A review of the literature concerning resuscitation from hypothermia: Part II--Selected rewarming protocols.

In Part I of this paper, a description of the problems confronted in resuscitation from immersion hypothermia was presented and the debate between passive and active rewarming approaches was summarized. In this paper, a review of the literature concerning selected specific rewarming protocols is given. The protocols considered are: peritoneal irrigation, gastrointestinal rewarming, extracorporeal blood rewarming, airway rewarming, and diathermy.

Initial treatment of profound accidental hypothermia.

The performance of inhalation, heating pads, plumbed garment, inhalation + heating pads, inhalation + plumbed garment, and body-to-body heat exchange rewarming were compared to trunk immersion and spontaneous rewarming under laboratory conditions with mildly cooled volunteers. The experiment included 72 rewarmings. Trunk immersion exhibited the smallest afterdrop, shortest recovery period, and most rapid rewarming. Of the therapies suitable for use in the field, small afterdrops were seen with inhalation, inhalation + plumbed garment, inhalation + heating pads, and spontaneous rewarming. The largest afterdrops were seen with the heating pads and plumbed garment. Body-to-body heat exchange was seen to produce somewhat larger afterdrops than spontaneous rewarming. It is concluded that heating pads and plumbed garment should not be used in treatment of profound hypothermia. It is further concluded that, because of the depression in respiratory minute volume accompanying profound hypothermia, the heating pads and plumbed garment in combination with inhalation therapy should not be used. This leaves inhalation therapy alone as the recommended treatment for profound hypothermia in the field.