HYPO ECMO

Effect of Moderate Hypothermia vs Normothermia on 30-Day Mortality in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation: The HYPO-ECMO study – A Randomized Clinical Trial 
Levy et al | Journal of the American Medical Association | Feb 2022 DOI:10.1001/jama.2021.24776

Clinical Question

In patients with cardiogenic shock receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO), does early use of moderate hypothermia (33-34°C) compared with strict normothermia (36-37 °C) improve 30 day mortality?

N = 374, 20 ICUs in France

Authors’ Conclusions

In a mixed population of adults requiring VA-ECMO for refractory cardiogenic shock, early application of moderate hypothermia for 24 hours did not significantly increase survival compared with normothermia. However, the 95% confidence interval was wide and included a potentially important effect size, warranting further study

The Bottom Line

-  Early moderate hypothermia for patients requiring VA-ECMO was not shown to reduce 30 day mortality
-  The observed effect size could be clinically significant and warrants further investigation
-  I would be interested to know if there was a difference in effect size between those with and without cardiac arrest
-  For now I will continue to utilise normothermia for patients requiring VA-ECMO for refractory cardiogenic shock