Accidental hypothermia: ECMO linked to better outcomes

Takeaway

• For patients experiencing accidental hypothermia without vital signs, venoarterial extracorporeal membrane oxygenation (VA-ECMO) correlates with improved survival and more favorable neurological outcomes.

Why this matters

• VA-ECMO is the fastest rewarming method.
• Previous studies of VA-ECMO in this population have been small and heterogeneous.
• Still, both the European Resuscitation Council and the American Heart Association recommend ECMO for these patients.

Key results

• 318 (19%) patients underwent ECMO on the day of admission.
• ECMO vs CPR:
  • Crude in-hospital mortality: 65% vs 84%.
  • Risk difference after propensity-score matching: −13% (95% CI, −21% to −5.1%).
  • Crude alert consciousness at discharge: 21% vs 10% (both were 62% among survivors).
  • Risk difference after propensity-score matching: 8.3% (95% CI, 1.9%-15%).
  • Risk difference among survivors: 2.7% (95% CI, −14% to 19%).

Study design

• Retrospective study of national inpatient database over 81 months (n=1661).
• Researchers used propensity scores to compare outcomes among pulseless adults who received admission-day CPR plus VA-ECMO vs CPR only.
• Outcome: in-hospital mortality.
• Funding: Japanese governmental agencies.

Limitations

• Nonrandomised.
• No data on patients’ core temperatures or on how CPR-only group was rewarmed.
• Population was relatively old and ill; results might not generalize to other populations.