Abstract
Aim
To investigate whether intentional cooling, achieved temperature and hypothermia duration
were associated with in-hospital death in patients treated with extracorporeal cardiopulmonary
resuscitation (ECPR) for refractory cardiac arrest.
Methods
This is a retrospective analysis of the Extracorporeal Life Support Organization Registry.
Patients 18–79 years of age who received ECPR between 2010 and 2019 were included.
We compared outcomes for intentional cooling versus no intentional cooling. Then,
among those who completed intentional cooling, we compared the outcomes between i)
achieved temperature ≤ 34 °C, 34–36 °C, and > 36 °C, and ii) duration ≤ 36 °C for < 12 h,
12–48 h, and ≥ 48 h. The primary outcome was in-hospital mortality within 90 days.
Cox proportional hazard models were generated with adjustment for covariates.
Results
Among 4,214 ECPR patients, 1,511 patients were included in the final analysis. After
multivariable adjustment, there was no significant difference in in-hospital mortality
between patients with intentional cooling and no intentional cooling (hazard ratio
[HR], 1.06 [95% CI 0.93–1.21]; p = 0.394). In the 609 patients who completed intentional cooling, temperature at 34–36 °C
had a significantly lower adjusted HR for in-hospital mortality compared with > 36 °C
(HR, 0.73 [0.55–0.96]; p = 0.025). Moreover, temperature ≤ 36 °C for 12–48 h had a significantly lower adjusted
HR for in-hospital mortality compared with ≤ 36 °C for < 12 h (HR, 0.69 [0.53–0.90];
p = 0.005).
Conclusion
Intentional cooling was not associated with lower in-hospital mortality in ECPR patients.
However, among patients with intentional cooling, achieving temperature of 34–36 °C
for 12–48 h was associated with lower in-hospital mortality.
Keywords
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Article info
Publication history
Published online: July 01, 2022
Accepted:
June 26,
2022
Received in revised form:
May 29,
2022
Received:
March 7,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
