Prague Med. Rep. 2026, 127, 39-43

https://doi.org/10.14712/23362936.2026.6

Accidental Environmental Hypothermia in a Nonagenarian Resulting in Cardiac Arrest

Jan Stingl1ID, Francis X. Guyette2ID, Tomáš Drábek3ID

1Faculty of Medicine, Masaryk University, Brno, Czech Republic
2Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
3Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Received June 4, 2025
Accepted February 26, 2026

References

1. Ballester, J. M., Harchelroad, F. P. (1999) Hypothermia: An easy-to-miss, dangerous disorder in winter weather. Geriatrics 54(2), 51–52, 55–57.
2. Dow, J., Giesbrecht, G. G., Danzl, D. F., Brugger, H., Sagalyn, E. B., Walpoth, B., Auerbach, P. S., McIntosh, S. E., Nemethy, M., McDevitt, M., Schoene, R. B., Rodway, G. W., Hackett, P. H., Zafren, K., Bennett, B. L., Grissom, C. K. (2019) Wilderness Medical Society clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2019 update. Wilderness Environ. Med. 30(4S), S47–S69. <https://doi.org/10.1016/j.wem.2019.10.002>
3. El-Menyar, A., Naduvilekandy, M., Rizoli, S., Di Somma, S., Cander, B., Galwankar, S., Lateef, F., Abdul Rahman, M. A., Nanayakkara, P., Al-Thani, H. (2024) Mechanical versus manual cardiopulmonary resuscitation (CPR): An umbrella review of contemporary systematic reviews and more. Crit. Care 28(1), 259. <https://doi.org/10.1186/s13054-024-05037-4>
4. Frei, C., Darocha, T., Debaty, G., Dami, F., Blancher, M., Carron, P. N., Oddo, M., Pasquier, M. (2019) Clinical characteristics and outcomes of witnessed hypothermic cardiac arrest: A systematic review on rescue collapse. Resuscitation 137, 41–48. <https://doi.org/10.1016/j.resuscitation.2019.02.001>
5. Gordon, L., Paal, P., Ellerton, J. A., Brugger, H., Peek, G. J., Zafren, K. (2015) Delayed and intermittent CPR for severe accidental hypothermia. Resuscitation 90, 46–49. <https://doi.org/10.1016/j.resuscitation.2015.02.017>
6. Gottula, A. L., Shaw, C. R., Gorder, K. L., Lane, B. H., Latessa, J., Qi, M., Koshoffer, A., Al-Araji, R., Young, W., Bonomo, J., Langabeer, J. R., Yannopoulos, D., Henry, T. D., Hsu, C. H., Benoit, J. L. (2022) Eligibility of out-of-hospital cardiac arrest patients for extracorporeal cardiopulmonary resuscitation in the United States: A geographic information system model. Resuscitation 180, 111–120. <https://doi.org/10.1016/j.resuscitation.2022.09.017>
7. Gottula, A. L., Qi, M., Lane, B. H., Shaw, C. R., Gorder, K., Powell, E., Danielson, K., Ciullo, A., Johnson, N. J., Tonna, J. E., Hinckley, W. R., Koshoffer, A., Al-Araji, R., Bartos, J., Benoit, J., Hsu, C. H., Group, C. S. (2025) Prehospital ground and helicopter-based Extracorporeal Cardiopulmonary Resuscitation (ECPR) reduce barriers to ECPR: A GIS model. Prehosp. Emerg. Care 29(1), 53–61. <https://doi.org/10.1080/10903127.2024.2355652>
8. Greif, R., Bray, J. E., Djarv, T., Drennan, I. R., Liley, H. G., Ng, K. C., Cheng, A., Douma, M. J., Scholefield, B. R., Smyth, M., Weiner, G., Abelairas-Gomez, C., Acworth, J., Anderson, N., Atkins, D. L., Berry, D. C., Bhanji, F., Bottiger, B. W., Bradley, R. N., Breckwoldt, J., Carlson, J. N., Cassan, P., Chang, W. T., Charlton, N. P., Phil Chung, S., Considine, J., Cortegiani, A., Costa-Nobre, D. T., Couper, K., Bittencourt Couto, T., Dainty, K. N., Dassanayake, V., Davis, P. G., Dawson, J. A., de Caen, A. R., Deakin, C. D., Debaty, G., Del Castillo, J., Dewan, M., Dicker, B., Djakow, J., Donoghue, A. J., Eastwood, K., El-Naggar, W., Escalante-Kanashiro, R., Fabres, J., Farquharson, B., Fawke, J., Fernanda de Almeida, M., Fernando, S. M., Finan, E., Finn, J., Flores, G. E., Foglia, E. E., Folke, F., Goolsby, C. A., Granfeldt, A., Guerguerian, A. M., Guinsburg, R., Malta Hansen, C., Hatanaka, T., Hirsch, K. G., Holmberg, M. J., Hooper, S., Hoover, A. V., Hsieh, M. J., Ikeyama, T., Isayama, T., Johnson, N. J., Josephsen, J., Katheria, A., Kawakami, M. D., Kleinman, M., Kloeck, D., Ko, Y. C., Kudenchuk, P., Kule, A., Kurosawa, H., Laermans, J., Lagina, A., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Han