Date Published: January 23, 2017
Publisher: Public Library of Science
Author(s): Jeong-Am Ryu, Taek Kyu Park, Chi Ryang Chung, Yang Hyun Cho, Kiick Sung, Gee Young Suh, Tae Rim Lee, Min Seob Sim, Jeong Hoon Yang, Chiara Lazzeri.
We evaluated the association of body temperature patterns with neurological outcomes after extracorporeal cardiopulmonary resuscitation (ECPR). Between December 2013 and December 2015, we enrolled 48 patients with cardiac arrest who survived for at least 24 hours after ECPR. Based on their body temperature patterns and the intention to control fever, we divided the patients into those in whom fever was actively controlled (N = 25), those with normothermia (N = 17), and those with unintended hypothermia (N = 6). The primary outcome was the Cerebral Performance Categories (CPC) scale at discharge. Of the 48 ECPR patients, 23 patients (47.9%) had good neurological outcomes (CPC 1 and 2) and 27 patients (56.3%) survived to discharge. The normothermia group showed a pattern of higher temperatures compared with the other groups during 48 hours after ECPR. Not only poor neurological outcomes but also intensive care unit (ICU) mortality occurred more often in the unintended hypothermia group than in the other two groups, regardless of the fever control strategy (p = 0.023 and p = 0.002, respectively). There were no differences in neurological outcomes and ICU mortality between the actively controlled fever group and the normothermia group (p = 0.845 and p = 0.616, respectively). Unintentionally sustained hypothermia may be associated with poor neurological outcomes after ECPR. These findings suggest that patients who are unable to generate a fever following ECPR may incur severe hypoxic brain injury.
Body temperatures are associated with neurological injuries and other clinical outcomes in comatose patients after return of spontaneous circulation (ROSC) [1–3]. There are many reports regarding therapeutic temperature management and clinical outcomes in patients who have had a cardiac arrest [1, 4–7]. Although there are some debates about the optimal target temperature after cardiac arrest, fever exacerbates acute neurological injury and contributes to poor clinical outcomes after ROSC [1–3, 8–14]. Recently, extracorporeal cardiopulmonary resuscitation (ECPR) has been increasingly utilized to supply oxygenated blood and to provide hemodynamic support in the absence of spontaneous cardiac circulation. Several recent studies have reported that neurological prognoses were better in patients who received ECPR after cardiac arrest than in those who did not receive ECPR after cardiac arrest [15–20]. In patients who had undergone ECPR, extracorporeal circulation and external volume infusion could lower the body temperature . Accordingly, extracorporeal circulation may provide some degree of neuroprotection through induced hypothermia. However, there have been no reports regarding the association between body temperature patterns and neurological outcome in patients receiving ECPR. Therefore, we investigated the association between body temperature patterns and neurological outcomes following ECPR.
In the present study, we investigated the neurological outcomes and clinical outcomes according to body temperature patterns in patients who underwent ECPR after cardiac arrest. These patterns were very similar between the actively controlled fever group and the unintended hypothermia group, but the normothermia group showed a pattern of higher temperatures compared with the other two groups within the 48-hour period following ECPR. Approximately half of the patients who underwent ECPR had good neurological outcomes. Neurological outcomes and ICU mortality were similar between the actively controlled fever group and the normothermia group; however, unintended hypothermia was associated with a higher incidence of poor neurological outcomes and in-hospital mortality compared with actively controlled fever and normothermia.
In the ECPR setting, neurological outcomes and mortality were similar between the actively controlled fever group and the normothermia group, but unintentionally sustaining hypothermia may be associated with poor neurological outcomes. These findings suggest that patients who are unable to generate a fever following ECPR may incur severe hypoxic brain injury.