Comparison of heat donation through the head or torso on mild hypothermia rewarming.

OBJECTIVE: The purpose of the study was to compare the effectiveness of head vs torso warming in rewarming mildly hypothermic, vigorously shivering subjects using a similar source of heat donation.

METHODS: Six subjects (1 female) were cooled on 3 occasions in 8 ºC water for 60 minutes or to a core temperature of 35 ºC. They were then dried, insulated, and rewarmed by 1) shivering only; 2) charcoal heater applied to the head; or 3) charcoal heater applied to the torso. The order of rewarming methods followed a balanced design. Esophageal temperature, skin temperature, heart rate, oxygen consumption, and heat flux were measured.

RESULTS: There were no significant differences in rewarming rate among the 3 conditions. Torso warming increased skin temperature and inhibited shivering heat production, thus providing similar net heat gain (268 ± 66 W) as did shivering only (355 ± 105 W). Head warming did not inhibit average shivering heat production (290 ± 72 W); it thus provided a greater net heat gain during 35 to 60 minutes of rewarming than did shivering only.

CONCLUSIONS: Head warming is as effective as torso warming for rewarming mildly hypothermic victims. Head warming may be the preferred method of rewarming in the field management of hypothermic patients if: 1) extreme conditions in which removal of the insulation and exposure of the torso to the cold is contraindicated; 2) excessive movement is contraindicated (eg, potential spinal injury or severe hypothermia that has a risk of ventricular fibrillation); or 3) if emergency personnel are working on the torso.