2 The clinical presentation of severe and profound accidental hypothermia is difficult to distinguish from clinical signs of death. The salvageable accidentally hypothermic patient could present without pulse, respiration and consciousness and with dilated non-reacting pupils and muscle rigidity. We have therefore advocated resuscitating and treating these patients aggressively regardless of clinical presentation, risking over-triage. Hypothermia protects vital organs during

ischaemia but can also lead to cardiac arrest, increased bleeding and may impede conventional resuscitation.3, 4, 5 and 6 The combination of hypothermia with trauma is therefore especially dangerous.7, 8, 9 and 10 Lifeless, hypothermic snow avalanche victims without air pocket have been found to have poor prognosis.11 and 12 Excessive hyperkalaemia and Selleck GW3965 asphyxia are other known predictors of death.13, 14, 15 and 16 Although mortality is high, the long-term outcome in most surviving hypothermic cardiac arrest patients is good with favourable neurological results

and high quality of life, but some suffer neurological sequelae.17, 18 and 19 Apart from consensus on using extracorporeal life support (ECLS) for rewarming,20, 21 and 22 GS-7340 price details regarding the emergency treatment remain ambiguous.5 An algorithm for in-hospital triage and treatment of hypothermic cardiac arrest patients, The Bernese Hypothermia Algorithm, have recently been suggested.23 This algorithm focuses on the integration of

trauma diagnostics with ECLS rewarming. The University Hospital of North Norway, Tromsø (UNN Tromsø) is located in subarctic Norway at 69 °N latitude. The warmest month is July with a mean air temperature of 11.8 °C and mean sea temperature of 10.8 °C. Morin Hydrate The coldest month is January with a mean air temperature of −4.4 °C and mean sea temperature of 5.1 °C.24 As a consequence of this all trauma patients in this region are at risk of hypothermia both summer and winter.25 Cases of accidental cooling in water and snow combined with asphyxia are common due to the costal and pelagic fisheries and increasing outdoor activities with water and snow sports. Our hospital catchment area is large but sparsely populated, covering the northern part of Norway and Svalbard with about 500,000 inhabitants. The region has 12 smaller and larger emergency hospitals with cardiac surgery and extracorporeal circulation centralized to UNN Tromsø. Our region has a well developed public Emergency Medical System (EMS) with a dense network of ground and sea ambulances staffed with professional paramedics working closely with decentralized doctors watch stations. Governmental air-ambulances with a total of four rotor-wing and six fixed-wing aircrafts are located at six different bases on 24/7/365 service.