Extracorporeal membrane oxygenation versus conventional rewarming for severe hypothermia in an urban emergency department

Matthew E Prekker; Megan Rischall; Michelle Carlson; Brian E Driver; Melissa Touroutoutoudis; Jessica Boland; Michael Hu; Beth Heather; Nicholas S Simpson

doi:10.1111/acem.14585

Extracorporeal membrane oxygenation versus conventional rewarming for severe hypothermia in an urban emergency department

Acad Emerg Med. 2023 Jan;30(1):6-15. doi: 10.1111/acem.14585. Epub 2022 Sep 6.

Authors

Affiliations

¹ Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
² Division of Pulmonary and Critical Care, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
³ Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
⁴ Department of Critical Care Medicine, Allina Health, Minneapolis, Minnesota, USA.
⁵ Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
⁶ Critical Care Nursing and the Extracorporeal Life Support Program, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
⁷ Hennepin Emergency Medical Services, Minneapolis, Minnesota, USA.

PMID: 36000288
DOI: 10.1111/acem.14585

Abstract

Background: Severe hypothermia (core body temperature < 28°C) is life-threatening and predisposes to cardiac arrest. The comparative effectiveness of different active internal rewarming methods in an urban U.S. population is unknown. We aim to compare outcomes between hypothermic emergency department (ED) patients rewarmed conventionally using an intravascular rewarming catheter or warm fluid lavage versus those rewarmed using extracorporeal membrane oxygenation (ECMO).

Methods: We performed a retrospective cohort analysis of adults with severe hypothermia due to outdoor exposure presenting to an urban ED in Minnesota, 2007-2021. The primary outcome was hospital survival. We also calculated the rewarming rate in the 4 h after ED arrival and compared these data between patients rewarmed with ECMO (the extracorporeal rewarming group) versus without ECMO (the conventional rewarming group). We repeated these analyses in the subgroup of patients with cardiac arrest.

Results: We analyzed 44 hypothermic ED patients: 25 patients in the extracorporeal rewarming group (median temperature 24.1°C, 84% with cardiac arrest) and 19 patients in the conventional rewarming group (median temperature 26.3°C, 37% with cardiac arrest; 89% received an intravascular rewarming catheter). The median rewarming rate was greater in the extracorporeal versus conventional group (2.3°C/h vs. 1.5°C/h, absolute difference 0.8°C/h, 95% confidence interval [CI] 0.3-1.2°C/h) yet hospital survival was similar (68% vs. 74%). Among patients with cardiac arrest, hospital survival was greater in the extracorporeal versus conventional group (71% vs. 29%, absolute difference 42%, 95% CI 4%-82%).

Conclusions: Among ED patients with severe hypothermia and cardiac arrest, survival was significantly higher with ECMO versus conventional rewarming. Among all hypothermic patients, ECMO use was associated with faster rewarming than conventional methods.

Keywords: ECMO; accidental; cardiac arrest; environmental; extracorporeal membrane oxygenation; hypothermia; urban.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Adult
Emergency Service, Hospital
Extracorporeal Membrane Oxygenation* / methods
Heart Arrest* / therapy
Humans
Hypothermia* / complications
Hypothermia* / therapy
Retrospective Studies
Rewarming / methods