Abstract P158: Hypothermia Therapy in Patients Rescued with Extracorporal Membrane Oxygenation for In-hospital Cardiac Arrest with Initial Coma
Background. Extracorporeal membrane oxygenation(ECMO) could rescue some patients with prolonged cardiac arrest, and hypothermia is advocated to improve the neurological outcome for patients with return of spontaneous circulation after cardiac arrest. However, the report about hypothermia in patients rescued with extracorporeal membrane oxygenation for cardiopulmonary resuscitation (ECPR) is rare. We want to see if the hypothermia is benefit to the patients with initial coma after ECPR.
Patients and methods. From January 2007 to March 2008, 48 adult patients with in-hospital cardiac arrest received ECPR. We excluded 16 patients because the circulation could not be maintained by ECMO (n=10, all died) and clear consciousness soon after ECPR (n=6, 5 of them (83%) survived). Thirty two patients with initial coma after ECPR were included in the study. The hypothermia group (n=14) was cooled to 32–34°C by extracorporeal membrane oxygenation. The normothermia group (n=18) were kept at 36–37°C. Clear consciousness was defined as the patients could follow verbal commands. The hospital survival and “regain of clear consciousness” were compared between the two groups.
Results. In the study, regain of clear consciousness were noted in 53% (17/32) in patients with initial coma and the survival to discharge was 25% (8/32). The median CPR duration was 35 minutes (range 5–114 minutes) in the hypothermia group and 37 minutes (range: 20–57 minutes) in the normothermia group (p=N.S.). The initial rhythm was vt/vf in 6 (42.8%) in the hypothermia group and 12(66%) in the normothermia group (p=N.S.). The survival to discharge was 7% (1/14) in the hypothermia group, and 39%(7/18) in the normothermia group (p=0.053). The regain of clear consciousness was lower in the hypothermia group than the normothermia group (28% (4/14) vs 72% (13/18), p=0.031). The ECMO complications were not significant different between the two groups.
Conclusions. Although hypothermia could be easily induced by ECMO, the improvement in clinical outcome for in-hospital ECPR patients with initial coma was not demonstrated in this preliminary study. We need more study for the hypothermia therapy in the ECPR patients before its routine use.