iiduka
雑誌名: Am J Emerg Med. 2019 Apr;37(4):565-570. doi: 10.1016/j.ajem.2018.06.025. Epub 2018 Jun 20.
Abstract/Text INTRODUCTION: In cases of severe accidental hypothermia (AH) in urban areas, the prognostic factors are unknown. We identified factors associated with in-hospital mortality in patients with moderate-to-severe AH in urban areas of Japan.
METHOD: The J-Point registry database is a multi-institutional retrospective cohort study for AH in 12 Japanese emergency departments. From this registry, we enrolled patients whose core body temperature was 32 °C or less on admission. In-hospital death was the primary outcome of this study. We investigated the association between each candidate prognostic factor and in-hospital death by applying the multivariate logistic regression analyses with adjusted odds ratios (AORs) and their 95% confidence interval [CI] as the effect variables.
RESULTS: Of 572 patients registered in the J-point registry, 358 hypothermic patients were eligible for analyses. Median body temperature was 29.2 °C (interquartile range, 27.0 °C-30.8 °C). In-hospital deaths comprised 26.3% (94/358) of all study patients. Factors associated with in-hospital death were age ≥ 75 years (AOR, 3.09; 95% CI, 1.31-7.27), need for assistance with activities of daily living (ADL; AOR, 3.06; 95% CI, 1.68-5.59), hemodynamic instability (AOR, 2.49; 95% CI, 1.32-4.68), and hyperkalemia (≥5.6 mEq/L; AOR, 2.65; 95% CI, 1.13-6.21).
CONCLUSION: The independent prognostic factors associated with in-hospital mortality of patients with moderate-to-severe AH in urban areas of Japan were age ≥ 75 years, need for assistance with ADL, hemodynamic instability, and hyperkalemia.

Copyright © 2018 Elsevier Inc. All rights reserved.
PMID 29950275  Am J Emerg Med. 2019 Apr;37(4):565-570. doi: 10.1016/j.・・・
著者: Kenji Kandori, Yohei Okada, Tasuku Matsuyama, Sachiko Morita, Naoki Ehara, Nobuhiro Miyamae, Takaaki Jo, Yasuyuki Sumida, Nobunaga Okada, Makoto Watanabe, Masahiro Nozawa, Ayumu Tsuruoka, Yoshihiro Fujimoto, Yoshiki Okumura, Tetsuhisa Kitamura, Ryoji Iiduka
雑誌名: Scand J Trauma Resusc Emerg Med. 2019 Nov 12;27(1):103. doi: 10.1186/s13049-019-0681-8. Epub 2019 Nov 12.
Abstract/Text BACKGROUND: Severe accidental hypothermia (AH) is life threatening. Thus, prognostic prediction in AH is essential to rapidly initiate intensive care. Several studies on prognostic factors for AH are known, but none have been established. We clarified the prognostic ability of the Sequential Organ Failure Assessment (SOFA) score in comparison with previously reported prognostic factors among patients with AH.
METHODS: The J-point registry database is a multi-institutional retrospective cohort study for AH in 12 Japanese emergency departments. From this registry, we enrolled patients who were treated at the intensive care unit (ICU) in various critical care medical centers. In-hospital mortality was the primary outcome. We investigated the discrimination ability of each candidate prognostic factor and the in-hospital mortality by applying the logistic regression models with areas under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI).
RESULTS: Of the 572 patients with AH registered in the J-point registry, 220 were eligible for the analyses. The in-hospital mortality was 23.2%. The AUROC of the SOFA score (0.80; 95% CI: 0.72-0.86) was the highest among all factors. The other factors were serum potassium (0.65; 95% CI: 0.55-0.73), lactate (0.67; 95% CI: 0.57-0.75), quick SOFA (qSOFA) (0.55; 95% CI: 0.46-0.65), systemic inflammatory response syndrome (SIRS) (0.60; 95% CI: 0.50-0.69), and 5A severity scale (0.77; 95% CI: 0.68-0.84).
DISCUSSION: Although serum potassium and lactate had relatively good discrimination ability as mortality predictors, the SOFA score had slightly better discrimination ability. The reason is that lactate and serum potassium were mainly reflected by the hemodynamic state; conversely, the SOFA score is a comprehensive score of organ failure, basing on six different scores from the respiratory, cardiovascular, hepatic, coagulation, renal, and neurological systems. Meanwhile, the qSOFA and SIRS scores underestimated the severity, with low discrimination abilities for mortality.
CONCLUSIONS: The SOFA score demonstrated better discrimination ability as a mortality predictor among all known prognostic factors in patients with AH.

