November 17, 1978

Treatment of Profound Hypothermia

Author Affiliations

From the Department of Cardiology (Drs Welton and Miller), the Cora and Webb Mading Department of Surgery (Dr Mattox), and the Departments of Medicine (Dr Miller) and Thoracic Surgery (Dr Petmecky), Baylor College of Medicine, Houston, and the Emergency Surgical Services (Dr Mattox), Ben Taub General Hospital, Houston.

JAMA. 1978;240(21):2291-2292. doi:10.1001/jama.1978.03290210073038

MANY lives were lost due to accidental hypothermia during the severe winters of 1977 and 1978. The alcoholic, the trauma victim, and the elderly with underlying medical disorders are at risk of losing consciousness outdoors and therefore are prone to the development of this medical emergency.1

Severe hypothermia depresses the CNS, the medullary respiratory center, and the cardiovascular system.2 The profoundly hypothermic patient is comatose and hyporeflexive. Ventilatory drive is reduced, resulting in hypoxemia. Respiratory arrest occurs at temperatures of less than 24°C (75°F). In addition, there is hypotension due to low cardiac output and cardiac abnormalities such as atrial fibrillation, atrial flutter, conduction defects, premature ventricular contractions, and junctional rhythms. The ECG may show T-wave inversion and prolonged PR, QRS, and QT intervals as well as the unique "J" wave at the end of the QRS complex3 (Figure). In patients with moderate