All emergency providers should be familiar with hypothermia regardless of the climate in which they practice. Hypothermia can occur in a variety of climates, indoors or outdoors, and in patients of all ages regardless of health status. Frostbite, chilblains, trench foot, and cold urticaria are cold-related injuries that may present to any emergency department during any time of year.
In a multicenter trial in France, patients admitted to the ICU from 2011-2015 for convulsive status epilepticus were randomly assigned to receive standard therapy (control group) or hypothermia plus standard therapy (treatment group). The primary outcome measure was an absence of functional impairment at 90 days after seizure onset, as measured by the Glasgow Outcome Scale (score of 5). There was no significant difference in outcomes between the two groups.
Current guidelines recommend the use of therapeutic hypothermia in patients with in-hospital cardiac arrest, even though its efficacy has been demonstrated only in randomized trials after out-of-hospital cardiac arrest. This non-randomized, observational cohort study based on a large national registry found that the use of therapeutic hypothermia was associated with lower likelihood of survival and less favorable neurological outcome in patients successfully resuscitated after an in-hospital cardiac arrest.
Hypothermia therapy is effective after severe traumatic brain injury for patients ages 50 years and younger. However, mortality was increased in patients treated with hypothermia who had diffuse injury with swelling on CT.