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Hypothermic cardiac arrest — DIPIMC MCQ

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HardResuscitationHypothermic cardiac arrestDIPIMCDipIMC

A hill walker is found in cardiac arrest after prolonged exposure in winter conditions. He is rigid and profoundly cold, with a tympanic temperature of 26 degrees Celsius. The monitor shows ventricular fibrillation and CPR is in progress. How should drug and defibrillation therapy be approached?

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Correct answer: B — Withhold adrenaline and limit shocks to three until rewarmed above 30C

Below 30 degrees Celsius the severely hypothermic heart responds poorly to drugs and defibrillation, so adrenaline is withheld and defibrillation is limited to three attempts until the core temperature rises above 30 degrees Celsius. Standard or double dosing risks drug accumulation without benefit in the cold heart. Compressions should continue, as prolonged resuscitation with rewarming can achieve neurologically intact survival. Pearl: a patient is not dead until warm and dead, so resuscitation continues during active rewarming.

Reference: Resuscitation Council UK Guidelines 2025 (Special Circumstances)