Box 2: Staging and treatment of accidental hypothermia11
StageClinical signsApproximate core temperature (°C)Treatment
Mild (HT I)Conscious, shivering32 to 35• Warm environment and clothing; warm, sweet drinks; active movement if possible
Moderate (HT II)Impaired consciousness, with or without shivering28 to < 32• Active external and minimally invasive rewarming
• Cardiac and core temperature monitoring
• Minimize movements, horizontal position, immobilization
• Full body insulation
Severe (HT III)Unconscious, vital signs present< 28• HT II management, plus:
  • Airway management as required

  • Preference to treat in ECLS centre*

Cardiac arrest (HT IV)Unconscious, vital signs absent< 28 (variable)• CPR and up to 3 doses of epinephrine and defibrillation
• Airway management
• Transport to ECLS centre
• Prevent further heat loss (insulation, warm environment, do not apply heat to head)
• Active external and minimally invasive rewarming during transport (as per HTII)
  • Note: CPR = cardiopulmonary resuscitation, ECLS = extracorporeal life support, HT = hypothermia.

  • * Refer to Box 1 for proposed ECLS criteria.