Therapeutic Hypothermia May Improve Neurological Outcomes in Extracorporeal Life Support for Adult Cardiac Arrest.
BACKGROUND
Limited data exists on patients receiving therapeutic hypothermia during extracorporeal life support (ECLS). We investigated outcomes and prognostic factors in these patients.


METHODS
A retrospective review was conducted for 225 consecutive adult patients treated with ECLS between July 2003 and January 2016. Extracorporeal life support was initiated for refractory cardiac arrest (>10 mins) in 79 patients (35.1%). Patient demographics, ECLS-related complications, in-hospital mortality and neurological outcomes were analysed.


RESULTS
The mean age was 49.9±12.4 years. Sixty-two patients (78.5%) were male. The mean duration of CPR and ECLS were respectively, 32.0±23.3 mins and 5.4±4.0 days. Therapeutic hypothermia (34oC) was maintained for 24hours in 14 patients (17.7%). Thirty-five patients (44.3%) were weaned off ECLS. Twenty-one patients (26.6%) survived to hospital discharge with 16 (20.3%) recovering good neurological function. Compared to ECLS at normothermia, neurologically favourable survival was higher in the hypothermia group (42.9% vs 15.4%, p=0.020). Multivariable analysis identified a non-shockable rhythm [odds ratio (OR) 5.1, confidence interval (CI) 1.5-16.8], ischaemic hepatitis (OR 6.2, CI 1.1-33.6) and hypoxic ischaemic encephalopathy (OR 5.1, CI 1.5-17.1) as predictors of in-hospital mortality. Therapeutic hypothermia (OR 4.9, CI 1.2-20.4) and acute renal failure (OR 0.19, CI 0.05-0.70) were predictors of neurologically favourable survival.


CONCLUSIONS
In this report of patients treated with ECLS, in-hospital survival and survival with good neurological performance were 26.6% and 20.3% respectively. A non-shockable rhythm, ischaemic hepatitis and hypoxic ischaemic encephalopathy were predictors of in-hospital mortality. Therapeutic hypothermia during ECLS was associated with improved neurological outcomes.
Department of Cardiothoracic Surgery, National Heart Centre, Singapore; Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA. Electronic address: philip.pang.y.k@nhcs.com.sg.
Philip Y K
PYK
Pang
Cardiothoracic Intensive Care Unit, National Heart Centre, Singapore.
Gillian H L
GHL
Wee
Department of Cardiothoracic Surgery, National Heart Centre, Singapore.
Ming Jie
MJ
Huang
Perfusion Unit, National Heart Centre, Singapore.
Anne E E
AEE
Hoo
Cardiothoracic Intensive Care Unit, National Heart Centre, Singapore.
Ismail Mohamed
IM
Tahir Sheriff
Department of Cardiothoracic Surgery, National Heart Centre, Singapore.
See Lim
SL
Lim
Department of Cardiothoracic Surgery, National Heart Centre, Singapore.
Teing Ee
TE
Tan
Department of Cardiothoracic Surgery, National Heart Centre, Singapore.
Yee Jim
YJ
Loh
Department of Cardiothoracic Surgery, National Heart Centre, Singapore.
Victor T T
VTT
Chao
Department of Cardiothoracic Surgery, National Heart Centre, Singapore.
Jia Lin
JL
Soon
Mechanical Circulatory Support, Heart and Lung Transplant Unit, National Heart Centre, Singapore.
Ka Lee
KL
Kerk
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University, Singapore.
Zakir Hussain
ZH
Abdul Salam
Department of Cardiothoracic Surgery, National Heart Centre, Singapore.
Yoong Kong
YK
Sin
Department of Cardiothoracic Surgery, National Heart Centre, Singapore; Mechanical Circulatory Support, Heart and Lung Transplant Unit, National Heart Centre, Singapore.
Chong Hee
CH
Lim
D000328:Adult; D018572:Disease-Free Survival; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate
Cardiac arrest; Extracorporeal life support; Therapeutic hypothermia