Before pronouncing death in ACLS, what must be attempted?

• A. Administer epinephrine
• B. Defibrillation
• C. Obtain EEG
• D. Rewarm to core temperature 86F/30C

Answer: (D)

In severe hypothermia, the body’s metabolism slows so dramatically that a person who seems clinically dead may still be reviveable once warmth is restored. The critical step before pronouncing death is to pursue active rewarming and bring the core temperature up to about 30°C (86°F). At or above that temperature, reassessing for return of spontaneous circulation becomes meaningful, and many guidelines emphasize continuing resuscitation during rewarming because recovery is possible even after prolonged arrest. Additional resuscitation steps like epinephrine and defibrillation remain part of the process, but they do not substitute for warming the patient. An EEG is not a practical determinant of death in this setting.