February 9, 2007

Severe hypothermia cases arrive at the MGH

When Boston's mild winter ended abruptly last month, temperatures took a sharp downturn, reaching only 6 degrees Jan. 17. Clinicians at the MGH expected to see a few weather-related emergency room patients, but they were surprised to deal with two cases of hypothermia — in two homeless men so severe that treatment required a rarely used course of action to save their lives.

Cases of extreme hypothermia often are difficult to treat. Patients can experience life-threatening arrhythmias due to the low body temperature, and if the body is warmed too slowly, or too quickly and unevenly, the patient can die because blood flow has not properly been restored. To safely warm the body, clinicians at the MGH put the patients on cardiopulmonary bypass with a heart-lung machine to gradually warm them from the inside out. Using the bypass procedure, blood was taken from their bodies, gently warmed and then returned to them.

"In my ten years of working here, I've seen no more than three cases similar to this," says Jennifer Walker, MD, staff surgeon. "One of our patients had a core body temperature of 79 degrees and the other only 75. This really speaks to the extreme temperatures that we are experiencing."

Thanks to the MGH clinicians and the technology available today, both patients received the care they desperately needed. James O'Connell, MD, president of the Boston Health Care for the Homeless Program (BHCHP) at the MGH, helped to identify the men and follow their care. Today, the men (seen at left) are recuperating at the BHCHP's Barbara McInnis House, a local respite facility. This account is only one example of the vital lifesaving work performed by MGH health care workers and BHCHP staff members every day.

To avoid cold weather problems, Walker suggests dressing in layers of warm clothing, finding shelter on extremely cold nights and making sure that all body parts, especially extremities, are covered. As little as 15 to 20 minutes of extreme cold exposure can have devastating effects.