Abstract 10907: Association of Intentional Cooling, Achieved Temperature, and Hypothermia Duration with Survival in Patients Treated with Extracorporeal Cardiopulmonary Resuscitation-An Exploratory Analysis of ELSO Registry

Abstract

Background: The efficacy of targeted temperature management remains unclear for patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) due to refractory cardiac arrest. Methods: We analyzed the Extracorporeal Life Support Organization registry between 2010 and 2019. Patients 18-79 years old who received ECPR and had a reported temperature were included. First, we compared outcomes between patients who completed intentional cooling (IC) and those who did not complete intentional cooling (NIC). Among those who completed IC, we compared the outcomes between i) actual observed temperature <34°C, 34 - 36°C, and ≥36°C, and ii) hypothermia duration below 36°C for <12 hours, 12 - 48 hours, and >48 hours. The primary outcome was in-hospital death within 90 days. Cox proportional hazard models were conducted with adjustment for covariates. Results: Among a total of 8,060 patients who received ECPR, 911 patients who had a record of actual temperature were identified. After multivariable adjustment, there was no significant difference in in-hospital mortality between patients treated with IC and NIC (Hazard ratio [HR] 1.13 [95% CI 0.93 - 1.39], p=0.2252). However, among patients treated with IC, recorded temperature at 34 - 36°C had a significantly lower adjusted HR for in-hospital mortality compared with ≥36°C (HR 0.73 [0.56 - 0.97], p=0.0274). Maintaining a temperature <36°C for 12 - 48 hours had a significantly lower adjusted HR for in-hospital mortality compared with <36°C for <12 hours (HR 0.70 [0.53 - 0.91], p=0.0080). Conclusion: In this exploratory analysis, IC was not associated with lower in-hospital mortality in patients treated with ECPR. However, among those treated with IC, achieving a target temperature of 34 - 36°C and maintaining it for 12 - 48 hours were associated with lower in-hospital mortality.