This case report describes the resuscitation of a 19-year-old man who had been immersed in ice water for 14 h and presented with a rectal temperature of 22 degrees C and no pulses. It reports the successful use of prolonged cardiac massage (3.5 h) and closed thoracic cavity lavage in the treatment of severe hypothermia. It also confirms that victims of severe hypothermia can be effectively treated in peripheral hospitals not equipped for cardiopulmonary bypass.