PMID 31718708  Scand J Trauma Resusc Emerg Med. 2019 Nov 12;27(1):103.・・・
著者: Gabby Elbaz, Ohad Etzion, Jorge Delgado, Avi Porath, Daniel Talmor, Victor Novack
雑誌名: Am J Emerg Med. 2008 Jul;26(6):683-8. doi: 10.1016/j.ajem.2007.10.016.
Abstract/Text INTRODUCTION: The goal of our study was to characterize patients admitted to the hospital with hypothermia in a desert climate.
METHODS: This was a retrospective study (1999-2005) in a 1200-bed tertiary care hospital in southern Israel. Patients' data and weather condition (including mean day high and low temperatures, humidity, wind velocity and precipitation) within 48 hours before admission were assessed.
RESULTS: One hundred sixty-nine patients with hypothermia were admitted. The mean highest environmental temperature over 48 hours before admission was 15.3 degrees C in the severe hypothermia (9 cases, 5.3%), 21.4 degrees C in the moderate (40 cases, 23.7%), and 29.3 degrees C in the mild group (120 cases, 71.0%). Major medical conditions associated with decreased body temperature were sepsis (65, 38.5%), trauma (34, 20.1%), endocrine disorders (19, 11.2%), and substance abuse (15, 8.9%). The inhospital mortality rate was 47.3%. A risk score based on 5 admission variables (age > or = 70 years, mean arterial pressure < 90 mm Hg, pH < 7.35, creatinine > 1.5 mg/dL, and confusion) was generated, predicting inhospital mortality with area under the receiver operating characteristic (ROC) curve of 0.81 (95% confidence interval, 0.75-0.87).
CONCLUSIONS: Hypothermia should not be overlooked in geographical areas with temperate climates. Using a prognostication system based upon clinical and laboratory variables may identify hypothermia patients with increased risk of death.

PMID 18606321  Am J Emerg Med. 2008 Jul;26(6):683-8. doi: 10.1016/j.aj・・・
著者: Naoto Ishimaru, Saori Kinami, Toshio Shimokawa, Hiroyuki Seto, Yohei Kanzawa
雑誌名: J Gen Fam Med. 2020 Jul;21(4):134-139. doi: 10.1002/jgf2.323. Epub 2020 Apr 27.
Abstract/Text Introduction: This study aimed to clarify the accuracy of an in-hospital mortality prediction score for patients with hypothermia. The score consists of five variables (age ≥70 years, mean arterial pressure <90 mm Hg, pH < 7.35, creatinine >1.5 mg/dL, and confusion). In contrast to the previously reported population in southern Israel, a desert climate, we apply the score system to a Japanese humid subtropical climate.
Methods: The study included patients with a principal diagnosis of hypothermia who were admitted to our community hospital between January 2008 and January 2019. Using the medical records from initial visits, we retrospectively calculated in-hospital mortality prediction scores along with sensitivity and specificity.
Results: We recruited 69 patients, 67 of which had analyzable data. Among them, the in-hospital mortality rate was 25.4%. Hypothermia was defined as mild (32-35°C) in 34 cases (50.7%), moderate (28-32°C) in 23 cases (34.3%), and severe (<28°C) in 10 cases (14.9%). The C-statistics of the in-hospital mortality prediction score was 0.703 (95% confidence interval, 0.55-0.84) for thirty-day survival prediction. After adjustment of the cutoff point of each item with ROC analysis and selection of the variants, the C-statistics of the in-hospital mortality prediction score rose to 0.81 (95% confidence interval, 0.69-0.92).
Conclusion: The in-hospital mortality prediction scores showed slightly less predictive value than those in the previous report. With some modification, however, the score system could still be applied efficiently in the humid Japanese subtropical climate. An appropriate management strategy could be established based on the predicted mortality risk.

© 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.
PMID 32742902  J Gen Fam Med. 2020 Jul;21(4):134-139. doi: 10.1002/jgf・・・
著者: Centers for Disease Control and Prevention (CDC)
雑誌名: MMWR Morb Mortal Wkly Rep. 2003 Feb 7;52(5):86-7.
Abstract/Text Hypothermia is defined as the unintentional lowering of the deep body (core) temperature below 95.0 degrees F (35.0 degrees C). Hypothermia can be mild (90.0 degrees F-<95.0 degrees F [32.2 degrees C-<35.0 degrees C]), moderate (82.5 degrees F-<90.0 degrees F [28.0 degrees C-<32.2 degrees C]), or severe (<82.5 degrees F [<28.0 degrees C]). Common risk factors for hypothermia include exposure to cold while under the influence of alcohol or drugs, altered mental status, and immersion in cold water. During 1979-1998, approximately 700 persons (range: 420-1,024) died annually in the United States from hypothermia; approximately half of these deaths were attributed to extremely cold weather. This report presents three cases of hypothermia-related deaths in Philadelphia during 2001 as examples of risk factors for hypothermia and summarizes information about hypothermia-related deaths in the United States during 1999. Hypothermia deaths are preventable; by avoiding hypothermia, persons also can prevent other adverse health effects of cold weather.

PMID 12588005  MMWR Morb Mortal Wkly Rep. 2003 Feb 7;52(5):86-7.
著者: K J Collins, A N Exton-Smith, C Doré
雑誌名: Br Med J (Clin Res Ed). 1981 Jan 17;282(6259):175-7.
Abstract/Text A study of 17 elderly men and 13 young adults of similar body build and wearing equivalent clothing insulation (0.8 clo) showed that when given control over their environment the elderly preferred the same mean comfort temperature (22-23 degrees C) but manipulated ambient temperature much less precisely than the young. Slow adjustment of ambient temperature was related to some cases to a higher temperature-discrimination threshold. These findings suggest that both physiological and behavioural changes contribute to the increased vulnerability of old people in cold conditions.

