Rewarming in Accidental Hypothermia



  1. Remove clothing
  2. Dry patient
  3. Cover with blankets / space blanket
  4. Provide warm sugary drinks

Active External:

  1. Forced Air Rewarmer (eg: Bair Hugger) ‐ to trunk only to reduce core temperature afterdrop.
  2. Arctic Sun (for moderate / severe).

Active Internal:

  1. Warmed fluids (D5 NS @ 40-42 C) – Initially 250-500mL bolus, repeat based on clinical
  2. Warm, humidified oxygen. By facemask or consider CPAP – by ETT if intubated.
  3. Peritoneal Lavage – 2 liters of diasylate @ 40 – 45 C, remove after 20-30 minutes. Rewarming rate of 1-3 C / hr.
  4. Body cavity lavage – Through Foley or NGT / OGT. 500mL boluses or continuous Consider risk of fluid / electrolyte shifts.
  5. Closed Thoracic Lavage – 2 large bore (38-40 fr) chest tubes in each hemithorax (one at mid clavicular line @ 2nd / 3rd interspace, second at post. axillary line @ 5th / 6th interspace). Infuse warmed (40-42 C) saline and drain though posterior tube.
  6. Thoracotomy with Mediastinal Lavage – 1-2 liters of warmed NS to mediastinum, remove after 1-2 minutes. May utilize cardiac massage and internal defibrillation. Highly Invasive, requires disposition to OR.


  1. Continuous Venovenous Rewarming (CVVR) – 2-3 C / hr.
  2. Continuous Arteriovenous Rewarming (CAVR) – 3-4 C / hr. Requires adequate MAP. Can be performed in ED with proper equipment.
  3. Hemodialysis – 3-4 C / hr. Requires adequate MAP. Possible to correct electrolyte and toxic abnormalities. Requires dialysis staff.
  4. Cardiopulmonary Bypass – Most rapid rewarming (8-10 C / hr). Provides full cardiopulmonary support for hemodynamically unstable patients.

Created by Jack Gervais MD, Matt Sholl, MD, and Jeff Holmes MD at Maine Medical Center