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Randomized Controlled Trial
. 2024 Jul:200:110235.
doi: 10.1016/j.resuscitation.2024.110235. Epub 2024 May 17.

Hypothermia in patients with cardiac arrest prior to ECMO-VA: Insight from the HYPO-ECMO trial

Bruno Levy  1 , Nicolas Girerd  2 , Kevin Duarte  2 , Marie-Lauren Antoine  3 , Luca Monzo  2 , Alexandre Ouattara  4 , Clément Delmas  5 , Daniel Brodie  6 , Alain Combes  7 , Antoine Kimmoun  8 , Guillaume Baudry  9 ; HYPO-ECMO Trial Group, the International ECMO Network ECMONet
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Free article
Randomized Controlled Trial

Hypothermia in patients with cardiac arrest prior to ECMO-VA: Insight from the HYPO-ECMO trial

Bruno Levy et al. Resuscitation. 2024 Jul.
Free article

Abstract

Aim: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has become a common intervention for patients with cardiogenic shock (CS), often complicated by cardiac arrest (CA). Moderate hypothermia (MH) has shown promise in mitigating ischemia-reperfusion injury following CA. The HYPO-ECMO trial aimed to compare the effect of MH versus normothermia in refractory CS rescued by VA-ECMO. The primary aim of this non-predefined post hoc study was to assess the treatment effect of MH in the subgroup of patients with cardiac arrest (CA) within the HYPO-ECMO trial. Additionally, we will evaluate the prognostic significance of CA in these patients.

Methods: This post hoc analysis utilized data from the randomized HYPO-ECMO trial conducted across 20 French cardiac shock care centers between October 2016 and July 2019. Participants included intubated patients receiving VA-ECMO for CS for less than 6 h, with 334 patients completing the trial. Patients were randomized to early MH (33-34 °C) or normothermia (36-37 °C) for 24 h.

Results: Of the 334 patients, 159 (48%) experienced preceding CA. Mortality in the CA group was 50.9% at 30 days and 59.1% at 180 days, compared to 42.3% and 51.4% in the no-CA group, respectively (adjusted risk difference [RD] at 30 days, 8.1% [-0.8 to 17.1%], p = 0.074 and RD at 180 days 7.0% [-3.0 to 16.9%], p = 0.17). MH was associated with a significant reduction in primary (RD -13.3% [-16.3 to -0.3%], p = 0.031) and secondary outcomes in the CA group only (p < 0.025 for all), with a significant interaction between MH and CA status for 180-day mortality [p = 0.03].

Conclusions: This post hoc analysis suggests that MH shows potential for reducing mortality and composite endpoints in patients with cardiac arrest and refractory CS treated with VA-ECMO without an increased risk of severe bleeding or infection. Further research is needed to validate these findings and elucidate underlying mechanisms.

Keywords: Cardiac arrest; Extracorporeal Membrane Oxygenation; Hypothermia, induced; Shock, cardiogenic.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Pr. Levy reported receiving personal fees from Abiomed, Gettinge, Baxter, Novartis, Sanofi, Amomed, and Orion, outside the submitted work. Pr. Girerd reported receiving personal fees from Novartis, Bayer, AstraZeneca, Lilly, Boehringer, and Vifor, outside the submitted work. Dr. Duarte reported no conflicts of interest regarding this work. Dr. Marie-Lauren Antoine reported no conflicts of interest regarding this work. Mrs. Dr. Monzo reported receiving personal fees from AstraZeneca and Vifor, outside the submitted work. Dr. Ouattara reported receiving personal fees from Abiomed, Nordic Pharma, LFB, VifOR Pharma, Orion Pharma, ISEP, Masimo, and Medtronic. Dr. Delmas reported receiving personal fees from Abiomed and Abbott Laboratories. Pr. Brodie reports receiving research support from and consults for LivaNova. He has been on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira and Cellenkos. He is the President-elect of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Executive Committee of the International ECMO Network (ECMONet), and he writes for UpToDate. Pr. Combes reported receiving personal fees from Getinge, Baxter, and Fresenius-Xenios, outside the submitted work. Pr. Kimmoun reported no conflicts of interest regarding this work. Dr. Baudry reported receiving personal fees from Abbott, AstraZeneca, and Boehringer, outside the submitted work.

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