Characteristics and Outcomes of Veno-Arterial Extracorporeal Membrane Oxygenation in Accidental Hypothermia: A Multicenter Study in Japan

Despite growing evidence supporting the efficacy of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for accidental hypothermia (AH), few studies have assessed its real-world application. We aimed to describe the use and outcomes of VA-ECMO in AH patients using data from a multicenter registry. This retrospective study included adult AH patients from the Japanese accidental hypothermia network registry (J-Point registry) between April 2011 and March 2016. We analyzed patient characteristics, in-hospital data, VA-ECMO indications, and clinical outcomes for those who received VA-ECMO. Of the 537 patients in this registry, 22 received VA-ECMO, with a median age of 80 years. Severe AH was present in 18 patients, and 10 experienced cardiac arrest (CA) on hospital arrival. VA-ECMO was indicated for CA on hospital arrival (10 patients), CA after hospital arrival (5), hemodynamic instability (5), and severe hypothermia (1), with 1 case having an unclear indication. Rewarming was successful in 18 patients, and 9 survived. Survival was higher among those with CA on hospital arrival (5/10) compared with those who developed CA after hospital arrival (1/5). This study highlights the clinical application and outcomes of VA-ECMO for AH patients using multicenter registry data. Among the 22 patients who received VA-ECMO, 9 survived. Patients with CA on hospital arrival showed better survival compared with those who developed CA after arrival, emphasizing the importance of timely VA-ECMO initiation. Further research is warranted to refine patient selection, optimize initiation timing, and evaluate long-term outcomes.