Hypothermia in Trauma - van Veelen, M. J.; Brodmann Maeder, M. (Int J Environ Res Public Health, 2021)
Hypothermia in trauma patients is a common condition. It is aggravated by traumatic hemorrhage, which leads to hypovolemic shock. This hypovolemic shock results in a lethal triad of hypothermia, coagulopathy, and acidosis, leading to ongoing bleeding. Additionally, hypothermia in trauma patients can deepen through environmental exposure on the scene or during transport and medical procedures such as infusions and airway management. This vicious circle has a detrimental effect on the outcome of major trauma patients. This narrative review describes the main factors to consider in the co-existing condition of trauma and hypothermia from a prehospital and emergency medical perspective. Early prehospital recognition and staging of hypothermia are crucial to triage to proper care to improve survival. Treatment of hypothermia should start in an early stage, especially the prevention of further cooling in the prehospital setting and during the primary assessment. On the one hand, active rewarming is the treatment of choice of hypothermia-induced coagulation disorder in trauma patients; on the other hand, accidental or clinically induced hypothermia might improve outcomes by protecting against the effects of hypoperfusion and hypoxic injury in selected cases such as patients suffering from traumatic brain injury (TBI) or traumatic cardiac arrest.
Keywords: journalArticle; *Blood Coagulation Disorders/etiology/therapy; *Hypothermia/complications/therapy; *Wounds and Injuries/complications/therapy; Ecls; Heart Arrest/therapy; Hemorrhage; Humans; Rewarming; cardiac arrest; coagulation; emergency preservation resuscitation; extracorporeal life support; hypothermia; lethal triad; trauma; traumatic brain injury