Hypothermia Outcome Prediction after ECLS (HOPE) Score
Predicts survival following rewarming of hypothermic cardiac arrest patients.
Special considerations:
- Hypothermia should be considered the likely cause of cardiac arrest in avalanche victims buried >60 minutes with a witnessed cardiac arrest; calculate the score using the non-asphyxia scenario in these cases.
- If there is any doubt that a fully buried avalanche victim was asphyxiated, using the non-asphyxia scenario minimizes the risk of underestimating post-rewarming survival.
Advice
- No prediction tool should dictate management in isolation; always integrate clinical judgment and clinical context.
- Consult relevant local and specialty guidelines for more detailed management of hypothermia and hypothermic cardiac arrest, such as:
- Wilderness Medicine Society.
- International Commission for Mountain Emergency Medicine.
- European Resuscitation Council.
- American Heart Association.
Management
Survival probability <10%:
- ECLS is unlikely to confer benefit; consider withholding ECLS if no other favorable factors are present.
- Discuss goals of care with family and/or caregivers.
- Transition to conventional rewarming and prognostically-guided resuscitation measures.
Survival probability ≥10%:
- Notify an ECLS-capable center.
- Activate or continue ECLS rewarming protocol (may be institution-specific).
- Maintain high-quality mechanical or manual CPR, warmed IV fluids, and insulating measures while cannulation and/or transport is arranged.
Critical Actions
- Alert an ECLS-capable center as soon as it becomes clear that transfer may be necessary.
- Clearly document the clinical rationale and all variables that guided decisions.