Outcome of extracorporeal membrane oxygenation use in severe accidental hypothermia with cardiac arrest and circulatory instability: A multicentre, prospective, observational study in Japan (ICE-CRASH study)

Takauji, Shuhei; Hayakawa, Mineji; Yamada, Daisuke; Tian, Tian; Minowa, Keita; Inoue, Akihiko; Fujimoto, Yoshihiro; Isokawa, Shutaro; Miura, Naoya; Endo, Tomoyuki; Irie, Jin; Otomo, Gen; Sato, Hiroki; Bando, Keisuke; Suzuki, Tsuyoshi; Toyohara, Takashi; Tomita, Akiko; Iwahara, Motoko; Murata, Satoru; Shimazaki, Junya; Matsuyoshi, Takeo; Yoshizawa, Jo; Nitta, Katsumi; Sato, Yuta

doi:10.1016/j.resuscitation.2022.12.001

Cited by 16 publications

(21 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This was a post-hoc analysis of a nationwide multicenter prospective observational study that was conducted by the Intensive Care with Extra Corporeal membrane oxygenation Rewarming in Accidentally Severe Hypothermia (ICE-CRASH) study group from December 2019 to March 2022 [ 17 , 18 ]. The ICE-CRASH study included patients with accidental hypothermia at participating 36 tertiary care centers and was registered at the University Hospital Medical Information Network Clinical Trial Registry on April 1, 2019 (UMIN-CTR ID, UMIN000036132) prior to study initiation.…”

Section: Methodsmentioning

confidence: 99%

Hyperoxia for accidental hypothermia and increased mortality: a post-hoc analysis of a multicenter prospective observational study

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background Supraphysiologic oxygen administration causes unfavorable clinical outcomes in various diseases, including traumatic brain injury, post–cardiac arrest syndrome, and acute lung injury. Accidental hypothermia is a critical illness that reduces oxygen demands, and excessive oxygen is likely to emerge. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with accidental hypothermia. Methods A post-hoc analysis of a nationwide multicenter prospective observational study (ICE-CRASH study) on patients with accidental hypothermia admitted in 2019–2022 was conducted. Adult patients without cardiac arrest whose core body temperature was < 32 °C and whose arterial partial pressure of oxygen (PaO2) was measured at the emergency department were included. Hyperoxia was defined as a PaO2 level of 300 mmHg or higher, and 28-day mortality was compared between patients with and without hyperoxia before rewarming. Inverse probability weighting (IPW) analyses with propensity scores were performed to adjust patient demographics, comorbidities, etiology and severity of hypothermia, hemodynamic status and laboratories on arrival, and institution characteristics. Subgroup analyses were conducted according to age, chronic cardiopulmonary diseases, hemodynamic instability, and severity of hypothermia. Results Of the 338 patients who were eligible for the study, 65 had hyperoxia before rewarming. Patients with hyperoxia had a higher 28-day mortality rate than those without (25 (39.1%) vs. 51 (19.5%); odds ratio (OR) 2.65 (95% confidence interval 1.47–4.78); p < 0.001). IPW analyses with propensity scores revealed similar results (adjusted OR 1.65 (1.14–2.38); p = 0.008). Subgroup analyses showed that hyperoxia was harmful in the elderly and those with cardiopulmonary diseases and severe hypothermia below 28 °C, whereas hyperoxia exposure had no effect on mortality in patients with hemodynamic instability on hospital arrival. Conclusions Hyperoxia with PaO2 levels of 300 mmHg or higher before initiating rewarming was associated with increased 28-day mortality in patients with accidental hypothermia. The amount of oxygen to administer to patients with accidental hypothermia should be carefully determined. Trial Registration: The ICE-CRASH study was registered at the University Hospital Medical Information Network Clinical Trial Registry on April 1, 2019 (UMIN-CTR ID, UMIN000036132).

show abstract

Section: Methodsmentioning

confidence: 99%

Hyperoxia for accidental hypothermia and increased mortality: a post-hoc analysis of a multicenter prospective observational study