PMID 6779937  Br Med J (Clin Res Ed). 1981 Jan 17;282(6259):175-7.
著者: K J Collins, C Dore, A N Exton-Smith, R H Fox, I C MacDonald, P M Woodward
雑誌名: Br Med J. 1977 Feb 5;1(6057):353-6.
Abstract/Text A longitudinal study of the age-related decline in thermoregulatory capacity was made in 47 elderly people to try to identify those at risk from spontaneous hypothermia. During the winters of 1971-2 and 1975-6 environmental and body temperature profiles were obtained in the home, and thermoregulatory function was investigated by cooling and warming tests. Environmental temperature and socioeconomic conditions had not changed but the body core-shell temperature gradients were smaller in 1976, indicating progressive thermoregulatory impairment. People at risk of developing hypothermia also seem to have low resting peripheral blood flows, a nonconstrictor pattern of vasomotor response to cold, and a higher incidence of orthostatic hypotension.

PMID 837095  Br Med J. 1977 Feb 5;1(6057):353-6.
著者: Kazuhiko Kibayashi, Hideki Shojo
雑誌名: Med Sci Law. 2003 Apr;43(2):127-31.
Abstract/Text We report two forensic autopsy cases of fatal accidental hypothermia in an 89-year-old woman and a 76-year-old man who were found dead and unclothed. In both cases, Alzheimer's disease (AD) was diagnosed by neuropathological examination. Wandering due to AD was determined as the cause of these accidents. Although paradoxical undressing in hypothermic victims is known to occur as a result of cold exposure, in our patients, undressing was attributed to dementia due to AD before they became hypothermic. These cases indicate that neuropathological examination is crucial to determining the cause of such accidents and that undressing is not always the result of hypothermia in elderly victims.

PMID 12741656  Med Sci Law. 2003 Apr;43(2):127-31.
著者: Ken Zafren, Gordon G Giesbrecht, Daniel F Danzl, Hermann Brugger, Emily B Sagalyn, Beat Walpoth, Eric A Weiss, Paul S Auerbach, Scott E McIntosh, Mária Némethy, Marion McDevitt, Jennifer Dow, Robert B Schoene, George W Rodway, Peter H Hackett, Brad L Bennett, Colin K Grissom, Wilderness Medical Society
雑誌名: Wilderness Environ Med. 2014 Dec;25(4 Suppl):S66-85. doi: 10.1016/j.wem.2014.10.010.
Abstract/Text To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445.

Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
PMID 25498264  Wilderness Environ Med. 2014 Dec;25(4 Suppl):S66-85. do・・・
著者: M D Schaller, A P Fischer, C H Perret
雑誌名: JAMA. 1990 Oct 10;264(14):1842-5.
Abstract/Text When hypothermic patients appear to be dead, the decision to resuscitate may be difficult due to lack of reliable criteria of death. To discover useful prognostic indicators, we reviewed the hospital charts of nine hypothermic victims of snow avalanches (group A: median value of rectal temperature, 29.6 degrees C; range, less than 12 degrees C to 34 degrees C) and of 15 patients with hypothermia following acute drug intoxication and/or cold exposure (group B: 28.8 degrees C; range, 25.5 degrees C to 32 degrees C. In group A, plasma potassium level on admission was extremely high (14.5 mmol/L; range, 6.8 to 24.5 mmol/L) compared with that obtained in group B (3.5 mmol/L; range, 2.7 to 5.3 mmol/L). All patients in group A were in cardiorespiratory arrest. None could be successfully resuscitated despite effective rewarming by cardiopulmonary bypass or peritoneal lavage. In contrast, all of the patients in group B recovered from hypothermia, including two in cardiorespiratory arrest. Thus, extreme hyperkalemia during acute hypothermia appears to be a reliable marker of death. It might be used to select those patients in whom heroic resuscitation efforts can be useful.

PMID 2402043  JAMA. 1990 Oct 10;264(14):1842-5.
著者: M L Mallet
雑誌名: QJM. 2002 Dec;95(12):775-85.
Abstract/Text Accidental hypothermia is an uncommon problem that affects people of all ages, but particularly the elderly. This review briefly outlines the aetiological factors that may predispose to hypothermia, with particular reference to the effects of sepsis, although the specific situation of cold-water immersion is not addressed. A more detailed analysis of the pathophysiology of hypothermia then examines the cardiovascular, haematological, neurological, respiratory, renal, metabolic, and gastrointestinal systems. Clinically relevant findings are highlighted and some associated management points are related to the physiological changes. Most of these changes are reversible on rewarming, and are resistant to pharmacological manipulation; some of the pathological effects are related more to the process of rewarming than to the hypothermia itself.

