A pilot investigation of mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO).
OBJECTIVE
To investigate the safety and feasibility of using mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO). Study design A prospective, nonrandomized pilot study of 25 neonates referred for ECMO. Whole body cooling was achieved by adjustment of the temperature of the extracorporeal circuit water bath. Five groups (N=5 per group) were each studied for the first 5 days of ECMO. The first group was maintained at 37 degrees C throughout the study period. Subsequent groups were cooled to 36 degrees C, to 35 degrees C, and, finally, to 34 degrees C, respectively, for 24 hours and the final group to 34 degrees C for 48 hours before being rewarmed to 37 degrees C. Patients were carefully assessed clinically and biologically. In addition to routine laboratory tests, cytokines (IL-6 and IL-8), complement (C3a), and molecular markers of coagulation (thrombin/antithrombin III [TAT], antithrombin III, and plasmin-alpha2plasminogen) were measured.


RESULTS
No major clinical or circuit problems were noted during cooling or rewarming. In particular, there were no problems of bleeding or cardiac arrhythmia. No significant difference was found between groups in terms of molecular markers of coagulation, complement, cytokines, and platelet transfusions.


CONCLUSIONS
Applying mild hypothermia (34 degrees C) for 24 or 48 hours to neonates receiving ECMO is both feasible and safe.
Department of Child Health, University of Leicester, London United Kingdom.
Marie
M
Horan
Shingo
S
Ichiba
Richard K
RK
Firmin
Hilliary M
HM
Killer
David
D
Edwards
Denis
D
Azzopardi
Rachel
R
Hodge
Sailesh
S
Kotecha
David
D
Field
D001794:Blood Pressure; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006339:Heart Rate; D006801:Humans; D007036:Hypothermia, Induced; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies
D015850:Interleukin-6; D016209:Interleukin-8