Abstract 101: Effect of Extracorporeal Membrane Oxygenation for Accidental Hypothermia With Absent Vital Signs: A Nationwide Observational Study

Abstract

Introduction: Patients with accidental hypothermia and absent vital signs are increasingly receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, there is limited knowledge on the efficacy of this advanced rewarming method. Despite the limited evidence, the resuscitation guidelines from the European Resuscitation Council and the American Heart Association both recommended the use of extracorporeal life support in patients with accidental hypothermia and absent vital signs. Hypothesis: We hypothesized that VA-ECMO is associated with lower in-hospital mortality compared with cardiopulmonary resuscitation (CPR) only in patients with accidental hypothermia and absent vital signs. Methods: Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2017, we identified patients diagnosed with accidental hypothermia (International Classification of Diseases Tenth Revision code T68) who received closed-chest cardiac massage in hospital on admission day. Patients who received VA-ECMO on admission day were allocated to the VA-ECMO group, and those who received CPR only were allocated to the conventional CPR group. The primary outcome was in-hospital mortality. The secondary outcome was alert consciousness for Japan Coma Scale status at discharge. Propensity score analyses were performed to compare the outcomes between the two groups. Results: We identified 1,624 eligible patients during the 81-month study period. Of these, 19% (314 of 1,624) received VA-ECMO on admission day. Crude in-hospital mortality was 65.3% (205 of 314) and 84.1% (1,102 of 1,310) in the VA-ECMO and conventional CPR groups, respectively. Propensity score-matching analyses demonstrated significantly lower in-hospital mortality (risk difference, –14.1%; 95% confidence interval, –21.9% to –6.3%) and higher proportion of alert consciousness at discharge (risk difference, 8.5%; 95% confidence interval, 2.1% to 15.0%) in the VA-ECMO group compared with the conventional CPR group. Conclusions: VA-ECMO was significantly associated with decreased in-hospital mortality and favorable neurologic outcome compared with conventional CPR in patients with accidental hypothermia and absent vital signs.