PMID 12454320  QJM. 2002 Dec;95(12):775-85.
著者: C R Valeri, H Feingold, G Cassidy, G Ragno, S Khuri, M D Altschule
雑誌名: Ann Surg. 1987 Feb;205(2):175-81.
Abstract/Text Baboons that were subjected to systemic hypothermia at 32 C had an arm skin temperature of 27.3 C and bleeding time of 5.8 minutes. With local warming of the arm skin to 34 C, the bleeding time was 2.4 minutes. In normothermic baboons with arm skin temperature of 34.6 C, the bleeding time was 3.1 minutes. Local cooling of the arm skin to 27.6 C produced a bleeding time of 6.9 minutes. Increasing the skin temperature of the arm in hypothermic baboons to 38.9 C and in normothermic baboons to 40.1 C reduced bleeding times to 2.1 and 2.3 minutes, respectively. In both hypothermic and normothermic baboons there was a negative and significant correlation between the bleeding time and the arm skin temperature and the thromboxane B2 level in the shed blood obtained at the template bleeding time site. There was a significant positive correlation between the thromboxane B2 level in the shed blood and the arm skin temperature. Both in-vivo and in-vitro studies have shown that the production of thromboxane B2 by platelets is temperature-dependent, and that a cooling of skin temperature produces a reversible platelet dysfunction. Data also suggest that when a hypothermic patient bleeds without surgical cause, skin and wound temperature should be restored to normal before the administration of blood products that are not only expensive but may also transmit disease.

PMID 3813688  Ann Surg. 1987 Feb;205(2):175-81.
著者: L Rosenkranz
雑誌名: South Med J. 1985 Mar;78(3):358-9.
Abstract/Text Two patients with hypothermia were noted to have pancytopenia. Bone marrow examination showed failure of all marrow elements in both patients. Although a wide variety of hematologic abnormalities have been found in patients with hypothermia, bone marrow failure has not been previously reported.

PMID 3975756  South Med J. 1985 Mar;78(3):358-9.
著者: F T Fitzgerald
雑誌名: West J Med. 1980 Aug;133(2):105-7.
Abstract/Text Hypoglycemia is but one of a number of causes of hypothermia, but is important to keep in mind as a possible precipitating or concurrent event even in those cases in which there are other obvious explanations for decreased body temperature (exposure, alcoholism, starvation, sepsis or hypothyroidism). Hypoglycemia may occur in as many as 40 percent of very cold patients, and be clinically unrecognized because symptoms are masked by the hypothermia itself. Although serum glucose levels are depressed, a cold-induced renal tubular glycosuria may occur. Glucose in the urine, therefore, cannot be used as assurance of hyperglycemia in a hypothermic patient. And, although cold protects against serious end organ damage from hypoglycemia by decreasing tissue metabolic need for glucose, a serum specimen should be drawn for glucose determination in all hypothermic patients and a 50 percent glucose solution immediately given intravenously. If this is not done, serum glucose levels may plummet as the patient is rewarmed and begins to shiver.

PMID 7233890  West J Med. 1980 Aug;133(2):105-7.
著者: J A Swain
雑誌名: Arch Intern Med. 1988 Jul;148(7):1643-6.
Abstract/Text Management of the hypothermic patient concerns physicians in many specialties. Accidental hypothermia is commonly encountered in the emergency and operating rooms and in the adult and neonatal intensive care units. Intentional induction of hypothermia is used routinely in cardiac surgery to reduce total body metabolism and oxygen consumption, which is beneficial when an increased tolerance to ischemia is required, such as during total circulatory arrest. Hypothermia is associated with such complications as acidosis, impaired myocardial function, altered blood clotting, decreased kidney and liver function, and intracellular swelling. This review summarizes the laboratory, theoretical, and clinical evidence that the management of blood pH during hypothermia may alter the appearance or magnitude of these deleterious effects.

PMID 3289522  Arch Intern Med. 1988 Jul;148(7):1643-6.
著者: D F Danzl, R S Pozos
雑誌名: N Engl J Med. 1994 Dec 29;331(26):1756-60. doi: 10.1056/NEJM199412293312607.
Abstract/Text
PMID 7984198  N Engl J Med. 1994 Dec 29;331(26):1756-60. doi: 10.1056・・・
著者: T Vassal, B Benoit-Gonin, F Carrat, B Guidet, E Maury, G Offenstadt
雑誌名: Chest. 2001 Dec;120(6):1998-2003.
Abstract/Text STUDY OBJECTIVES: To assess the characteristics and outcomes of patients admitted to an ICU for severe accidental hypothermia, and to identify risk factors for mortality.
METHODS: All consecutive patients admitted to an ICU between January 1, 1979, and July 31, 1998, with a temperature of < or = 32 degrees C were retrospectively analyzed. Rewarming was always conducted passively with survival blankets and conventional covers. Prognostic factors were studied by means of univariate analysis (Mann-Whitney U and chi(2) tests) and multivariate analysis (logistic regression).
RESULTS: Forty-seven patients were enrolled (mean +/- SD age, 61.7 +/- 16 years). Five patients had a cardiac arrest before ICU admission. Patient characteristics at ICU admission were as follows: temperature, 28.8 +/- 2.5 degrees C; systolic BP, 85 +/- 23 mm Hg; heart rate, 60 +/- 24 beats/min; Glasgow Coma Scale, 10.4 +/- 3.7; and simplified acute physiology score (SAPS) II, 50.9 +/- 27. Mechanical ventilation was necessary in 23 cases, and 22 patients in shock received vasoactive drugs. The mean length of stay in the ICU was 6.7 +/- 9 days. Eighteen patients (38%) died, but ventricular arrhythmia was never the cause. Univariate analysis identified several prognostic factors (p < 0.05): age (57 +/- 16 years vs 69 +/- 14 years), systolic arterial BP (93 +/- 20 mm Hg vs 71 +/- 21 mm Hg), blood bicarbonate level (23.5 +/- 5.2 mmol/L vs 16.6 +/- 6.2 mmol/L), SAPS II score (35.3 +/- 19.5 vs 72 +/- 21), mechanical ventilation (34% vs 81%), vasopressor agents (42% vs 82%), rewarming time (11.5 +/- 7.2 h vs 17.2 +/- 7 h), and discovery of the patient at home (2.3% vs 54.5%). The initial temperature did not influence vital outcome (28.9 +/- 2.6 degrees C vs 28.6 +/- 2.2 degrees C). Only the use of vasoactive drugs (odds ratio, 9; 95% confidence interval, 1.6 to 50.1) was identified as a prognostic factor in the multivariate analysis.
CONCLUSION: Severe accidental hypothermia is a rare cause of ICU admission in an urban area. Its mortality remains high, but there is no overmortality according to the SAPS II-derived prediction of death. Shock, requiring treatment with vasoactive drugs, is an independent risk factor for mortality, while initial core temperature is not. It remains to be determined whether aggressive rather than passive rewarming procedures are better.

