Many hypothermic patients have severe infections or other life-threatening illnesses. Patients with "uncomplicated" hypothermia (often purely due to cold exposure) have a fairly low mortality rate; patients with significant associated diseases have a much worse prognosis. 21 In terms of ultimate outcome, the underlying disease process is far more important than the initial temperature or the rewarming method chosen. Therefore, evaluation and treatment of these patients must include a search for associated diseases as well as treatment of the hypothermia itself.

The protective effect of hypothermia may have an important influence on prognosis; decreased oxygen requirements can protect the brain and other organs against anoxic and ischemic damage. This means that the usual criteria indicating death or irreversibility of disease are not valid in the hypothermic patient, who may even survive prolonged cardiac arrest without neurologic sequelae.

Hypothermic patients may recover completely after presenting in a rigid, apneic state with fixed and dilated pupils. Recovery has been documented with core temperatures as low as 14.2°C (57.6°F),22 and with cardiac arrest for 6.5 h.23 Death in hypothermia must be defined as a failure to revive with rewarming; unless there is strong evidence that the patient is not viable, resuscitative efforts should be continued until core temperature is at least 30 to 32°C (86-89.6°F).

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