Prognosis
The prognosis depends on several factors such as exposure duration, associated injuries, comorbidities, and the degree of hypothermia. Generally, patients with mild hypothermia will recover without any residual effects. If the core temperature was between 26°C and 32°C (78.8°F to 89.6°F) and the patient received acute resuscitation, recovery is likely but with lasting morbidity. Most patients with a core temperature <26°C (<78.8°F) do not survive. The triad of coagulopathy, acidosis, and hypothermia is also associated with increased mortality.
Emerging evidence suggests that extracorporeal life support (ECLS) re-warming offers a better survival outcome than other treatment modalities.[42][43] ECLS re-warming increases core temperature 1°C to 2°C over 3 to 5 minutes.[46] One retrospective review reported a 47% long-term survival rate among 32 patients who underwent extracorporeal blood warming for severe hypothermia (core temperature <28°C [82°F]) associated with cardiac arrest.[41] Long-term survival may be explained by patient characteristics (young and previously in good health), but it is possible that cardiopulmonary bypass, which offers rapid core re-warming and provides circulatory support that other modalities lack, may have contributed.
Chronic medical conditions
Most hypothermia-related deaths occur in patients with underlying chronic conditions, as chronic illness may impair thermoregulatory mechanisms.[47] Two independent studies have reported that 10% to 14% of all accidental hypothermia cases result in fatality.[48][49] When these patients had associated chronic medical disorders, the mortality risk was 75% to 90%.[48]
Cardiac symptoms
The prognosis may be improved through early identification of resulting arrhythmias and prompt initiation of treatment.
Rhabdomyolysis
Even with advances in critical care, the in-hospital mortality of patients with moderate or severe accidental hypothermia associated with rhabdomyolysis approaches 40%.[50]
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