A pilot investigation of mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO)

Objective To investigate the safety and feasibility of using mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO). Study design A prospective, nonrandomized pilot study of 25 neonates referred for ECMO. Whole body cooling was achieved by adjustment of the temperature of the extracorporeal circuit water bath. Five groups (NI = 5 per group) were each studied for the first 5 days of ECMO. The first group was maintained at 37degreesC throughout the study period. Subsequent groups were cooled to 36degreesC, to 35degreesC. and, finally, to 34degreesC, respectively, for 24 hours and the final group to 34degreesC for 48 hours before being rewarmed to 37degreesC. Patients were carefully assessed clinically and biologically. In addition to routine laboratory tests, cytokines (IL-6 and IL-8), complement (C3a), and molecular markers of coagulation (thrombin/antithrombin III [TAT], antithrombin III, and plasmin-alpha2plasminogen) were measured. Results No major clinical or circuit problems were noted during cooling or rewarming. In particular, there were no problems of bleeding or cardiac arrhythmia. No significant difference was found between groups in terms of molecular markers of coagulation, complement, cytokines, and platelet transfusions. Conclusions Applying mild hypothermia (34degreesC) for 24 or 48 hours to neonates receiving ECMO is both feasible and safe.