AIM Patients with accidental hypothermia without vital signs increasingly receive venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, there is limited knowledge regarding the efficacy of this advanced rewarming method. We aimed to determine whether VA-ECMO improved outcomes in patients with accidental hypothermia without vital signs, using a large nationwide inpatient database in Japan. METHODS Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2017, we identified patients diagnosed with accidental hypothermia who received closed-chest cardiac massage in-hospital on the day of admission. Patients who received VA-ECMO on the day of admission were allocated to the VA-ECMO group, and those who received cardiopulmonary resuscitation (CPR) only were allocated to the conventional CPR group. The primary outcome was in-hospital mortality, and the secondary outcome was a Japan Coma Scale status of "alert consciousness" at discharge. Propensity score-matching analyses were performed to compare the outcomes. RESULTS We identified 1661 eligible patients during the 81-month study period, and 318 (19%) received VA-ECMO on the day of admission. Crude in-hospital mortality was 65% in the VA-ECMO group and 84% in the conventional CPR group. Propensity score-matching analyses demonstrated significantly lower in-hospital mortality (risk difference: -13%; 95% confidence interval: -21% to -5.1%) and a higher proportion of "alert consciousness" at discharge (risk difference: 8.3%; 95% confidence interval: 1.9%-15%) in the VA-ECMO group compared with the conventional CPR group. CONCLUSION VA-ECMO was associated with higher survival and favourable neurological outcomes compared with conventional CPR alone in patients with accidental hypothermia without vital signs.

中文翻译：

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体外膜肺氧合可改善没有生命体征的意外体温过低的结果：一项全国性观察研究

目的 无生命​​体征的意外低温患者越来越多地接受静脉动脉体外膜肺氧合 (VA-ECMO)。然而，关于这种先进的复温方法的功效的知识有限。我们的目的是确定 VA-ECMO 是否可以改善无生命体征的意外体温过低患者的预后，使用日本的大型全国住院患者数据库。方法 使用 2010 年 7 月至 2017 年 3 月的日本诊断程序组合住院患者数据库，我们确定了在入院当天接受了闭胸心脏按摩的被诊断为意外体温过低的患者。入院当天接受 VA-ECMO 的患者被分配到 VA-ECMO 组，仅接受心肺复苏（CPR）的患者被分配到常规 CPR 组。主要结果是院内死亡率，次要结果是出院时日本昏迷量表的“警觉意识”状态。进行倾向评分匹配分析以比较结果。结果 我们在 81 个月的研究期间确定了 1661 名符合条件的患者，其中 318 名（19%）在入院当天接受了 VA-ECMO。VA-ECMO 组的粗院内死亡率为 65%，常规 CPR 组为 84%。倾向评分匹配分析显示院内死亡率显着降低（风险差异：-13%；95% 置信区间：-21% 至 -5.1%）和更高比例的出院时“警觉意识”（风险差异：8.3% ; 与常规 CPR 组相比，VA-ECMO 组的 95% 置信区间：1.9%-15%)。