CASE 02 / RESUSCITATION

Hypothermic Cardiac Arrest

Unresponsive man found beside a creek on a November morning. Core temperature 25°C. No pulse.

20-minute scenario · 15-minute debrief · Low-tech

Facilitator Guide ↓

Laboratory Results ↓

Participant Resource ↓

Recap Email Template ↓

Why run this case?

Rewarming a profoundly hypothermic patient is a team and systems challenge. The clinical decisions matter - but so do the equipment, staff and specialist connections available in your rural ED.

Learning objectives

  1. Recognize hypothermic cardiac arrest and adapt resuscitation according to a current guideline.

  2. Initiate available rewarming while planning for prolonged CPR and early ECLS consultation.

  3. Identify one local equipment, workflow or transfer barrier to managing profound hypothermia.

Set up

Use your resuscitation bay, a basic mannequin, usual crash cart, airway equipment and the department's actual warming equipment. Have a low-reading core temperature available. Do not pre-stage an ideal warming setup: part of the exercise is finding and preparing what your team actually has.

The scenario

A 35-year-old man is brought in by EMS after being found outdoors near a creek on a November morning. He is pulseless, with CPR underway. Last seen drinking around 10 p.m.; downtime and potential asphyxia unclear.

Initial findings:

PEA · Core temperature 25°C · GCS 3 · Glucose 8 mmol/L

Run the case

STAGE 01 · 0–4 MIN

Establish resuscitation

Start or continue effective CPR; confirm temperature, secure airway and begin rewarming. Contact the receiving ECLS/critical care team early.

Facilitator focus: Prepare the team for prolonged resuscitation. Is a mechanical CPR device available?

STAGE 02 · 4-12 MIN

Rewarm and adapt

At approximately 26°C, rhythm changes to VF. Teams adapt defibrillation and medication decisions according to an agreed guideline, set up warming equipment.

Facilitator prompt: How would we actually prime the HotLine fluid warmer here?

STAGE 03 · 12-20 MIN

Reassess and plan

Temperature approaches 27°C. Bloodwork returns with K 12 mmol/L, severe acidemia and lactate 10. Teams confront difficult prognosis and ECLS feasibility.

Facilitator focus: Confirm unexpected results; consider context, expert advice and broader prognostication rather than stopping solely for the potassium.

Debrief

Keep it practical. Focus on one or two clinical decisions and what the case revealed about your department.

01 / Reactions

How did that feel? When did you recognize this as hypothermic cardiac arrest?

02 / Clinical decisions

What changed about ACLS? How might we sustain CPR for a prolonged course?

03 / Systems

Where is the HotLine? Could we prime it and begin rewarming safely tonight?

04 / Takeaway

What is one thing we could improve before the next patient?

What we learned in Espanola

Knowing that rewarming methods exist is one thing. Preparing to deliver them is another.

Our team worked through HotLine setup and priming and explored single- and double-chest-tube thoracic lavage configurations. This made the local equipment and staff roles tangible. Invasive lavage requires trained clinicians, a safe protocol and specialist advice, and should not delay early ECLS consultation where feasible.

The point: test the system, not just the learner.

Clinical takeaways

Continue resuscitation concurrently with rewarming. Consider early transfer discussions with an ECLS centre. AHA and ERC recommendations for shocks and drugs at very low temperatures differ. High potassium is a serious prognostic signal, but is not an automatic termination rule - consider broader factors. The HOPE score can be helpful.

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