PMID- 35152478
OWN - NLM
STAT- MEDLINE
DCOM- 20220303
LR  - 20240214
IS  - 1540-8191 (Electronic)
IS  - 0886-0440 (Print)
IS  - 0886-0440 (Linking)
VI  - 37
IP  - 4
DP  - 2022 Apr
TI  - Mild hypothermia and neurologic outcomes in patients undergoing venoarterial 
      extracorporeal membrane oxygenation.
PG  - 825-830
LID - 10.1111/jocs.16308 [doi]
AB  - BACKGROUND: Patients with venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO) are at risk of cerebral reperfusion injury after prolonged 
      hypoperfusion and immediate restoration of systemic blood flow. We aimed to 
      examine the impact of mild hypothermia during the first 24 h post-ECMO on 
      neurological outcomes in VA-ECMO patients. METHODS: This was a retrospective 
      study of adult VA-ECMO patients from a tertiary care center. Mild hypothermia was 
      defined as 32-36 degrees C during the first 24 h post-ECMO. The primary outcome was a 
      good neurological function at discharge measured by a modified Rankin Scale </=3. 
      Multivariable logistic regression analysis was performed for primary outcome 
      adjusting for pre-specified covariates. RESULTS: Overall, 128 consecutive 
      patients with VA-ECMO support (median age: 60 years and 63% males) were included. 
      Within the first 24 h of VA-ECMO cannulation, we found a median of 71 readings 
      per patient (interquartile range 45-88). Eighty-eight patients (68.8%) 
      experienced mild hypothermia within the first 24 h while 18 of those 88 patients 
      (14.2%) had a mean temperature <36 degrees C. ECMO indications included post-cardiotomy 
      shock (39.8%), cardiac arrest (29.7%), and cardiogenic shock (26.6%). Duration of 
      mild hypothermia, but not mean temperature, was independently associated with 
      increased odds of good neurological outcome at discharge (odds ratio [OR] = 1.16, 
      95% confidence interval [CI] = 1.04-1.31, p = .01) after adjusting for age, the 
      severity of illness, post-ECMO systemic hemorrhage, post-cardiotomy shock, acute 
      brain injury, and mean 24-h PaO(2) . Neither duration of mild hypothermia 
      (OR = 0.93, CI = 0.84-1.03, p = .17) nor mean temperature (OR = 0.78, 
      CI = 0.29-2.08, p = .62) was significantly associated with mortality. Similarly, 
      duration of mild hypothermia (p = .47) and mean 24-h temperature (p = .76) were 
      not significantly associated with the frequency of systemic hemorrhages. 
      CONCLUSIONS: In this single-center study, a longer duration of mild hypothermia 
      during the first 24 h of ECMO support was significantly associated with improved 
      neurological outcomes. Mild hypothermia was not associated with an increased risk 
      of systemic hemorrhage or improved survival.
CI  - (c) 2022 Wiley Periodicals LLC.
FAU - Al-Kawaz, Mais
AU  - Al-Kawaz M
AD  - Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology 
      and Critical Care Medicine, Johns Hopkins University School of Medicine, 
      Baltimore, Maryland, USA.
FAU - Shou, Benjamin
AU  - Shou B
AUID- ORCID: 0000-0003-2825-3301
AD  - Division of Cardiac Surgery, Department of Surgery, Heart and Vascular Institute, 
      Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
FAU - Prokupets, Rochelle
AU  - Prokupets R
AD  - Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology 
      and Critical Care Medicine, Johns Hopkins University School of Medicine, 
      Baltimore, Maryland, USA.
FAU - Whitman, Glenn
AU  - Whitman G
AD  - Division of Cardiac Surgery, Department of Surgery, Heart and Vascular Institute, 
      Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
FAU - Geocadin, Romergryko
AU  - Geocadin R
AD  - Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology 
      and Critical Care Medicine, Johns Hopkins University School of Medicine, 
      Baltimore, Maryland, USA.
FAU - Cho, Sung-Min
AU  - Cho SM
AUID- ORCID: 0000-0002-5132-0958
AD  - Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology 
      and Critical Care Medicine, Johns Hopkins University School of Medicine, 
      Baltimore, Maryland, USA.
LA  - eng
GR  - R01 HL071568/HL/NHLBI NIH HHS/United States
GR  - L30 NS119233/NS/NINDS NIH HHS/United States
GR  - UG3 HL145269/HL/NHLBI NIH HHS/United States
GR  - K23 HL157610/HL/NHLBI NIH HHS/United States
GR  - R01 NS119825/NS/NINDS NIH HHS/United States
PT  - Journal Article
DEP - 20220213
PL  - United States
TA  - J Card Surg
JT  - Journal of cardiac surgery
JID - 8908809
SB  - IM
MH  - Adult
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Female
MH  - *Heart Arrest/etiology/therapy
MH  - Humans
MH  - *Hypothermia/etiology
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/etiology/therapy
PMC - PMC8891050
MID - NIHMS1778524
OTO - NOTNLM
OT  - TTM
OT  - VA-ECMO
OT  - hypothermia
OT  - neurological outcome
OT  - reperfusion injury
EDAT- 2022/02/14 06:00
MHDA- 2022/03/04 06:00
PMCR- 2023/04/01
CRDT- 2022/02/13 20:38
PHST- 2021/12/07 00:00 [revised]
PHST- 2021/11/09 00:00 [received]
PHST- 2021/12/24 00:00 [accepted]
PHST- 2022/02/14 06:00 [pubmed]
PHST- 2022/03/04 06:00 [medline]
PHST- 2022/02/13 20:38 [entrez]
PHST- 2023/04/01 00:00 [pmc-release]
AID - 10.1111/jocs.16308 [doi]
PST - ppublish
SO  - J Card Surg. 2022 Apr;37(4):825-830. doi: 10.1111/jocs.16308. Epub 2022 Feb 13.