PMID 11742934  Chest. 2001 Dec;120(6):1998-2003.
著者: M G Hector
雑誌名: Am Fam Physician. 1992 Feb;45(2):785-92.
Abstract/Text Hypothermia is an underreported cause of death in the United States. The clinical presentation of hypothermia may include neurologic, cardiovascular and metabolic abnormalities. In severely hypothermic patients, evaluation may reveal no signs of life until the patient is rewarmed. Treatment is directed at restoring normal body temperature and attending to fluid resuscitation, electrolyte disorders, cardiac arrhythmias and associated disease states or conditions. Groups at particular risk for hypothermia include outdoor workers, the homeless, trauma victims and the very young or very old. Also at risk are persons with preexisting serious illnesses and those who are taking medications or abusing drugs. Cardiac arrest, hypotension, unresponsiveness and severe hyperkalemia portend a poorer prognosis.

PMID 1739061  Am Fam Physician. 1992 Feb;45(2):785-92.
著者: Daniel J Niven, Jonathan E Gaudet, Kevin B Laupland, Kelly J Mrklas, Derek J Roberts, Henry Thomas Stelfox
雑誌名: Ann Intern Med. 2015 Nov 17;163(10):768-77. doi: 10.7326/M15-1150.
Abstract/Text BACKGROUND: Body temperature is commonly used to screen patients for infectious diseases, establish diagnoses, monitor therapy, and guide management decisions.
PURPOSE: To determine the accuracy of peripheral thermometers for estimating core body temperature in adults and children.
DATA SOURCES: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL Plus from inception to July 2015.
STUDY SELECTION: Prospective studies comparing the accuracy of peripheral (tympanic membrane, temporal artery, axillary, or oral) thermometers with central (pulmonary artery catheter, urinary bladder, esophageal, or rectal) thermometers.
DATA EXTRACTION: 2 reviewers extracted data on study characteristics, methods, and outcomes and assessed the quality of individual studies.
DATA SYNTHESIS: 75 studies (8682 patients) were included. Most studies were at high or unclear risk of patient selection bias (74%) or index test bias (67%). Compared with central thermometers, peripheral thermometers had pooled 95% limits of agreement (random-effects meta-analysis) outside the predefined clinically acceptable range (± 0.5 °C), especially among patients with fever (-1.44 °C to 1.46 °C for adults; -1.49 °C to 0.43 °C for children) and hypothermia (-2.07 °C to 1.90 °C for adults; no data for children). For detection of fever (bivariate random-effects meta-analysis), sensitivity was low (64% [95% CI, 55% to 72%]; I2 = 95.7%; P < 0.001) but specificity was high (96% [CI, 93% to 97%]; I2 = 96.3%; P < 0.001). Only 1 study reported sensitivity and specificity for the detection of hypothermia.
LIMITATIONS: High-quality data for some temperature measurement techniques are limited. Pooled data are associated with interstudy heterogeneity that is not fully explained by stratified and metaregression analyses.
CONCLUSION: Peripheral thermometers do not have clinically acceptable accuracy and should not be used when accurate measurement of body temperature will influence clinical decisions.
PRIMARY FUNDING SOURCE: None.

PMID 26571241  Ann Intern Med. 2015 Nov 17;163(10):768-77. doi: 10.732・・・
著者: A M Klidjian, K J Foster, R M Kammerling, A Cooper, S J Karran
雑誌名: Br Med J. 1980 Oct 4;281(6245):899-901.
Abstract/Text Prediction of serious postoperative complications by using standard anthropometric and biochemical nutritional variables was attempted in 225 patients admitted for major abdominal surgery. In 102 of the patients hand-grip dynamometry was also measured, and this proved the most sensitive test, predicting complications in 48 of the 55 patients (87%) who developed them (p < 0.001). Arm muscle circumference and forearm muscle circumference below 85% of the standard value were also of predictive value (p < 0.02 and p < 0.01 respectively); weight for height and serum albumin concentrations were less satisfactory, while weight loss of more than 10% was not significantly related to complications. Dynamometry is a useful, rapid, and inexpensive screening test for detecting malnutrition that is likely to predispose to serious postoperative morbidity.

