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

Moreau, Anthony; Lévy, Bruno; Annoni, Filippo; Lorusso, Roberto; Su, Fuhong; Belliato, Mirko; Taccone, Fabio Silvio

doi:10.1016/j.resplu.2023.100360

Cited by 5 publications

(3 citation statements)

References 79 publications

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“…Therefore, we propose that the neuroprotective benefits of TTM may be diminished in patients receiving ECPR compared with post-cardiac arrest patients with spontaneous circulation. In addition, ECMO machines can integrate heat exchangers to decrease blood temperature to a specified desired range, usually 32-36 • C, without TTM devices [35][36][37][38][39]. In other words, ECMO may have similar effects to TTM, even without using TTM.…”

Section: Discussionmentioning

confidence: 99%

Target Temperature Management Effect on the Clinical Outcome of Patients with Out-of-Hospital Cardiac Arrest Treated with Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Observational Study

Kim,

Kang

et al. 2024

JPM

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This study aimed to investigate whether targeted temperature management (TTM) could enhance outcomes in patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Using a nationwide OHCA registry, adult patients with witnessed OHCA of presumed cardiac origin who underwent ECPR at the emergency department between 2008 and 2021 were included. We examined the effect of ECPR with TTM on survival and neurological outcomes at hospital discharge using propensity score matching and multivariable logistic regression compared with patients treated with ECPR without TTM. Odds ratios and 95% confidence intervals were determined. A total of 399 ECPR cases were analyzed among 380,239 patients with OHCA. Of these, 330 underwent ECPR without TTM and 69 with TTM. After propensity score matching, 69 matched pairs of patients were included in the analysis. No significant differences in survival and good neurological outcomes between the two groups were observed. In the multivariable logistic regression, no significant differences were observed in survival and neurological outcomes between ECPR with and without TTM. Among the patients who underwent ECPR after OHCA, ECPR with TTM did not improve outcomes compared with ECPR without TTM.

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Section: Discussionmentioning

confidence: 99%

Target Temperature Management Effect on the Clinical Outcome of Patients with Out-of-Hospital Cardiac Arrest Treated with Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Observational Study

Kim,

Kang

et al. 2024

JPM

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“…Targeted temperature management (TTM), the application of various interventions to reach and maintain a specific body temperature, may play a cerebral protective role among patients supported by ECLS [126]. Potential benefits of TTM, specifically induced hypothermia, include reduced inflammation, minimized ischemiareperfusion injury, increased oxygen delivery, increased systemic vascular resistance, improved gas exchange and protective ventilation, and neuroprotection in patients on VV or VA ECMO [126]. However, there is an absence of data evaluating TTM in VV ECMO [126] and a paucity of inconclusive data evaluating its application in VA ECMO for cardiogenic shock [127].…”

Section: Temperature Managementmentioning

confidence: 99%

“…Potential benefits of TTM, specifically induced hypothermia, include reduced inflammation, minimized ischemiareperfusion injury, increased oxygen delivery, increased systemic vascular resistance, improved gas exchange and protective ventilation, and neuroprotection in patients on VV or VA ECMO [126]. However, there is an absence of data evaluating TTM in VV ECMO [126] and a paucity of inconclusive data evaluating its application in VA ECMO for cardiogenic shock [127]. Comparatively, hypothermic TTM may play a role in the preservation of CA in patients after return of spontaneous circulation (ROSC).…”

Section: Temperature Managementmentioning

confidence: 99%

Cerebral Autoregulation: A Target for Improving Neurological Outcomes in Extracorporeal Life Support

Chalifoux,

Ko,

Slovis

et al. 2024

Neurocrit Care

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Despite improvements in survival after illnesses requiring extracorporeal life support, cerebral injury continues to hinder successful outcomes. Cerebral autoregulation (CA) is an innate protective mechanism that maintains constant cerebral blood flow in the face of varying systemic blood pressure. However, it is impaired in certain disease states and, potentially, following initiation of extracorporeal circulatory support. In this review, we first discuss patient-related factors pertaining to venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) and their potential role in CA impairment. Next, we examine factors intrinsic to ECMO that may affect CA, such as cannulation, changes in pulsatility, the inflammatory and adaptive immune response, intracranial hemorrhage, and ischemic stroke, in addition to ECMO management factors, such as oxygenation, ventilation, flow rates, and blood pressure management. We highlight potential mechanisms that lead to disruption of CA in both pediatric and adult populations, the challenges of measuring CA in these patients, and potential associations with neurological outcome. Altogether, we discuss individualized CA monitoring as a potential target for improving neurological outcomes in extracorporeal life support.

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Thought experiments, sentience, and animalism

Hermida

2023

Synthese

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Animalism is prima facie the most plausible view about what we are; it aligns better with science and common sense, and is metaphysically more parsimonious. Thought experiments involving the brain, however, tend to elicit intuitions contrary to animalism. In this paper, I examine two classical thought experiments from the literature, brain transplant and cerebrum transplant, and a new one, cerebrum regeneration. I argue that they are theoretically possible, but that a scientifically informed account of what would actually happen shows that in none of the cases would the person be separated from the animal. Our intuitions in these cases, when adequately informed by neuroscience, do not conflict with animalism – rather, they suggest a correction of the animalist position: the persisting animal should be at least minimally sentient. Sentience animalism is a new formulation of the animalist account of personal identity that allows us to reconcile facts about our biological persistence conditions with the intuition that human persistence should involve some kind of psychological continuity.

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

Cited by 5 publications

References 79 publications

Target Temperature Management Effect on the Clinical Outcome of Patients with Out-of-Hospital Cardiac Arrest Treated with Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Observational Study

Target Temperature Management Effect on the Clinical Outcome of Patients with Out-of-Hospital Cardiac Arrest Treated with Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Observational Study

Cerebral Autoregulation: A Target for Improving Neurological Outcomes in Extracorporeal Life Support

Thought experiments, sentience, and animalism

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