Under cold exposure protocol, which statement about CPR may be indicated?

• A. Prolonged CPR may be indicated
• B. Prolonged CPR is contraindicated
• C. Only life support if temperature normal
• D. Do not suction airways

Answer: (A)

In cold exposure, whether resuscitation should continue hinges on the possibility of recovery despite a long pause in circulation. Hypothermia dramatically lowers the body’s metabolic demands, which can protect the brain and other organs and allow for successful revival even after extended cardiac arrest. Because of that, CPR may be continued for a prolonged period while efforts to rewarm the patient are pursued, rather than terminating early simply due to the cold or the duration of arrest. The saying often applied is that you don’t declare someone dead until they’re warm and dead, so prolonged CPR may be indicated.

Understanding this also helps with other management steps: defibrillation attempts may be less likely to work at very low temperatures until warming occurs, and active rewarming (external and, if available, internal methods) is a critical component of care. Suctioning airways is a routine airway management step and isn’t precluded by hypothermia; the focus is on continuing resuscitation and rewarming.

So, the best-supported stance in cold exposure protocols is that prolonged CPR may be indicated.