PMID 7427501  Br Med J. 1980 Oct 4;281(6245):899-901.
著者: A M Klidjian, T J Archer, K J Foster, S J Karran
雑誌名: JPEN J Parenter Enteral Nutr. 1982 Mar-Apr;6(2):119-21.
Abstract/Text The assessment of malnutrition by simple methods was studied in 120 patients undergoing elective major abdominal surgery to determine which index was of the most value in predicting postoperative complications. Weight for height and weight loss were of little significant value; serum albumin less than 35 g/l was more significant (p less than 0.05) but predicted only a quarter of those patients who developed serious complications. Measurements of muscle stores by anthropometry (arm and forearm muscle circumference) predicted nearly half the patients (p less than 0.01). By far the most useful index was hand-grip dynamometry, which predicted 90% of those who developed complications (p less than 0.001). The incidence of serious complications was 6 times greater in those patients with a low grip strength. Hand-grip dynamometry appears to be a useful screening test of patients at risk, and a valuable additional test for nutritional assessment.

PMID 7201531  JPEN J Parenter Enteral Nutr. 1982 Mar-Apr;6(2):119-21.・・・
著者: D R Hunt, B J Rowlands, D Johnston
雑誌名: JPEN J Parenter Enteral Nutr. 1985 Nov-Dec;9(6):701-4.
Abstract/Text This study evaluates hand grip strength as an indicator of nutritional status and a predictor of postoperative complications. Hand grip strength and other parameters of nutritional status, namely, midarm muscle circumference, forearm muscle circumference, triceps skinfold, percentage ideal body weight, serum albumin, and percent usual weight were determined preoperatively in 205 patients. Complications occurred in 28 patients (14%). Patients with at least one abnormal nutritional parameter had a higher incidence of postoperative complications. Their length of total and postoperative hospitalization was greater by 6.2 and 4.6 days, respectively (p less than 0.01). Grip strength was the most sensitive single parameter, but forearm muscle circumference and percentage ideal body weight were the most specific indices. Hand grip strength is a simple measure of nutritional status and an accurate prognostic indicator that requires further clinical evaluation.

PMID 4068194  JPEN J Parenter Enteral Nutr. 1985 Nov-Dec;9(6):701-4.
著者: M S Seshadri, B U Samuel, A S Kanagasabapathy, A M Cherian
雑誌名: J Gen Intern Med. 1989 Nov-Dec;4(6):490-2.
Abstract/Text A clinical scoring system for hypothyroidism was evaluated against an established "gold standard" (low serum thyroxine and elevated thyroid-stimulating hormone) in 52 adults in a peripheral hospital and in 53 adults in a endocrinology referral clinic. Using a score of 0 as a cutoff point, the scoring system selected patients with hypothyroidism from the referral center for further biochemical evaluation; at the same time, it excluded hypothyroidism with confidence in 42% of euthyroid subjects. In the peripheral hospital, a cutoff score of -10 selected 92% of hypothyroid subjects for further evaluation and excluded hypothyroidism in 55% of euthyroid subjects. Two cutoff points were needed because the prevalences of hypothyroidism in the two centers differed. The simple scoring system increased the pretest probability of disease by 15% in the peripheral hospital and by 19% in the referral clinic. In countries where resources are limited, this scoring system can improve the clinical evaluation of patients who have one or more symptoms of hypothyroidism and reduce the load on referral centers.

PMID 2585156  J Gen Intern Med. 1989 Nov-Dec;4(6):490-2.
著者: R Indra, S S Patil, R Joshi, M Pai, S P Kalantri
雑誌名: J Postgrad Med. 2004 Jan-Mar;50(1):7-11; discussion 11.
Abstract/Text BACKGROUND: Hypothyroidism is a common, potentially treatable endocrine disorder. Since hypothyroidism is not always associated with the signs and symptoms typically attributed to it, the diagnosis is often missed. Conversely, patients with typical signs and symptoms may not have the disease when laboratory tests are performed.
AIMS: We aimed to determine the accuracy of physical examination in the diagnosis of hypothyroidism.
SETTING AND DESIGN: Prospective, hospital-based, cross-sectional diagnostic study.
MATERIAL AND METHODS: Consecutive outpatients from the medicine department were screened and an independent comparison of physical signs (coarse skin, puffy face, slow movements, bradycardia, pretibial oedema and ankle reflex) against thyroid hormone assay (TSH and FT4) was performed.
STATISTICAL ANALYSIS: Diagnostic accuracy was measured as sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and positive and negative predictive values.
RESULTS: Of the 1450 patients screened, 130 patients (102 women and 28 men) underwent both clinical examination and thyroid function tests. Twenty-three patients (18%) were diagnosed to have hypothyroidism by thyroid hormone assays. No single sign could easily discriminate a euthyroid from a hypothyroid patient (range of positive likelihood ratio (LR+) 1.0 to 3.88; range of negative likelihood ratio (LR-): 0.42 to 1.0). No physical sign generated a likelihood ratio large enough to increase the post-test probability significantly. The combination of signs that had the highest likelihood ratios (coarse skin, bradycardia and delayed ankle reflex) was associated with modest accuracy (LR+ 3.75; LR- 0.48).
CONCLUSION: Clinicians cannot rely exclusively on physical examination to confirm or rule out hypothyroidism. Patients with suspected hypothyroidism require a diagnostic workup that includes thyroid hormone assays.

