• Anne Mecklenburg, Johannes Stamm, Federico Angriman, Lorenzo Del Sorbo, Eddy Fan, Gerold Soeffker, Alexander Bernhardt, Herrmann Reichenspurner, Benedikt Schrage, Dirk Westermann, Stephan Braune, and Stefan Kluge.
• Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, 585 University Avenue, Toronto, ON M5G 2N2, Canada. Electronic address: a.mecklenburg@uke.de.
• J Crit Care. 2021 Apr 1; 62: 12-18.

PurposeWhether therapeutic hypothermia (TH) adds to the risk of bleeding in patients on extracorporeal life support (ECLS) peri-cardiac arrest remains unknown.Material And MethodsSingle center retrospective study on patients receiving veno-arterial ECLS peri-cardiac arrest ± TH at 32-34 °C (January 2009-December 2015).Primary Outcomemajor bleeding (including intracerebral hemorrhage, ICH) < 72 h of cardiac arrest. Logistic regression and marginal structural models were used to analyze associations with major bleeding.ResultsOf 66 patients receiving ECLS, 36 were treated with TH. Major bleeding occurred in 14 patients (39%) treated with ECLS+TH and in 17 patients (57%) with ECLS alone. ICH was reported in 3 (8%) and one patient (3%), respectively. There was no difference in mortality, but lung injury occurred more often in ECLS+TH. A platelet count <60 × 109/L but not TH was associated with major bleeding (including ICH). The estimated causal risk ratio of TH on the occurrence of major bleeding (including ICH) at 72 h post cardiac arrest was 0.95 (95%CI 0.62-1.45).ConclusionsBleeding complications were common in our study. However, TH (32-34 °C) was not associated with an increased risk of major bleeding in patients on ECLS peri-cardiac arrest.Copyright © 2020 Elsevier Inc. All rights reserved.

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