A mountaineer is rescued after falling into an icy stream. He is pulseless and apnoeic with a core temperature of 26 degrees Celsius. Resuscitation is ongoing during transport. The principle guiding continuation versus termination of resuscitation is:
- A Continue resuscitation and rewarm; he should not be declared dead until the core temperature rises above 32 degrees ✓
- B Stop efforts now because arrests below 28 degrees are universally fatal
- C Continue only if the rhythm is ventricular fibrillation, otherwise stop
- D Give adrenaline at half dose since metabolism is slowed
Correct answer: A. Continue resuscitation and rewarm; he should not be declared dead until the core temperature rises above 32 degrees
Explanation
In accidental hypothermic arrest, complete neurological recovery is documented even after prolonged arrests, giving rise to the dictum that a patient is not dead until warm and dead. Resuscitation continues with concurrent active rewarming until core temperature exceeds 32 degrees, at which point persistent arrest carries its usual prognosis. Asystole does not mandate stopping, and adrenaline is dosed normally, though intervals may be extended at very low temperatures because of reduced drug metabolism and peripheral perfusion.
Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.