PMID 15047991  J Postgrad Med. 2004 Jan-Mar;50(1):7-11; discussion 11.・・・
著者: Jennifer Dow, Gordon G Giesbrecht, Daniel F Danzl, Hermann Brugger, Emily B Sagalyn, Beat Walpoth, Paul S Auerbach, Scott E McIntosh, Mária Némethy, Marion McDevitt, Robert B Schoene, George W Rodway, Peter H Hackett, Ken Zafren, Brad L Bennett, Colin K Grissom
雑誌名: Wilderness Environ Med. 2019 Dec;30(4S):S47-S69. doi: 10.1016/j.wem.2019.10.002. Epub 2019 Nov 15.
Abstract/Text To provide guidance to clinicians, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and a balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is the 2019 update of the Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2014 Update.

Copyright © 2019 Marketing EDGE.org. Published by Elsevier Inc. All rights reserved.
PMID 31740369  Wilderness Environ Med. 2019 Dec;30(4S):S47-S69. doi: 1・・・
著者: Les Gordon, Peter Paal, John A Ellerton, Hermann Brugger, Giles J Peek, Ken Zafren
雑誌名: Resuscitation. 2015 May;90:46-9. doi: 10.1016/j.resuscitation.2015.02.017. Epub 2015 Feb 25.
Abstract/Text INTRODUCTION: Cardiac arrest (CA) in patients with severe accidental hypothermia (core temperature <28 °C) differs from CA in normothermic patients. Maintaining CPR throughout the prehospital period may be impossible, particularly during difficult evacuations. We have developed guidelines for rescuers who are evacuating and treating severely hypothermic CA patients.
METHODS: A literature search was performed. The authors used the findings to develop guidelines.
RESULTS: Full neurological recovery is possible even with prolonged CA if the brain was already severely hypothermic before CA occurred. Data from surgery during deep hypothermic CA and prehospital case reports underline the feasibility of delayed and intermittent CPR in patients who have arrested due to severe hypothermia.
CONCLUSIONS: Continuous CPR is recommended for CA due to primary severe hypothermia. Mechanical chest-compression devices should be used when available and CPR-interruptions avoided. Only if this is not possible should CPR be delayed or performed intermittently. Based on the available data, a patient with a core temperature <28 °C or unknown with unequivocal hypothermic CA, evidence supports alternating 5 min CPR and ≤5 min without CPR. With core temperature <20 °C, evidence supports alternating 5 min CPR and ≤10 min without CPR.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
PMID 25725297  Resuscitation. 2015 May;90:46-9. doi: 10.1016/j.resusci・・・
著者: Mathieu Pasquier, Olivier Hugli, Peter Paal, Tomasz Darocha, Marc Blancher, Paul Husby, Tom Silfvast, Pierre-Nicolas Carron, Valentin Rousson
雑誌名: Resuscitation. 2018 May;126:58-64. doi: 10.1016/j.resuscitation.2018.02.026. Epub 2018 Mar 2.
Abstract/Text AIMS: Currently, the decision to initiate extracorporeal life support for patients who suffer cardiac arrest due to accidental hypothermia is essentially based on serum potassium level. Our goal was to build a prediction score in order to determine the probability of survival following rewarming of hypothermic arrested patients based on several covariates available at admission.
METHODS: We included consecutive hypothermic arrested patients who underwent rewarming with extracorporeal life support. The sample comprised 237 patients identified through the literature from 18 studies, and 49 additional patients obtained from hospital data collection. We considered nine potential predictors of survival: age; sex; core temperature; serum potassium level; mechanism of hypothermia; cardiac rhythm at admission; witnessed cardiac arrest, rewarming method and cardiopulmonary resuscitation duration prior to the initiation of extracorporeal life support. The primary outcome parameter was survival to hospital discharge.
RESULTS: Overall, 106 of the 286 included patients survived (37%; 95% CI: 32-43%), most (84%) with a good neurological outcome. The final score included the following variables: age, sex, core temperature at admission, serum potassium level, mechanism of cooling, and cardiopulmonary resuscitation duration. The corresponding area under the receiver operating characteristic curve was 0.895 (95% CI: 0.859-0.931) compared to 0.774 (95% CI: 0.720-0.828) when based on serum potassium level alone.
CONCLUSIONS: In this large retrospective study we found that our score was superior to dichotomous triage based on serum potassium level in assessing which hypothermic patients in cardiac arrest would benefit from extracorporeal life support. External validation of our findings is required.

Copyright © 2018 Elsevier B.V. All rights reserved.
PMID 29481910  Resuscitation. 2018 May;126:58-64. doi: 10.1016/j.resus・・・
著者: Carsten Lott, Anatolij Truhlář, Annette Alfonzo, Alessandro Barelli, Violeta González-Salvado, Jochen Hinkelbein, Jerry P Nolan, Peter Paal, Gavin D Perkins, Karl-Christian Thies, Joyce Yeung, David A Zideman, Jasmeet Soar, ERC Special Circumstances Writing Group Collaborators
雑誌名: Resuscitation. 2021 Apr;161:152-219. doi: 10.1016/j.resuscitation.2021.02.011. Epub 2021 Mar 24.
Abstract/Text These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).

