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

Objective: To investigate the feasibility of applying mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO).;Design: A prospective, non-randomised pilot study of twenty five neonates referred for ECMO. Whole body cooling was achieved by adjustment of the extracorporeal circuit water bath temperature. Five groups (N=5 per group) were each studied for the first five days of ECMO. The first group was maintained at 37°C throughout the study period. Subsequent groups were cooled to 36°C, 35°C and finally 34°C respectively for twenty four hours and the final group to 34°C for forty eight hours before being rewarmed to 37°C. 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, antithrombin III and plasmin alpha 2 plasminogen) 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 arrhythmias. No systematic difference was found between groups in terms of molecular markers of coagulation complement, cytokines and platelet transfusions. This could however not be tested statistically due to small group sizes.;Conclusions: This pilot study has demonstrated that the use of mild hypothermia in patients receiving ECMO is feasible and in the number of patients studied did not produce adverse effects, as indicated by the measurements undertaken.