Single Center Experience In Totally Percutaneous Veno-arterial Ecmo Rewarming In Treatment Of Deep Accidental Hypothermia.
Jakub Staromlynski, Mariusz Kowalewski, Radoslaw Smoczynski, Anna Witkowska, Mariusz Bartczak, Dominik Drobinski, Wojciech Sarnowski, Piotr Suwalski.
Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
BACKGROUND:Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO) is among methods of treatment in deep accidental hypothermia (DAH). Which patients with DAH are best candidates for V-A ECMO has not been yet defined. Objective of the current report is to present our recent results of totally percutaneus V-A ECMO treatment in hypotermic patients.METHODS:Between 2016 and 2019, 20 selected patients (mean age: 40 [17-60], male- 90%) underwent totally percutaneous V-A ECMO rewarming. Included were only cardiac arrest patients in 3rd and 4th stage of Swiss Staging of Hypothermia scale (13.7oC - 28oC). In all patients the V-A ECMO access was provided via right or left groin cannulation (Fig 1 and 2). In all cases Doppler ultrasonography was used. RESULTS: Of the 20 patients, 18 (90%) were in the 3rd Swiss Staging of Hypothermia stage. The rewarmed patients were mostly homeless. Mean temperature measured in eosophagus was 25.2oC (min temp 21; max temp 28). In 14 (70%) the cause of cardiac arrest was ventricular fibrillation; asystole in 5 patients and in pulseless electrical activity in 1 case. Rewarming times were on average 190 min (180-240). There was no case of conversion to sternotomy for direct cannulation. Median duration of intensive care unit stay was 4.0 [1.0-5.0] days. Three patients (15%) expired during thirty-day follow-up. In the survivors, there were no early neurological complications.CONCLUSIONS:Early diagnosis and institution of V-A ECMO rewarming protocols to patients in 3rd and 4th stages of Swiss Staging of Hypothermia is feasible and safe with promising short-term survival.
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