Copyright © 2021. Published by Elsevier B.V.
PMID 33773826  Resuscitation. 2021 Apr;161:152-219. doi: 10.1016/j.res・・・
著者: M T Steele, M J Nelson, D I Sessler, L Fraker, B Bunney, W A Watson, W A Robinson
雑誌名: Ann Emerg Med. 1996 Apr;27(4):479-84.
Abstract/Text STUDY OBJECTIVE: To compare the rates of rewarming of forced-air and passive insulation as a treatment for accidental hypothermia.
METHODS: We carried out a prospective, randomized clinical trial in two urban, university-affiliated emergency departments. Our subjects were 16 adult hypothermia victims with core temperatures less than 32 degrees C. A convective cover inflated with air at about 43 degrees C (forced-air group) or cotton blankets (control group) were applied until the patient's core temperature reached 35 degrees C. Members of both groups were given IV fluids warmed to 38 degrees C and warmed, humidified oxygen at 40 degrees C by inhalation.
RESULTS: The mean +/- SD initial temperature was 28.8 degrees +/- 2.5 degrees C (range, 25.5 degrees C to 31.9 degrees C) in the patients who underwent forced-air rewarming and 29.8 degrees +/- 1.5 degrees C (range, 28.2 degrees C to 31.9 degrees C) in those given blankets. Core temperature increased about 1 degree C/hour faster in patients treated with forced-air rewarming (about 2.4 degrees C/hour) than in patients given only cotton blankets (about 1.4 degrees C/hour, P = .01). Core-temperature afterdrop was detected in neither group.
CONCLUSION: Forced air accelerated the rate of rewarming without producing apparent complications in hypothermic patients.

PMID 8604866  Ann Emerg Med. 1996 Apr;27(4):479-84.
著者: C P Shields, D M Sixsmith
雑誌名: Ann Emerg Med. 1990 Oct;19(10):1093-7.
Abstract/Text STUDY OBJECTIVES: To study the treatment of moderate-to-severe hypothermia using a combination of core rewarming techniques.
DESIGN: A prospective study.
SETTING: The emergency department of an urban, community hospital. TYPE OF PATIENTS: Sixteen patients who presented with accidental hypothermia with a core temperature of less than 32 C.
INTERVENTIONS: All patients were treated with warmed IV fluids either through central or peripheral IV lines and heated aerosol masks.
MEASUREMENTS AND MAIN RESULTS: The patients had a mean rewarming rate of 1.16 C/hr; all survived. The majority were chronic alcoholic patients who presented with multiple medical conditions that required hospitalization.
CONCLUSION: All patients recovered with this method of core rewarming.

PMID 2221514  Ann Emerg Med. 1990 Oct;19(10):1093-7.
著者: B H Walpoth, B N Walpoth-Aslan, H P Mattle, B P Radanov, G Schroth, L Schaeffler, A P Fischer, L von Segesser, U Althaus
雑誌名: N Engl J Med. 1997 Nov 20;337(21):1500-5. doi: 10.1056/NEJM199711203372103.
Abstract/Text BACKGROUND: Cardiopulmonary bypass has been used to rewarm victims of accidental deep hypothermia. Unlike other rewarming techniques, it restores organ perfusion immediately in patients with inadequate circulation. This study evaluated the long-term outcome of survivors of accidental deep hypothermia with circulatory arrest who had been rewarmed with cardiopulmonary bypass.
METHODS: Deep hypothermia (core temperature, <28 degrees C) with circulatory arrest was found in 46 of 234 patients with accidental hypothermia. In 32 of the 46 patients, rewarming with cardiopulmonary bypass was attempted, resulting in 15 long-term survivors. In most of these patients, deep hypothermia developed after mountaineering accidents or suicide at tempts. After an average (+/-SD) of 6.7+/-4.0 years of follow-up, we obtained the patients' medical histories and performed neurologic and neuropsychological examinations, neurovascular ultrasound studies, electroencephalography, and magnetic resonance imaging of the brain.
RESULTS: The average age of the patients was 25.2+/-9.9 years; seven were female and eight were male. The mean interval from discovery of the patient to rewarming with cardiopulmonary bypass was 141+/-50 minutes (range, 30 to 240). At follow-up there were no hypothermia-related sequelae that impaired quality of life. Neurologic and neuropsychological deficits observed in the early period after rewarming had fully or almost completely disappeared. One patent had cerebellar atrophy on magnetic resonance imaging with mild clinical signs, a condition that may have been caused by hypothermia. Other clinical abnormalities were either preexisting or due to injuries not related to hypothermia
CONCLUSIONS: This clinical experience demonstrates that young, otherwise healthy people can survive accidental deep hypothermia with no or minimal cerebral impairment, even with prolonged circulatory arrest. Cardiopulmonary bypass appears to be an efficacious rewarming technique.

PMID 9366581  N Engl J Med. 1997 Nov 20;337(21):1500-5. doi: 10.1056/・・・

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