Lim, S., Lin, Y., Lockey, A. S., Lopez-Herce, J., Lukas, G., Macneil, F., Maconochie, I. K., Madar, J., Martinez-Mejas, A., Masterson, S., Matsuyama, T., Mausling, R., McKinlay, C. J. D., Meyran, D., Montgomery, W., Morley, P. T., Morrison, L. J., Moskowitz, A. L., Myburgh, M., Nabecker, S., Nadkarni, V., Nakwa, F., Nation, K. J., Nehme, Z., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G., Ohshimo, S., Olasveengen, T., Olaussen, A., Ong, G., Orkin, A., Parr, M. J., Perkins, G. D., Pocock, H., Rabi, Y., Raffay, V., Raitt, J., Raymond, T., Ristagno, G., Rodriguez-Nunez, A., Rossano, J., Rudiger, M., Sandroni, C., Sawyer, T. L., Schexnayder, S. M., Schmolzer, G., Schnaubelt, S., Lene Seidler, A., Semeraro, F., Singletary, E. M., Skrifvars, M. B., Smith, C. M., Soar, J., Lee Solevag, A., Soll, R., Stassen, W., Sugiura, T., Thilakasiri, K., Tijssen, J., Kumar Tiwari, L., Topjian, A., Trevisanuto, D., Vaillancourt, C., Welsford, M., Wyckoff, M. H., Yang, C. W., Yeung, J., Zelop, C. M., Zideman, D. A., Nolan, J. P., Berg, K. M. (2024) 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Resuscitation 205, 110414. <https://doi.org/10.1016/j.resuscitation.2024.110414>
9. Kaneko, T., Neely, R. C., Shekar, P., Javed, Q., Asghar, A., McGurk, S., Gosev, I., Byrne, J. G., Cohn, L. H., Aranki, S. F. (2015) The safety of deep hypothermic circulatory arrest in aortic valve replacement with unclampable aorta in non-octogenarians. Interact. Cardiovasc. Thorac. Surg. 20(1), 79–84. <https://doi.org/10.1093/icvts/ivu314>
10. Lott, C., Truhlar, A., Alfonzo, A., Barelli, A., Gonzalez-Salvado, V., Hinkelbein, J., Nolan, J. P., Paal, P., Perkins, G. D., Thies, K. C., Yeung, J., Zideman, D. A., Soar, J.; ERC Special Circumstances Writing Group Collaborators (2021) European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation 161, 152–219. <https://doi.org/10.1016/j.resuscitation.2021.02.011>
11. Mallet, M. L. (2002) Pathophysiology of accidental hypothermia. QJM 95(12), 775–785. <https://doi.org/10.1093/qjmed/95.12.775>
12. Morita, S., Matsuyama, T., Ehara, N., Miyamae, N., Okada, Y., Jo, T., Sumida, Y., Okada, N., Watanabe, M., Nozawa, M., Tsuruoka, A., Fujimoto, Y., Okumura, Y., Kitamura, T., Hayashi, Y. (2018) Prevalence and outcomes of accidental hypothermia among elderly patients in Japan: Data from the J-Point registry. Geriatr. Gerontol. Int. 18(10), 1427–1432. <https://doi.org/10.1111/ggi.13502>
13. Nishiyama, C., Kiguchi, T., Okubo, M., Alihodzic, H., Al-Araji, R., Baldi, E., Beganton, F., Booth, S., Bray, J., Christensen, E., Cresta, R., Finn, J., Grasner, J. T., Jouven, X., Kern, K. B., Maconochie, I., Masterson, S., McNally, B., Nolan, J. P., Eng Hock Ong, M., Perkins, G. D., Ho Park, J., Ristau, P., Savastano, S., Shahidah, N., Do Shin, S., Soar, J., Tjelmeland, I., Quinn, M., Wnent, J., Wyckoff, M. H., Iwami, T. (2023) Three-year trends in out-of-hospital cardiac arrest across the world: Second report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation 186, 109757. <https://doi.org/10.1016/j.resuscitation.2023.109757>
14. Okada, Y., Matsuyama, T., Morita, S., Ehara, N., Miyamae, N., Jo, T., Sumida, Y., Okada, N., Kitamura, T., Iiduka, R. (2019) Prognostic factors for patients with accidental hypothermia: A multi-institutional retrospective cohort study. Am. J. Emerg. Med. 37(4), 565–570. <https://doi.org/10.1016/j.ajem.2018.06.025>
15. Olson, T., Anders, M., Burgman, C., Stephens, A., Bastero, P. (2022) Extracorporeal cardiopulmonary resuscitation in adults and children: A review of literature, published guidelines and pediatric single-center program building experience. Front. Med. (Lausanne) 9, 935424. <https://doi.org/10.3389/fmed.2022.935424>
