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.