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

Abstract

Despite venovenous or venoarterial extracorporeal membrane oxygenation (ECMO) being increasingly used in patients with severe acute respiratory disease syndrome, severe cardiogenic shock, and refractory cardiac arrest, mortality rates still remain high mainly because of the severity of the underlying disease and the numerous complications associated with initiation of ECMO. Induced hypothermia might minimize several pathological pathways present in patients requiring ECMO; even though numerous studies conducted in the experimental setting have reported promising results, there are currently no recommendations suggesting the routine use of this therapy in patients requiring ECMO. In this review, we summarized the existing evidence on the use of induced hypothermia in patients requiring ECMO. Induced hypothermia was a feasible and relatively safe intervention in this setting; however, the effects on clinical outcomes remain uncertain. Whether controlled normothermia has an impact on these patients compared with no temperature control remains unknown. Further randomized controlled trials are required to better understand the role and impact of such therapy in patients requiring ECMO according to the underlying disease.

Keywords: Acute distress respiratory syndrome; Brain; Cardiac arrest; Cardiogenic shock; ECMO; Induced hypothermia; Ischemia; Monitoring; Perfusion; Targeted temperature management.

Fig. 1

Potential benefits from induced hypothermia (IH) in patients with venoarterial (V-A) or venovenous (V-V) extracorporeal membrane oxygenation (ECMO) therapy.