When Active External Rewarming Fails in Moderate to Severe Accidental Hypothermia (Core Temperature ≤32 °C)

Clinical Scenario

This protocol addresses patients with moderate accidental hypothermia (core temperature 28–32 °C, impaired consciousness, vital signs present) or severe accidental hypothermia (core temperature below 28 °C, unconscious, vital signs present) who have not responded adequately to initial surface rewarming.

Previous Treatment — Inadequate Response

Initial active external rewarming — comprising forced-air surface rewarming, heating pads, and warmed intravenous fluids, with whole-body insulation maintained throughout — failed to achieve the target goal of normothermia (core temperature returning to approximately 37 °C).

When surface-based methods do not restore core temperature to the normothermic range, escalation to active internal rewarming is the indicated next step.

Next-Step Treatment Overview

Partial Overview

The structured regimen shifts from surface approaches to active internal rewarming, targeting restoration of core temperature. The complete protocol — including which internal modalities apply and in what clinical context — is available via the link below.

Clinical Goal

Achievement of normothermia, with the core temperature returning to approximately 37 °C.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3390/ijerph19010501
Hypothermia II (moderate) — Impaired consciousness; may or may not be shivering — <32–28 °C
Hypothermia III (severe) — Unconscious; vital signs present — <28 °C
If a patient fails to rewarm adequately, active internal rewarming should be used.
Active internal rewarming methods in moderate to severe hypothermia include intravascular rewarming catheters and continuous renal replacement therapy (CRRT, Table 5).

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