Highlights & Basics
- Accidental hypothermia is defined by the unintentional lowering of core body temperature to <95°F (<35°C).
- Classified as mild, moderate, or severe according to core temperature. Some experts have suggested a further (more severe) category of profound hypothermia, at a core temperature <75.2°F (<24°C) according to some and <68°F (<20°C) according to others.
- Core temperature measured in the lower third of the esophagus correlates well with pulmonary artery temperature and is preferred in patients with a secure airway.
- Initial management should focus on stopping further cooling, resuscitation, and supportive care. This includes removing the patient from the cold environment, careful removal of wet or cold clothing, insulation, warming the body, securing the airway, monitoring breathing and circulation, and maintaining circulation using warm intravenous fluids.
- Choice of rewarming strategy (passive external, active external, active interna/corel) is based on the patient's core temperature and clinical features; a combination of techniques may be used.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Paal P, Pasquier M, Darocha T, et al. Accidental hypothermia: 2021 update. Int J Environ Res Public Health. 2022;19(1):501.[Abstract][Full Text]
Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021 Apr;161:152-219.[Abstract][Full Text]
Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16 Suppl 2):S366-468.[Abstract][Full Text]
Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2019 update. Wilderness Environ Med. 2019 Dec;30(4 Suppl):S47-69.[Abstract][Full Text]
1. Chivers K. Accidental hypothermia: pathophysiology, investigations and management. Emerg Nurse. 2022 Oct 25.[Abstract]
2. van Veelen MJ, Brodmann Maeder M. Hypothermia in trauma. Int J Environ Res Public Health. 2021 Aug 18;18(16):8719.[Abstract][Full Text]
3. Rösli D, Schnüriger B, Candinas D, et al. The impact of accidental hypothermia on mortality in trauma patients overall and patients with traumatic brain injury specifically: a systematic review and meta-analysis. World J Surg. 2020 Dec;44(12):4106-17.[Abstract][Full Text]
4. Gasparrini A, Guo Y, Hashizume M, et al. Mortality risk attributable to high and low ambient temperature: a multicountry observational study. Lancet. 2015 Jul 25;386(9991):369-75.[Abstract][Full Text]
5. MacDonell JE, Wrenn K. Hypothermia in the summer. South Med J. 1991 Jun;84(6):804-5.[Abstract]
6. Burke WP. A case report of warm weather accidental hypothermia. J Miss State Med Assoc. 2004 Sep;45(9):263-6.[Abstract]
7. Baumgartner EA, Belson M, Rubin C, et al. Hypothermia and other cold-related morbidity emergency department visits: United States, 1995-2004. Wilderness Environ Med. 2008 Winter;19(4):233-7.[Abstract][Full Text]
8. Centers for Disease Control and Prevention (CDC). Hypothermia-related deaths - United States, 2003-2004. MMWR Morb Mortal Wkly Rep. 2005 Feb 25;54(7):173-5.[Abstract][Full Text]
9. Meiman J, Anderson H, Tomasallo C, et al. Hypothermia-related deaths--Wisconsin, 2014, and United States, 2003-2013. MMWR Morb Mortal Wkly Rep. 2015 Feb 20;64(6):141-3.[Abstract][Full Text]
10. QuickStats: death rates attributed to excessive cold or hypothermia, by urbanization level and sex - National Vital Statistics System, 2018-2020. MMWR Morb Mortal Wkly Rep. 2022 Feb 18;71(7):282.[Abstract][Full Text]
11. Mallet ML. Pathophysiology of accidental hypothermia. QJM. 2002 Dec;95(12):775-85.[Abstract][Full Text]
12. Morita S, Matsuyama T, Ehara N, et al. Prevalence and outcomes of accidental hypothermia among elderly patients in Japan: data from the J-Point registry. Geriatr Gerontol Int. 2018 Oct;18(10):1427-32.[Abstract]
13. Matsuyama T, Morita S, Ehara N, et al. Characteristics and outcomes of accidental hypothermia in Japan: the J-Point registry. Emerg Med J. 2018 Nov;35(11):659-66.[Abstract]
14. Romaszko J, Cymes I, Dragańska E, et al. Mortality among the homeless: causes and meteorological relationships. PLoS One. 2017 Dec 21;12(12):e0189938.[Abstract][Full Text]
15. Lane K, Ito K, Johnson S, et al. Burden and risk factors for cold-related illness and death in New York city. Int J Environ Res Public Health. 2018 Mar 30;15(4):632.[Abstract][Full Text]
16. Zhang P, Wiens K, Wang R, et al. Cold weather conditions and risk of hypothermia among people experiencing homelessness: implications for prevention strategies. Int J Environ Res Public Health. 2019 Sep 5;16(18):3259.[Abstract][Full Text]
17. Walpoth BH, Maeder MB, Courvoisier DS, et al. Hypothermic cardiac arrest - retrospective cohort study from the International Hypothermia Registry. Resuscitation. 2021 Oct;167:58-65.[Abstract][Full Text]
18. Cheshire WP Jr. Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci. 2016 Apr;196:91-104.[Abstract][Full Text]
19. Paal P, Pasquier M, Darocha T, et al. Accidental hypothermia: 2021 update. Int J Environ Res Public Health. 2022;19(1):501.[Abstract][Full Text]
20. Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021 Apr;161:152-219.[Abstract][Full Text]
