Hypothermia is a marker for adequacy of resuscitation in severe truncal injury

Introduction

Hypothermia after massive resuscitation is known to lead to coagulopathy, myocardial depression, and a depressed immune response. Attempts at prevention or correction of hypothermia in the perioperative period frequently fail in spite of utilizing aggressive rewarming modalities. We hypothesized that the response to rewarming is directly correlated to control of bleeding and adequacy of resuscitation.

Methods

Retrospective review of injured patients admitted to a level 1 trauma center who: 1. underwent emergent celiotomy and/or thoracotomy, 2. received six or more units of blood within 12 hours of operation, 3. arrived at the ED normothermic (temperature > 96°F), and 4. developed perioperative hypothermia. Hypothermia was defined as mild (temperature 92–94°F), moderate (temperature 90–92°F), or severe (temperature < 90°F). pH and base excess were measured sporadically. All patients were managed in one institution, and temperature control procedures were standardized.

Results

Thirty-eight patients met inclusion criteria. 28 patients sustained penetrating injury of which 24 survived. Ten patients sustained blunt injury of which six survived. All deaths occurred within 24 hours of injury. The Table represents degree of hypothermia in survivors and non-survivors. Two non-survivors had initial control of surgical bleeding and a transient partial correction of temperature, but had progressive hypothermia and death related to bleeding recurrence.

Table

Discussion

Failure of correction of hypothermia indicates inadequate resuscitation or failure to control bleeding. In survivors and non-survivors, the pH response tended to lag behind temperature fluctuations, implying hypothermia may be superior to pH in reflecting correction of hypovolemia. At 8 hours, survivors achieved temperatures over 96°F, while non-survivors averaged < 90°F. Non-survivors failed to correct hypothermia, probably due to inadequacy of resuscitation.

Conclusion

Hypothermia is a marker for the adequacy of resuscitation in patients with severe truncal injury. Failure to correct a hypothermic trend should prompt a search for ongoing bleeding.