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…In patients with cardiac arrest from severe hypothermia, extracorporeal life support (e.g., ECMO) provides rapid active internal rewarming and may improve survival. In a multicenter, prospective study (ICE-CRASH) that included 242 patients with severe hypothermia (mostly older adults with indoor-onset hypothermia), in the 57 patients with cardiac arrest, treatment with ECMO (24 patients) was associated with better 28-day survival (adjusted odds ratio [OR] 0.17) and favorable neurologic outcome (adjusted OR 0.22) 1. In patients without cardiac arrest, treatment with ECMO (17 patients) was not associated with improved 28-day survival or favorable neurologic outcomes but was associated with more adverse events such as bleeding.…”

Section: Ecmo For Severe Hypothermia In Adults (February 2023)mentioning

confidence: 99%

UpToDate

2023

Emergency Medicine News

View full text Add to dashboard Cite

“…Most previous studies have included patients with medical causes, such as those with presumed cardiac causes [5,[7][8][9][10][11][12] and pulmonary embolism [13,14]. On the other hand, although ECPR for non-medical causes such as accidental hypothermia and drug intoxication has been shown to be effective, it has been limited to a few studies [15][16][17]. Prognostic comparison based on the aetiology of cardiac arrest is one of the most important factors affecting patient outcomes; however, this remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Prognosis by aetiologies in extracorporeal cardiopulmonary resuscitation for out-of- hospital cardiac arrest: a retrospective multicentre cohort study

Takiguchi

Tominaga

Hamaguchi

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Background The relative contributions of various factors to patient outcomes are essential for optimal patient selection for extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA). However, evidence of these aetiologies is limited. Therefore, in this study, we investigated the prognosis of the aetiologies of ECPR for OHCA.Methods This retrospective multicentre registry study involved 36 institutions in Japan and included adult patients with out-of-hospital cardiac arrest who underwent ECPR between January 2013 and December 2018. We assessed neurological outcomes at discharge based on aetiology using the cerebral performance category (CPC) score. The primary outcome was a favourable neurological outcome (CPC 1–2) at hospital discharge. We performed a multivariable logistic regression analysis to determine favourable neurological outcomes according to the aetiology of cardiac arrest.Results We identified 2,140 eligible patients, of whom 1,988 (92.9%) had cardiac arrest due to medical causes, and 152 (7.1%) had cardiac arrest due to non-medical causes. Most patients (1,663) were presumed to have cardiac causes. The proportion of patients with favourable neurological outcomes at hospital discharge was significantly higher in the non-medical-cause group than in the medical-cause group (26.3% vs. 14.0%, p < 0.001). Multivariable logistic regression analysis showed that accidental hypothermia (adjusted odds ratio [OR] = 6.89; 95% confidence interval [CI] = 4.01–11.85, p < 0.001) and pulmonary embolism (adjusted OR = 2.35; 95% CI = 1.14–4.85, p = 0.020) were associated with a significantly higher rate of favourable outcome than the presumed cardiac causes.Conclusions In this retrospective multicentre cohort study, accidental hypothermia and pulmonary embolism were associated with more favourable neurologic outcomes than the presumed cardiac causes. Prospective studies should be conducted to validate the findings of the present study.

show abstract

Outcome of extracorporeal membrane oxygenation use in severe accidental hypothermia with cardiac arrest and circulatory instability: A multicentre, prospective, observational study in Japan (ICE-CRASH study)

Cited by 16 publications

References 30 publications

Hyperoxia for accidental hypothermia and increased mortality: a post-hoc analysis of a multicenter prospective observational study

Hyperoxia for accidental hypothermia and increased mortality: a post-hoc analysis of a multicenter prospective observational study

UpToDate

Prognosis by aetiologies in extracorporeal cardiopulmonary resuscitation for out-of- hospital cardiac arrest: a retrospective multicentre cohort study

Contact Info

Product

Resources

About