Version July 2025
ACLS: advanced cardiac life support; AER: active external rewarming; AIR: active internal rewarming; BLS: basic life support; ECLS: extracorporeal life support; ECMO: extracorporeal membrane oxygenation; IO: intraosseous; IV: intravenous; PER: passive external rewarming.
* We do not advocate chest compressions in patients with an organized, regular cardiac rhythm. In a patient with a core temperature <30°C (86°F), we do not administer ACLS medications (epinephrine, amiodarone) and attempt defibrillation up to three times if they have a ventricular arrhythmia. CPR should continue until the patient is rewarmed to 30°C (86°F), at which point renewed attempts at defibrillation and resuscitation with ACLS medications are undertaken. After the patient is rewarmed to 30°C (86°F), we administer 1 mg IV but with doubled intervals as compared with normothermia (every 6 to 10 minutes), and then resume normal intervals when the temperature is ≥35°C (95°F). Refer to UpToDate topics on accidental hypothermia for details.
¶ Inadequate temperature rise may be due to any number of causes, including sepsis, trauma, intoxication, or stroke. Refer to UpToDate topics on accidental hypothermia for details.
