Introduction
Therapeutic hypothermia has been shown to improve neurological outcome
and mortality in comatose cardiac arrest patients.1-3Patients undergoing extracorporeal membrane oxygenation (ECMO)
constitute a special population with a high risk of acute brain injury
(ABI), up to 15.1% in patients undergoing veno-arterial (VA) ECMO, and
7.1% in patients undergoing veno-venous ECMO.4 While
evidence for improving neurological outcome with therapeutic hypothermia
32-36°C is well delineated in cardiac arrest,1,5-9 the
effect of hypothermia in VA-ECMO is unknown. VA-ECMO patients are
susceptible to reperfusion injury given their prolonged hypoperfusion
preceding full restoration of cerebral blood flow, which may benefit
from hypothermia. However, hypothermia may increase the risk of
hemorrhagic events with acquired coagulopathy in
ECMO.10 We hypothesized that mild hypothermia during
the first 24 hours of ECMO may improve neurological outcome without
exacerbating the frequency of systemic hemorrhages.