The impact of different targeted temperatures on out-of-hospital cardiac arrest outcomes in patients receiving extracorporeal membrane oxygenation: a nationwide cohort study

Abstract

Background Targeted temperature management (TTM) is recommended in the management of out-of-hospital cardiac arrest (OHCA) when coma persists after the return of spontaneous circulation. In the setting of extracorporeal membrane oxygenation (ECMO) for OHCA patients, TTM is associated with good neurological outcomes and is recommended in the Extracorporeal Life Support Organization guidelines. However, the optimal targeted temperature for these patients has not yet been adequately investigated. This study aimed to compare the impact of different targeted temperatures on the outcomes in OHCA patients receiving ECMO. Methods This was a retrospective analysis of data from the Japanese Association for Acute Medicine (JAAM)-OHCA Registry, a multicentre nationwide prospective database in Japan in which 103 institutions providing emergency care participated. OHCA patients aged ≥ 18 years who required ECMO with TTM between June 2014 and December 2019 were included in our analysis. The primary outcome was 30-day survival with favourable neurological outcomes, defined as a Glasgow–Pittsburgh cerebral performance category score of 1 or 2. Patients were divided into two groups according to their targeted temperature: normothermic TTM (n-TTM) (35–36 °C) and hypothermic TTM (h-TTM) (32–34 °C). We compared the outcomes between the two targeted temperature groups using multivariable logistic regression and inverse probability weighting (IPW). Results A total of 890 adult OHCA patients who received ECMO and TTM were eligible for our analysis. Of these patients, 249 (28%) and 641 (72%) were treated with n-TTM and h-TTM, respectively. The proportions of patients with 30-day favourable neurological outcomes were 16.5% (41/249) and 15.9% (102/641), in the n-TTM and h-TTM groups, respectively. No difference in neurological outcomes was observed in the multiple regression analysis [adjusted odds ratio 0.91, 95% confidence interval (CI) 0.58–1.43], and the result was constant in the IPW (odds ratio 1.01, 95% CI 0.67–1.54). Conclusion No difference was observed between n-TTM and h-TTM in OHCA patients receiving TTM with ECMO. The current understanding that changes to the targeted temperature have little impact on the outcome of patients may remain true regardless of ECMO use.

The use of induced hypothermia in extracorporeal membrane oxygenation: A narrative review

“…Watanabe et al 69 recently analyzed a retrospective cohort of 890 OHCA patients undergoing ECPR between 2014 and 2019; 249 patients were treated with NT (35–36 °C) and 641 with IH (32–34 °C). Whether by using multivariable logistic regression or inverse probability weighting, 30-day survival with favorable neurological outcome (CPC 1–2) was similar between the two groups (16.5% in the NT group and 15.9% in the IH group).…”

Response to: The difference in the association between included ECPR patients and neurological outcomes

“…We express our gratitude to Hifumi and their associates for their interest in our manuscript pertaining to the utilization of targeted temperature management (TTM) among patients treated with extracorporeal membrane oxygenation (ECMO) [ 1 ].…”

The difference in the association between included ECPR patients and neurological outcomes

“…The study contained two groups of patients: those receiving normothermic TTM (n-TTM) (35–36 °C) and those receiving hypothermic TTM (h-TTM) (32–34 °C). No differences in 30-day favorable neurological outcomes [OR (95% CI) 1.01 (0.67–1.54)] or survival [OR (95% CI) 1.05 (0.76–1.46)] were observed between the two groups [ 1 ].…”

“…In Japan, two studies on the use of ECPR for OHCA have recently been reported. The first is a retrospective observational study ( N = 890, 2014–2019) that used the JAAM-OHCA registry and included all kinds of OHCA patients [ 1 ]. The second is a retrospective registry study ( N = 1644, 2013–2018) with the largest number of ECPR patients in the world; it is known as the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan (SAVE-J II) [ 2 ].…”

“…The difference observed between the JAAM-OHCA registry (the current study) and SAVE-J II is mainly due to the difference in the included patients. The first included OHCA patients with all causes of arrest [ 1 ], whereas noncardiac conditions were excluded in the second [ 2 ]. According to another study using the JAAM-OHCA registry, the noncardiac cause was estimated to account for ~ 50% of cases [ 4 ].…”