Prognosis

The prognosis of hypothermia is dependent on the admitting temperature, but it is generally quite poor.

Prognosis depends on several factors such as exposure duration, associated injuries, comorbidities, and the degree of hypothermia.

Most people tolerate mild hypothermia, which is not associated with significant morbidity or mortality.

10% to 14% of all accidental hypothermia cases result in fatality. When these patients have associated chronic medical disorders, the mortality risk is 75% to 90%. (1)

Extracorporeal life support has revolutionised re-warming of the haemodynamically unstable patient, with survival rates of up to 100% (2)

Unfortunately, even with advances in critical care, the in-hospital mortality of patients with moderate or severe accidental hypothermia associated with rhabdomyolysis is almost 40% (3)

The decision to terminate resuscitation in hypothermia should come from the physician in charge; it is worth reiterating the adage that "The patient isn't dead until they're warm and dead".

References

1. White J. Hypothermia: the Bellevue experience. Ann Emerg Med. 1982 Aug;11(8):417-24.
2. Avellanas Chavala ML, Ayala Gallardo M, Soteras Martinez I, et al. Management of accidental hypothermia: A narrative review. Med Intensiva. 2019 Dec;43(9):556-568
3. Vassal T, Benoit-Gonin B, Carrat F, et al. Severe accidental hypothermia treated in an ICU: prognosis and outcome. Chest. 2001 Dec;120(6):1998-2003.