American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment is recommended for patients with severe hypothermia and hemodynamic instability?

1. Immediate warming blankets

2. Extracorporeal support, including cardiopulmonary bypass

3. High-flow oxygen therapy

4. Thoracotomy for rewarming

The correct answer is: Extracorporeal support, including cardiopulmonary bypass

For patients experiencing severe hypothermia accompanied by hemodynamic instability, the most effective treatment is extracorporeal support, such as cardiopulmonary bypass. This approach is particularly beneficial because it allows for controlled and efficient rewarming of the blood, which can restore normal physiological function more rapidly than passive external warming methods. Severe hypothermia can lead to significant cardiovascular compromise, including impaired cardiac output and dysrhythmias. In cases where the patient is not responding to conventional rewarming techniques, extracorporeal rewarming can effectively stabilize hemodynamic parameters and restore adequate perfusion to vital organs. By using cardiopulmonary bypass, the patient's blood is warmed outside the body and then returned, helping to mitigate the effects of hypothermia while providing respiratory support if needed. This method represents a critical intervention in severe cases where immediate and rapid rewarming is crucial to survival and recovery. Other treatments, while they may play a role in the management of hypothermia or support of the patient, do not provide the same level of rapid intervention necessary for severe hypothermia with hemodynamic instability.