Impact of therapeutic hypothermia on bleeding events in adult patients treated with extracorporeal life support peri-cardiac arrest.

Abstract

Whether therapeutic hypothermia (TH) adds to the risk of bleeding in patients on extracorporeal life support (ECLS) peri-cardiac arrest remains unknown. Single center retrospective study on patients receiving veno-arterial ECLS peri-cardiac arrest ± TH at 32-34°C (January 2009-December 2015). major bleeding (including intracerebral hemorrhage, ICH)<72h of cardiac arrest. Logistic regression and marginal structural models were used to analyze associations with major bleeding. Of 66 patients receiving ECLS, 36 were treated with TH. Major bleeding occurred in 14 patients (39%) treated with ECLS+TH and in 17 patients (57%) with ECLS alone. ICH was reported in 3 (8%) and one patient (3%), respectively. There was no difference in mortality, but lung injury occurred more often in ECLS+TH. A platelet count <60×109/L but not TH was associated with major bleeding (including ICH). The estimated causal risk ratio of TH on the occurrence of major bleeding (including ICH) at 72h post cardiac arrest was 0.95 (95%CI 0.62-1.45). Bleeding complications were common in our study. However, TH (32-34°C) was not associated with an increased risk of major bleeding in patients on ECLS peri-cardiac arrest.