Prise en charge d'un malade en hypothermie accidentelle

Accidental hypothermia below 32 °C is at risk for cardiac arrest. The decrease in tissue metabolism, which occurs along with hypothermia, protects the patient against hypoxia. This protection gives hope for successful resuscitation without sequelae in patients with cardiac arrest. To treat hypothermia in patients with a maintained cardiac function, a “low stress strategy” is first recommended. This strategy is aimed to support the spontaneous rewarming with non-invasive methods. This low stress strategy is designed to avoid invasive procedures which its inherent risk of causing ventricular fibrillation. If non-invasive techniques are inadequate (< 0,5 °C/hour), and moreover in case of cardiac arrest, femoral cardiopulmonary bypass is the best technique to assist the cardiac circulation and rewarm the patient. In order to increase the ratio of successful resuscitations with cardiopulmonary bypass, it is necessary to preselect the most appropriate patients in the field with the help of precise guidelines. A patient with a body temperature above 32 °C or with a plasma potassium level superior to 10 mmol.lit−1 will not be an appropriate candidate. This invasive therapeutic strategy needs to be integrated within specific care networks.