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Lesson

Hypothermic Cardiac Arrest

10 min Cardiac & ECG Skip to quiz

Objective: Work a cold arrest as a special circumstance. Get the patient out of the cold. Handle them gently. Start CPR after a short pulse check. Do not stop resuscitation in the field before rewarming is addressed.

Why this matters

The patient was in the river, and the monitor looks like asystole. Do not run this like a warm VF arrest. VF means ventricular fibrillation. Do not stop because the chest is stiff. A cold arrest is a special circumstance. Pulse checks are hard. Handle the patient gently. Rewarming is the therapy.

Clinical sequence

  1. Make the scene safe and get them out of the cold. Take wet clothes off. Put insulation on. That is the first action.
  2. If there are no signs of life after a brief pulse check of about 10 seconds, start CPR. Do not search for a pulse for a full minute while they are not breathing.
  3. Handle them gently. Rough movement can put severe hypothermia into VF.
  4. Choose a hospital that can rewarm, such as ECMO or bypass in some systems. ECMO means bedside heart-lung support. Protocol and destination rules decide. Do not stop resuscitation on a profoundly cold patient with a recoverable story until rewarming is addressed per protocol.

Teaching points

  • Handle gently. Rough movement can cause VF in severe hypothermia. Do not do a rough log-roll.
  • Defibrillation: one shock for VF is reasonable. Further shocks and drugs may change with temperature on your protocol. You usually cannot measure 30 °C (86 °F) in the field. Rewarming and the right hospital are the therapy.
  • Do not copy a warm-arrest epinephrine clock. Follow the special-circumstances card and online medical control. Do not give the usual warm-arrest epinephrine schedule just because that is the card you know.
  • Drowning plus cold still needs ventilation. See the drowning lesson.

Common errors

  • Declaring death because the chest is cold and stiff, without a protocol termination rule.
  • A rough log-roll that puts them into VF.
  • Giving a full warm-arrest drug cycle from memory.

Practice

One-minute check

Partner: an ice fisherman, unresponsive, no obvious pulse, and cold. Say the first three actions, including where you are going.

Related: Accidental hypothermia, Drowning.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. A profoundly cold pulseless patient with a recoverable story should get:
2. Handling in severe hypothermia should be:
3. ALS drugs and shocks in hypothermia:
4. Pulse checks in the cold should:
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