Aim

The International Hypothermia Registry (IHR) was created to increase knowledge of accidental hypothermia, particularly to develop evidence-based guidelines and find reliable outcome predictors. The present study compares hypothermic patients with and without cardiac arrest included in the IHR.

Methods

Demographic, pre-hospital and in-hospital data, method of rewarming and outcome data were collected anonymously in the IHR between 2010 and 2020.

Results

Two hundred and one non-consecutive cases were included. The major causeof hypothermia was mountain accidents, predominantly in young men. Hypothermic Cardiac Arrest (HCA) occurred in 73 of 201 patients. Core temperature was significantly lower in the patients in cardiac arrest (25.0 vs. 30.0 °C, p < 0.001). One hundred and fifteen patients were rewarmed externally (93% with ROSC), 53 by extra-corporeal life support (ECLS) (40% with ROSC) and 21 with invasive internal techniques (71% with ROSC). The overall survival rate was 95% for patients with preserved circulation and 36% for those in cardiac arrest. Witnessed cardiac arrest and ROSC before rewarming were positive outcome predictors, asphyxia, coagulopathy, high potassium and lactate negative outcome predictors.

Conclusions

This first analysis of 201 IHR patients with moderate to severe accidental hypothermia shows an excellent 95% survival rate for patients with preserved circulation and 36% for HCA patients. Witnessed cardiac arrest, restoration of spontaneous circulation, low potassium and lactate and absence of asphyxia were positive survival predictors despite hypothermia in young, healthy adults after mountaineering accidents. However, accidental hypothermia is a heterogenous entity that should be considered in both treatment strategies and prognostication.

中文翻译：

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低温心脏骤停——来自国际低温登记处的回顾性队列研究

目的

国际体温过低登记处 (IHR) 旨在增加对意外体温过低的了解，特别是制定循证指南并寻找可靠的结果预测因子。本研究比较了 IHR 中包含和不包含心脏骤停的体温过低患者。

方法

人口统计学、院前和院内数据、复温方法和结果数据是在 2010 年至 2020 年间在 IHR 中匿名收集的。

结果

包括201个非连续病例。体温过低的主要原因是山地事故，主要是年轻人。201 名患者中有 73 名发生了低温心脏骤停 (HCA)。心脏骤停患者的核心温度显着降低（25.0 与 30.0 °C，p  < 0.001）。115 名患者接受外部复温（93% 使用 ROSC），53 名使用体外生命支持（ECLS）（40% 使用 ROSC）和 21 名使用侵入性内部技术（71% 使用 ROSC）。循环正常患者的总生存率为 95%，心脏骤停患者的总生存率为 36%。复温前目击心脏骤停和 ROSC 是阳性结果预测因子，窒息、凝血障碍、高钾和乳酸阴性结果预测因子。

结论

对 201 名中度至重度意外体温过低的 IHR 患者进行的首次分析显示，循环正常患者的存活率为 95%，HCA 患者的存活率为 36%。尽管年轻、健康的成年人在登山事故后体温过低，但目睹心脏骤停、自主循环恢复、低钾和乳酸以及没有窒息是积极的生存预测因素。然而，意外体温过低是一种异质性实体，应在治疗策略和预后中加以考虑。