2022年 · 第102卷第25期

Initiation of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy for patients with cardiogenic shock has become an increasingly common measure, including patients with cardiac arrest who have failed conventional therapy. Patients with refractory cardiogenic shock who require VA-ECMO support may have the most severe ischemia-reperfusion injury. Although hypothermia is not currently demonstrated to significantly improve hemodynamics and mortality, moderate hypothermia attenuates the deleterious effects of ischemia-reperfusion injury and is well tolerated in patients with cardiac arrest and cardiogenic shock. In view of the absence of outcome data addressing this issue, in vitro life support currently recommends that these patients maintain normal body temperature. Although there is currently a lack of randomized clinical studies comparing standard therapy alone with standard therapy in combination with ECMO, the use of ECMO in the treatment of refractory cardiogenic shock is gradually increasing worldwide, so it is necessary to determine the optimal treatment. This HYPO-ECMO study was designed to verify whether early application of moderate hypothermia (33℃ ~34℃) can improve the prognosis of patients with refractory cardiogenic shock supported by VA-ECMO compared with strict control of normal body temperature (36℃ ~37℃).

Extracorporeal membrane oxygenation (ECMO) has been widely used to treat patients with severe respiratory failure caused by novel coronavirus pneumonia (COVID-19). Some reports have shown higher mortality rates in these COVID-19 patients treated with ECMO, while some other studies have found ECMO treatment to improve prognosis. Among them, a recent retrospective study found a pooled in-hospital mortality rate of 37.1%, which is comparable to mortality from pandemic influenza and non-COVID-19-caused acute respiratory distress syndrome. The consensus guidelines give cautious recommendations for the application of ECMO support in specific COVID-19 patients. Limited evidence from causal analyses of cohorts of ECMO-supported COVID-19 patients suggests that ECMO may have a survival benefit for such patients. However, considering different selection criteria, outcome judgment criteria, and patient baseline characteristics, the additional benefits of ECMO for patients with severe respiratory failure caused by COVID-19 are currently uncertain. At the start of the COVID-19 pandemic, a centralized national referral system was established in the UK, providing a unified pathway for those COVID-19 patients who may need ECMO support to be referred to specialist centres. The large number of referrals, as well as the detailed data recorded through the referral system, prompted the ability to use ECMO as an intervention to analyze a large cohort of patients with severe respiratory failure with COVID-19 with detailed records.