Abstract：
To elucidate the effectiveness of extracorporeal membrane oxygenation (ECMO) in accidental hypothermia (AH) patients with and without cardiac arrest (CA), including details of complications.
This study was a multicentre, prospective, observational study of AH in Japan. All adult (aged ≥18 years) AH patients with body temperature ≤32 °C who presented to the emergency department between December 2019 and March 2022 were included. Among the patients, those with CA or circulatory instability, defined as severe AH, were selected and divided into the ECMO and non-ECMO groups. We compared 28-day survival and favourable neurological outcomes at discharge between the ECMO and non-ECMO groups by adjusting for the patients\' background characteristics using multivariable logistic regression analysis.
Among the 499 patients in this study, 242 patients with severe AH were included in the analysis: 41 in the ECMO group and 201 in the non-ECMO group. Multivariable analysis showed that the ECMO group was significantly associated with better 28-day survival and favourable neurological outcomes at discharge in patients with CA compared to the non-ECMO group (odds ratio [OR] 0.17, 95% confidence interval [CI]: 0.05-0.58, and OR 0.22, 95%CI: 0.06-0.81). However, in patients without CA, ECMO not only did not improve 28-day survival and neurological outcomes, but also decreased the number of event-free days (ICU-, ventilator-, and catecholamine administration-free days) and increased the frequency of bleeding complications.
ECMO improved survival and neurological outcomes in AH patients with CA, but not in AH patients without CA.
This study was a multicentre, prospective, observational study of AH in Japan. All adult (aged ≥18 years) AH patients with body temperature ≤32 °C who presented to the emergency department between December 2019 and March 2022 were included. Among the patients, those with CA or circulatory instability, defined as severe AH, were selected and divided into the ECMO and non-ECMO groups. We compared 28-day survival and favourable neurological outcomes at discharge between the ECMO and non-ECMO groups by adjusting for the patients\' background characteristics using multivariable logistic regression analysis.
Among the 499 patients in this study, 242 patients with severe AH were included in the analysis: 41 in the ECMO group and 201 in the non-ECMO group. Multivariable analysis showed that the ECMO group was significantly associated with better 28-day survival and favourable neurological outcomes at discharge in patients with CA compared to the non-ECMO group (odds ratio [OR] 0.17, 95% confidence interval [CI]: 0.05-0.58, and OR 0.22, 95%CI: 0.06-0.81). However, in patients without CA, ECMO not only did not improve 28-day survival and neurological outcomes, but also decreased the number of event-free days (ICU-, ventilator-, and catecholamine administration-free days) and increased the frequency of bleeding complications.
ECMO improved survival and neurological outcomes in AH patients with CA, but not in AH patients without CA.
摘要：
目的：阐明体外膜肺氧合（ECMO）在有和没有心脏骤停（CA）的意外低温（AH）患者中的有效性，包括并发症的细节。
方法：这项研究是一个多中心，prospective,日本AH的观察研究。纳入所有在2019年12月至2022年3月期间就诊于急诊科的体温≤32°C的成人（年龄≥18岁）AH患者。在患者中,那些有CA或循环不稳定的人，定义为严重的AH，选择并分为ECMO组和非ECMO组。我们使用多变量逻辑回归分析，通过调整患者的背景特征，比较了ECMO组和非ECMO组的28天生存率和出院时的良好神经系统结局。
结果：在本研究的499名患者中，242例重度AH患者纳入分析：ECMO组41例，非ECMO组201例。多变量分析表明，与非ECMO组相比，ECMO组与CA患者出院时更好的28天生存率和良好的神经系统预后显着相关（比值比[OR]0.17，95％置信区间[CI]：0.05-0.58，OR0.22，95CI：0.06-0.81）。然而,在没有CA的患者中，ECMO不仅不能改善28天生存率和神经系统预后，但也减少了无事件天数(ICU-，呼吸机-,和不使用儿茶酚胺的天数），并增加了出血并发症的频率。
结论：ECMO可改善AH伴CA患者的生存和神经系统预后，但不是在没有CA的AH患者中。
方法：这项研究是一个多中心，prospective,日本AH的观察研究。纳入所有在2019年12月至2022年3月期间就诊于急诊科的体温≤32°C的成人（年龄≥18岁）AH患者。在患者中,那些有CA或循环不稳定的人，定义为严重的AH，选择并分为ECMO组和非ECMO组。我们使用多变量逻辑回归分析，通过调整患者的背景特征，比较了ECMO组和非ECMO组的28天生存率和出院时的良好神经系统结局。
结果：在本研究的499名患者中，242例重度AH患者纳入分析：ECMO组41例，非ECMO组201例。多变量分析表明，与非ECMO组相比，ECMO组与CA患者出院时更好的28天生存率和良好的神经系统预后显着相关（比值比[OR]0.17，95％置信区间[CI]：0.05-0.58，OR0.22，95CI：0.06-0.81）。然而,在没有CA的患者中，ECMO不仅不能改善28天生存率和神经系统预后，但也减少了无事件天数(ICU-，呼吸机-,和不使用儿茶酚胺的天数），并增加了出血并发症的频率。
结论：ECMO可改善AH伴CA患者的生存和神经系统预后，但不是在没有CA的AH患者中。