21. Jolly BT, Ghezzi KT. Accidental hypothermia. Emerg Med Clin North Am. 1992 May;10(2):311-27.[Abstract]
22. Krantz MJ, Lowery CM. Images in clinical medicine. Giant Osborn waves in hypothermia. N Engl J Med. 2005 Jan 13;352(2):184.[Abstract]
23. Darocha T, Sobczyk D, Kosiński S, et al. Electrocardiographic changes caused by severe accidental hypothermia. J Cardiothorac Vasc Anesth. 2015 Dec;29(6):e83-6.[Abstract][Full Text]
24. Severinghaus JW, Stupfel MA, Bradley AF. Alveolar, dead space, and arterial to end tidal carbon dioxide differences during hypothermia in dog and man. J Appl Physiol. 1957 May;10(3):349-55.[Abstract]
25. Sterba JA. Efficacy and safety of prehospital rewarming techniques to treat accidental hypothermia. Ann Emerg Med. 1991 Aug;20(8):896-901.[Abstract]
26. Ireland S, Endacott R, Cameron P, et al. The incidence and significance of accidental hypothermia in major trauma--a prospective observational study. Resuscitation. 2011 Mar;82(3):300-6.[Abstract]
27. Giesbrecht GG. Cold stress, near drowning and accidental hypothermia: a review. Aviat Space Environ Med. 2000 Jul;71(7):733-52.[Abstract]
28. Tipton MJ, Golden FS. A proposed decision-making guide for the search, rescue and resuscitation of submersion (head under) victims based on expert opinion. Resuscitation. 2011 Jul;82(7):819-24.[Abstract]
29. Quan L, Mack CD, Schiff MA. Association of water temperature and submersion duration and drowning outcome. Resuscitation. 2014 Jun;85(6):790-4.[Abstract]
30. Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J. 2006 May;83(5):1090-1104, 1107-13.[Abstract]
31. Leslie K, Sessler DI. Perioperative hypothermia in the high-risk surgical patient. Best Pract Res Clin Anaesthesiol. 2003 Dec;17(4):485-98.[Abstract]
32. Horn EP, Bein B, Böhm R, et al. The effect of short time periods of pre-operative warming in the prevention of peri-operative hypothermia. Anaesthesia. 2012 Jun;67(6):612-7.[Abstract]
33. National Institute for Health and Care Excellence. Hypothermia: prevention and management in adults having surgery. Dec 2016 [internet publication].[Full Text]
34. Bridwell RE, Willis GC, Gottlieb M, et al. Decompensated hypothyroidism: a review for the emergency clinician. Am J Emerg Med. 2021 Jan;39:207-12.[Abstract]
35. Snijders BMG, Roos MJ, Keijsers CJPW. Incidences of underlying causes of hypothermia in older patients in the emergency department: a systematic review. Eur Geriatr Med. 2023 Jun;14(3):411-20.[Abstract][Full Text]
36. Singer D. Pediatric hypothermia: an ambiguous issue. Int J Environ Res Public Health. 2021 Oct 31;18(21):11484.[Abstract][Full Text]
37. Bright F, Gilbert JD, Winskog C, et al. Additional risk factors for lethal hypothermia. J Forensic Leg Med. 2013 Aug;20(6):595-7.[Abstract]
38. Zonnenberg C, Bueno-de-Mesquita JM, Ramlal D, et al. Hypothermia due to antipsychotic medication: a systematic review. Front Psychiatry. 2017;8:165.[Abstract][Full Text]
39. Kamp D, Paschali M, Bouanane A, et al. Characteristics of antipsychotic drug-induced hypothermia in psychogeriatric inpatients. Hum Psychopharmacol. 2022 Mar;37(2):e2816.[Abstract][Full Text]
40. Mutch AM. Recurrent admissions for hypothermia from concomitant topiramate and phenobarbital: a case report. J Pharm Pract. 2019 Feb;32(1):109-12.[Abstract]
41. de Vries LJ, Boekema J, Sediq R, et al. Antidepressant overdose resulting in coma and hypothermia [in Dutch]. Ned Tijdschr Geneeskd. 2022 Feb 22:166:D6166.[Abstract]
42. Manouchehri A, Rashidian H, Zakariaei Z. Severe metabolic acidosis due to massive metformin overdose in a man: a case report. Oxf Med Case Reports. 2023 May;2023(5):omad049.[Abstract][Full Text]
43. Gershkovich B, McCudden C, Burns KD. A unique case of metformin-associated lactic acidosis. Case Rep Nephrol. 2018 Nov 15:2018:4696182.[Abstract][Full Text]
44. Pasquier M, Zurron N, Weith B, et al. Deep accidental hypothermia with core temperature below 24°C presenting with vital signs. High Alt Med Biol. 2014 Apr;15(1):58-63.[Abstract]
45. Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16 Suppl 2):S366-468.[Abstract][Full Text]
46. Durrer B, Brugger H, Syme D, et al. The medical on-site treatment of hypothermia: ICAR-MEDCOM recommendation. High Alt Med Biol. 2003 Spring;4(1):99-103.[Abstract]
47. Musi ME, Sheets A, Zafren K, et al. Clinical staging of accidental hypothermia: The revised Swiss system: Recommendation of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Resuscitation. 2021 May;162:182-7.[Abstract][Full Text]
48. Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2019 update. Wilderness Environ Med. 2019 Dec;30(4 Suppl):S47-69.[Abstract][Full Text]
49. Foggle JL. Accidental hypothermia: 'You're not dead until you're warm and dead'. R I Med J (2013). 2019 Feb 1;102(1):28-32.[Abstract][Full Text]
50. Higuchi S, Takahashi T, Kabeya Y, et al. J waves in accidental hypothermia. Circ J. 2014;78(1):128-34.[Abstract][Full Text]
51. Urdang M, Shoenberger JM, Triamarit P, et al. ECG analysis in accidental urban hypothermia. J Emerg Med. 2009 Aug;37(2):235.
