Considering veno-venous extracorporeal membrane oxygenation as a first-line strategy for rewarming in accidental hypothermia complicated by cardiac arrest - a case series

Severe accidental hypothermia can lead to cardiac arrest. The most efficient method of resuscitating and warming is by ECMO (Extracorporeal Membrane Oxygenation). While the convention is to use VA ECMO (Veno Arterial ECMO), using VV ECMO (Veno Venous ECMO) in which the blood is returned directly into the right ventricle could be an alternative and lead to conversion to life sustaining cardiac rhythm. In this article we present our case series of ECMO for resuscitation of accidental hypothermia complicated by cardiac arrest. We used VV ECMO for 4 patients; in 3 of them ROSC (Return of Spontaneous Circulation) was successfully achieved. We also discuss the potential advantages of VV ECMO and VA ECMO in this setting and present our algorithm for management.