Abstract
Aim
To elucidate the effectiveness of extracorporeal membrane oxygenation (ECMO) in accidental
hypothermia (AH) patients with and without cardiac arrest (CA), including details
of complications.
Methods
This study was a multicentre, prospective, observational study of AH in Japan. All
adult (aged ≥18 years) AH patients with body temperature ≤32 °C who presented to the
emergency department between December 2019 and March 2022 were included. Among the
patients, those with CA or circulatory instability, defined as severe AH, were selected
and divided into the ECMO and non-ECMO groups. We compared 28-day survival and favourable
neurological outcomes at discharge between the ECMO and non-ECMO groups by adjusting
for the patients’ background characteristics using multivariable logistic regression
analysis.
Results
Among the 499 patients in this study, 242 patients with severe AH were included in
the analysis: 41 in the ECMO group and 201 in the non-ECMO group. Multivariable analysis
showed that the ECMO group was significantly associated with better 28-day survival
and favourable neurological outcomes at discharge in patients with CA compared to
the non-ECMO group (odds ratio [OR] 0.17, 95% confidence interval [CI]: 0.05–0.58,
and OR 0.22, 95%CI: 0.06–0.81). However, in patients without CA, ECMO not only did
not improve 28-day survival and neurological outcomes, but also decreased the number
of event-free days (ICU-, ventilator-, and catecholamine administration-free days)
and increased the frequency of bleeding complications.
Conclusions
ECMO improved survival and neurological outcomes in AH patients with CA, but not in
AH patients without CA.
Keywords
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Article info
Publication history
Published online: December 09, 2022
Accepted:
December 3,
2022
Received in revised form:
November 30,
2022
Received:
October 15,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