52. Darocha T, Kosiński S, Jarosz A, et al. Should capnography be used as a guide for choosing a ventilation strategy in circulatory shock caused by severe hypothermia? Observational case-series study. Scand J Trauma Resusc Emerg Med. 2017 Feb 15;25(1):15.[Abstract][Full Text]
53. Gale EA, Bennett T, Green JH, et al. Hypoglycaemia, hypothermia and shivering in man. Clin Sci (Lond). 1981 Oct;61(4):463-9.[Abstract]
54. Breen EG, Coghlan JG, Egan E, et al. Impaired coagulation in accidental hypothermia of the elderly. Age Ageing. 1988 Sep;17(5):343-6.[Abstract]
55. Hewett Brumberg EK, Douma MJ, Alibertis K, et al. 2024 American Heart Association and American Red Cross guidelines for first aid. Circulation. 2024 Dec 10;150(24):e519-79.[Abstract][Full Text]
56. Weinberg AD. Hypothermia. Ann Emerg Med. 1993 Feb;22(2 Pt 2):370-7.[Abstract]
57. Austin MA, Maynes EJ, O'Malley TJ, et al. Outcomes of extracorporeal life support use in accidental hypothermia: a systematic review. Ann Thorac Surg. 2020 Dec;110(6):1926-32.[Abstract][Full Text]
58. Dunne B, Christou E, Duff O, et al. Extracorporeal-assisted rewarming in the management of accidental deep hypothermic cardiac arrest: a systematic review of the literature. Heart Lung Circ. 2014 Nov;23(11):1029-35.[Abstract]
59. Wallner B, Schenk B, Hermann M, et al. Hypothermia-associated coagulopathy: a comparison of viscoelastic monitoring, platelet function, and real time live confocal microscopy at low blood temperatures, an in vitro experimental study. Front Physiol. 2020 Jul 14:11:843.[Abstract][Full Text]
60. De Paulis S, Cavaliere F. Anticoagulation management in high bleeding-risk ECMO in adults. Front Cardiovasc Med. 2022 Apr 6;9:884063.[Abstract][Full Text]
61. Dépret F, Peacock WF, Liu KD, et al. Management of hyperkalemia in the acutely ill patient. Ann Intensive Care. 2019 Feb 28;9(1):32.[Abstract][Full Text]
62. Gilbert M, Busund R, Skagseth A, et al. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet. 2000 Jan 29;355(9201):375-6.[Abstract]
63. Forti A, Brugnaro P, Rauch S, et al. Hypothermic cardiac arrest with full neurologic recovery after approximately nine hours of cardiopulmonary resuscitation: management and possible complications. Ann Emerg Med. 2019 Jan;73(1):52-7.[Abstract][Full Text]
64. Riera J, Argudo E, Ruiz-Rodríguez JC, et al. Full neurological recovery 6 h after cardiac arrest due to accidental hypothermia. Lancet. 2020 May 16;395(10236):e89.[Abstract]
65. Ruttmann E, Weissenbacher A, Ulmer H, et al. Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. J Thorac Cardiovasc Surg. 2007 Sep;134(3):594-600.[Abstract][Full Text]
66. Saczkowski R, Kuzak N, Grunau B, et al. Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. Eur J Cardiothorac Surg. 2021 Apr 13;59(3):593-600.[Abstract][Full Text]
67. Ward MM. Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med. 1988 Jul;148(7):1553-7.[Abstract]
68. Reuler JB. Hypothermia: pathophysiology, clinical settings, and management. Ann Intern Med. 1978 Oct;89(4):519-27.[Abstract]
69. Foulis AK. Morphological study of the relation between accidental hypothermia and acute pancreatitis. J Clin Pathol. 1982 Nov;35(11):1244-8.[Abstract][Full Text]
70. Golden FS, Hervey GR, Tipton MJ. Circum-rescue collapse: collapse, sometimes fatal, associated with rescue of immersion victims. J R Nav Med Serv. 1991 Winter;77(3):139-49.[Abstract]
