Title: Cold on the outside, make 'em warm on the inside
題目：室外是寒冷的，讓體內溫暖起來
Author 作者: Haney Mallemat
翻譯：江利冰 校對：肖鋒

Each year approximately 1,300 Americans die of hypothermia.
每年大約有1300例美國人死于低溫。

Classification of hypothermia:
低溫的分類：

• Mild (32-35 Celsius): shivering, hyperventilation, tachycardia, but patients are usually hemodynamically stable.
• 輕度（32-35℃）：寒戰，過度通氣，心動過速，但是患者的血流動力學通常是穩定的。
• Moderate (28-32 Celsius): CNS depression, hypoventilation, loss of shivering, risk of arrhythmias, and paradoxical undressing
• 中度（28-32℃）：中樞抑制，換氣不足，寒戰消失，具有發生心律失常的風險，以及反常脫衣現象。
• Severe (<28 degrees Celsius): increased risk of ventricular tachycardia/fibrillation, pulmonary edema, and coma
• 重度（<28℃）：發生心動過速/心室顫動的風險增加，肺水腫以及昏迷。

The risk of cardiac arrest increases when the core temperature is less than 32 Celsius and significantly rises when the temperature is less than 28 Celsius. Rapid rewarming is required as part of resuscitation should cardiac arrest occur.
當中心體溫低于32℃時，發生心臟驟停的風險增加，當中心體溫低于28℃時，發生心臟驟停的風險顯著增加。在發生心臟驟停之前，應將快速復溫納入復蘇方案。

A rescue therapy to consider (when available) is extra corporeal membrane oxygenation (ECMO). ECMO not only provides circulatory support for patients in cardiac arrest, but allows re-warming of patients by 8-12 Celsius per hour.
一項可以考慮的搶救性策略是體外膜肺氧合（如果具備條件）。體外膜肺氧合不僅可以提供循環支持，還可以每小時復溫8-12℃。

Some studies quote survival rates of 50% with hypothermic cardiac arrest patients receiving ECMO versus 10% in similar patients who do not receive ECMO.
一些研究指出，低溫導致的心臟驟停使用體外膜肺氧合的患者生存率為50%，而不使用體外膜肺氧合的患者生存率為10%。

As winter just began, consider speaking to your cardiac surgeons now to plan an Emergency Department protocol for hypothermic patients that may require ECMO.
由于冬季剛剛開始，現在就和心臟外科醫師提出對于那些可能需要體外膜肺氧合的低溫癥患者，建議建立急診室救治規范。

References
參考文獻
Ginty, et. Al. Extracorporeal membrane oxygenation rewarming in the ED: an opportunity for success American Journal of Emergency Medicine 2014 December 3
http://www.ncbi.nlm.nih.gov/pubmed/25534814