RESUMO
BACKGROUND: Prolonged extrication of entrapped patients after road traffic accidents increases the risk of sustained hypothermia. Accident-related hypothermia increases mortality in severely injured patients, and prehospital efforts to prevent hypothermia are essential. We evaluated various warming measures regarding their preclinical suitability and efficacy for patient warming, tested in realistically-simulated road traffic accident scenarios under cold ambient conditions in a climate chamber. METHODS: The effects of a chemical warming blanket (CWB), forced-air warming (FAW) device, or infrared radiator (IRR) on the core body and skin surface temperature of a subject previously exposed to a cold environment (5°C for 12 minutes) was recorded via temperature sensors and thermographically, respectively. Physiological parameters such as oxygen saturation, blood pressure, and heart rate were also monitored. RESULTS: Under cold environmental conditions, all devices were able to compensate or overcompensate the cooling of body parts directly exposed to the heating measure. In the body areas that were not directly warmed (back, lower extremities), only the CWB limited further cooling. FAW and IR irradiation rapidly and effectively warmed the heat-exposed areas (head and arms). However, both methods - but especially the IRR - led to a noticeably accelerated cooling in body parts not directly exposed to heat (back, legs). CONCLUSION: The increased mortality associated with hypothermia in severely injured crash victims during prolonged vehicle extrication has intensified efforts to prevent sustained hypothermia. The use of a CWB, FAW or IRR are in principle all suitable for reducing or compensating for heat loss. The ongoing cooling of those body parts not directly exposed to the heat source was interpreted as a steal phenomenon in regional blood flow. However, the practicality and effectiveness of these measures, combined with their logistical requirements, must be evaluated in real extrication scenarios.
