Abstract: FR-PO1017
CRRT as a Lifesaving Rewarming Alternative for Severe Accidental Hypothermia
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Bermudez, Maria Camila, Geisinger Health, Danville, Pennsylvania, United States
- Mullen, Elise, Geisinger Health, Danville, Pennsylvania, United States
Introduction
Severe accidental hypothermia (< 30°C) is a high-mortality medical emergency. While the 2025 AHA Guidelines prioritize Extracorporeal Life Support (ECLS) for rapid rewarming—especially during cardiac arrest—systemic anticoagulation is often contraindicated in trauma. Continuous Renal Replacement Therapy (CRRT) provides a sophisticated alternative for active internal rewarming, offering precise thermal and metabolic control when ECLS is precluded.
Case Description
A 73-year-old male was found submerged following a fishing accident, presenting with severe hypothermia (25°C), bradycardia (HR 20), and hypotension (60/40 mmHg). Imaging revealed a C7 vertebral fracture with spinal shock. Due to the high risk of hemorrhage from acute spinal injury, ECMO was deferred.
Nephrology initiated CVVHDF via a right internal jugular catheter, positioned cautiously to avoid the irritable myocardium. The integrated warmer was set to 40°C with a blood flow rate (Q_b) of 200 mL/min. Given the trauma, a "no-anticoagulation" strategy was maintained using high flow rates and pre-filter replacement fluid. The patient’s core temperature rose to 32°C over 4 hours (1.6°C/h), enabling hemodynamic stabilization and successful spinal surgery.
Discussion
This case highlights CRRT as a viable rewarming framework when ECLS is contraindicated by trauma or hemorrhage risk. While slower than ECMO, CRRT allows for controlled thermal gain. To optimize efficiency, the following parameters are recommended:
Modality: CVVHDF is preferred to maximize heat transfer.
Blood Flow (Q_b): The primary rewarming driver; efficiency increases significantly at 150–200 mL/min.
Temperature: Set warmers to maximum (39–41°C). Dialysate flow has minimal impact on thermal gain compared to Q_b.
Anticoagulation: Hypothermia impairs citrate metabolism, increasing toxicity risk. High Q_b and pre-filter fluid often permit a "no-anticoagulation" approach.
Access: Femoral is preferred over internal jugular to avoid triggering ventricular fibrillation from guidewire contact with an irritable myocardium.
CRRT achieved 1.6°C/h, aligning with the Wilderness Medical Society’s 1–2°C/h target. It remains a vital tool when traditional circuits are contraindicated, underscoring the nephrologist's role in multidisciplinary emergency care.