부산대학교 도서관

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°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°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 PaO2. 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. [ABSTRACT FROM AUTHOR]