16. Paal, P., Pasquier, M., Darocha, T., Lechner, R., Kosinski, S., Wallner, B., Zafren, K., Brugger, H. (2022) Accidental hypothermia: 2021 update. Int. J. Environ. Res. Public Health 19(1), 501. <https://doi.org/10.3390/ijerph19010501>
17. Panchal, A. R., Bartos, J. A., Cabanas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., Kudenchuk, P. J., Kurz, M. C., Lavonas, E. J., Morley, P. T., O’Neil, B. J., Peberdy, M. A., Rittenberger, J. C., Rodriguez, A. J., Sawyer, K. N., Berg, K. M.; Adult Basic and Advanced Life Support Writing Group (2020) Part 3: Adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 142(16_suppl_2), S366–S468. <https://doi.org/10.1161/CIR.0000000000000916>
18. Patterson, P. D., Hupfeld, T. C., Forbes, N., Blickley, Z. J., Collins, J. A., Pegram, A. M., Guyette, F. X. (2020) Accidental hypothermic cardiac arrest and extracorporeal membrane oxygenation: A case report. J. Am. Coll. Emerg. Physicians Open 1(3), 158–162. <https://doi.org/10.1002/emp2.12048>
19. Podsiadlo, P., Darocha, T., Svendsen, O. S., Kosinski, S., Silfvast, T., Blancher, M., Sawamoto, K., Pasquier, M. (2021) Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review. Artif. Organs 45(3), 222–229. <https://doi.org/10.1111/aor.13818>
20. Ranhoff, A. H. (2002) Accidental hypothermia in the elderly. Tidsskr. Nor. Laegeforen. 122(7), 715–717. (in Norwegian)
21. Richardson, A. S. C., Tonna, J. E., Nanjayya, V., Nixon, P., Abrams, D. C., Raman, L., Bernard, S., Finney, S. J., Grunau, B., Youngquist, S. T., McKellar, S. H., Shinar, Z., Bartos, J. A., Becker, L. B., Yannopoulos, D., Bělohlávek, J., Lamhaut, L., Pellegrino, V. (2021) Extracorporeal cardiopulmonary resuscitation in adults. Interim Guideline Consensus Statement from the Extracorporeal Life Support Organization. ASAIO J. 67(3), 221–228. <https://doi.org/10.1097/MAT.0000000000001344>
22. Svensson, L. G., Crawford, E. S., Hess, K. R., Coselli, J. S., Raskin, S., Shenaq, S. A., Safi, H. J. (1993) Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients. J. Thorac. Cardiovasc. Surg. 106(1), 19–28; discussion 28–31. <https://doi.org/10.1016/S0022-5223(19)33737-7>
23. Swol, J., Darocha, T., Paal, P., Brugger, H., Podsiadlo, P., Kosinski, S., Puslecki, M., Ligowski, M., Pasquier, M. (2022) Extracorporeal life support in accidental hypothermia with cardiac arrest – A narrative review. ASAIO J. 68(2), 153–162. <https://doi.org/10.1097/MAT.0000000000001518>
24. Szekely, M., Garai, J. (2018) Thermoregulation and age. Handb. Clin. Neurol. 156, 377–395.
25. Takauji, S., Hifumi, T., Saijo, Y., Yokobori, S., Kanda, J., Kondo, Y., Hayashida, K., Shimazaki, J., Moriya, T., Yagi, M., Yamaguchi, J., Okada, Y., Okano, Y., Kaneko, H., Kobayashi, T., Fujita, M., Shimizu, K., Yokota, H. (2021) Accidental hypothermia: Characteristics, outcomes, and prognostic factors – A nationwide observational study in Japan (hypothermia study 2018 and 2019). Acute Med. Surg. 8(1), e694. <https://doi.org/10.1002/ams2.694>
26. Takiguchi, T., Tominaga, N., Hamaguchi, T., Seki, T., Nakata, J., Yamamoto, T., Tagami, T., Inoue, A., Hifumi, T., Sakamoto, T., Kuroda, Y., Yokobori, S.; SAVE-J II Study Group (2024) Etiology-based prognosis of extracorporeal CPR recipients after out-of-hospital cardiac arrest: A retrospective multicenter cohort study. Chest 165(4), 858–869. <https://doi.org/10.1016/j.chest.2023.10.022>
27. Teran, F., Dean, A. J., Centeno, C., Panebianco, N. L., Zeidan, A. J., Chan, W., Abella, B. S. (2019) Evaluation of out-of-hospital cardiac arrest using transesophageal echocardiography in the emergency department. Resuscitation 137, 140–147. <https://doi.org/10.1016/j.resuscitation.2019.02.013>
28. Wüst, H. J., Huse, K., Lennartz, H. (1976) Cardiovascular changes caused by atropine in normo- and hypothermic methoxyflurane anaesthesia (author’s transl.). Anaesthesist 25(9), 418–424. (in German)
front cover

ISSN 1214-6994 (Print) ISSN 2336-2936 (Online)

Archive