Title: ECMO (ECLS) FOR ACTIVE REWARMING IN ACCIDENTAL HYPOTHERMIA<br/>Author: Kim Boswell<br/><a href='http://umem.org/profiles/faculty/311/'>[Click to email author]</a><hr/><p class="p1" color:="" helvetica="" style="margin: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; line-height: normal; font-family: ">
<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Winter in the Baltimore area is often met with subfreezing temperatures. As a result, we are occasionally confronted with the patient in hypothermic arrest with body temperatures as low as 65 degrees farenheit.</span></span></p>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">ECMO has been an increasingly utilized resource in the rapid rewarming of these patients, helping to limit the immense amount of time and efforts required to care for these patients while actively rewarming and awaiting ROSC.</span></span></p>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">So, what’s the data to support the use of ECLS in these patients?</span></span></p>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">A systematic review of 19 studies over approximately 16 years, included 47 patients (majority, male) who underwent ECLS for accidental hypothermia was conducted.</span></span></p>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Data:</span></span></p>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Body temperatures at time of VA ECMO cannulation ranged from 22-26 degrees celsius.</span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Nearly 75% were in cardiac arrest (VF -47%; Asystole 26%)</span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">The primary cause of hypothermia was related to environmental exposure. </span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Average time to cannulation (from scene) 155 minutes (with ongoing CPR)</span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Results:</span></span></p>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">80% probability of neuroloigcally intact survival at 5 mos.</span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Nearly 20% had self reported cognitive impairment at 6 mos, which was mild</span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Rapid rewarming was associated with lower death rates (up to 4deg celcius/hour)<span class="Apple-converted-space"> </span></span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Initial potassium level can assist in decision making re: patient qualification for ECMO</span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">K+ levels >8 on presentation warrants cautious consideration for ecmo</span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Discussion Points:</span></span></p>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">What about those not <i>as</i> hypothermic... Will their outcome be as good?</span></span></li>
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<span style="font-family:arial,helvetica,sans-serif;"><span style="font-size:12px;">Small stud</span></span>ies were included… much room for additional studies to further elucidate details</li>
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<fieldset><legend>References</legend>
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Austin MA, Maynes EJ, O’Malley TJ, et al. Outcomes of extracorporeal life support use in accidental hypothermia: A systematic review. Ann Thor Surg. 2020;110(6):1926-1932.</p>
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