Clinical outcomes of challenging out-of-hospital hypothermia management: A retrospective assessment of DOKEI protocol.
The American journal of emergency medicine · 2024-09-02 · Observational study
Abstract
BACKGROUND: Accidental hypothermia (AH) is a major cause of death in mountainous areas globally, and the second highest of mountaineering deaths in Japan, accounting for 37 % in Hokkaido. Managing AH is a significant challenge, particularly when adverse weather complicates the application of recommended rewarming and rapid transfer. To address this, the Hokkaido Police Organization (DOKEI) AH protocol was applied in Hokkaido's remote areas from 2011 to 2022, integrating high-temperature active external rewarming (HT-AER) with on-site sustained treatment. METHODS: This study retrospectively analyzed the rescue reports and hospital records of hypothermia patients treated postprotocol, excluding patients with cold exposure, undetectable vital signs at rescue, and inadequate documentation. Protocol adherence and outcomes-hypothermia stage, cardiocirculatory collapse, survival, and neurological status-were assessed. RESULTS: Among the 60 protocol-treated patients (19-74 years, 85 % male), 14 had stage 2 hypothermia, and 3 had stage 3 hypothermia. HT-AER was applied in 96.7 % of the patients. A total of 98.3 % of patients improved before handover without cardiac arrest (CA) or extracorporeal life support (ECLS). Comparatively, ten preprotocol patients (18-60 years, 70 % male) had two CAs, one fatal and six with no improvement. CONCLUSION: The DOKEI AH protocol demonstrates feasibility in managing stages 1-3 hypothermia, enhancing survival and neurological recovery, and can offer a vital option in challenging AH rescue scenarios.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Fire service & police · Quality of life & function · Rural & remote · Temperature management · Time intervals
Related articles
- Impact of dual dispatch system implementation on response times and survival outcomes in out-of-hospital cardiac arrest in rural areas (Signa Vitae, 2022)
- Impact of dual dispatch system implementation on response times and survival outcomes in out-of-hospital cardiac arrest in rural areas (Signa Vitae, 2021)
- Sudden Cardiac Arrests in the Polish Tatra Mountains: A Retrospective Study. (Wilderness Environ Med, 2023)
- Swedish-Norwegian co-operation in the treatment of three hypothermia victims: a case report. (Scand J Trauma Resusc Emerg Med, 2017)
- Outcome of avalanche victims with out-of-hospital cardiac arrest. (Resuscitation, 2015)
- Hypothermic Cardiac Arrest With Full Neurologic Recovery After Approximately Nine Hours of Cardiopulmonary Resuscitation: Management and Possible Complications. (Ann Emerg Med, 2019)