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Introduction: Heater-cooler units (HCUs) are frequently incorporated into extracorporeal membrane oxygenation (ECMO) circuits to help maintain patient normothermia. However, these devices may be associated with increased cost and infection risk. This study describes our institution's experience managing adult ECMO patients without the routine use of in-circuit HCUs., Methods: We performed a retrospective analysis of adult patients treated with veno-venous (VV) or veno-arterial (VA) ECMO at our institution. The primary outcomes were rates of HCU use and the relative duration of the ECMO treatment course in which patients maintained normothermia (36-37.5°C), with and without HCUs. Secondary outcomes of mortality and ECMO-related complications were planned across HCU and non-HCU groups; exploratory analyses were performed across a 75% "ECMO time in normothermia" threshold., Results: Among a cohort of 71 patients, zero (0%) were managed with in-circuit HCUs. A majority of ECMO patient-hours were spent in the normothermic range. Median and mean percentages of ECMO normothermia time were 75% (IQR 49%-81%) and 62% (SD ± 27%). Twenty-nine patients (40%) met the threshold of 75% ECMO normothermia time, as used to evaluate secondary outcomes. At this threshold, mortality risk was significantly higher among the non-normothermic cohort; other ECMO-related complications did not vary significantly., Conclusions: In the absence of HCU use, the majority of ECMO patient-hours were spent in normothermia. However, only a minority of patients achieved normothermia for at least 75% of their ECMO course. In-circuit HCUs may be required to maintain high percentages of normothermic time in adult EMCO patients., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A 41-year-old female presented with a large anterior mediastinal mass adjacent to the heart. Biopsy demonstrated lymphoma. Upon administration of chemotherapy, she developed cardiogenic shock requiring a 5-day course of extracorporeal membrane oxygenation (ECMO) as a bridge through her treatment. After one cycle of chemotherapy, ECMO was discontinued and the patient completed her course of chemotherapy and recovered to hospital discharge.

Unlabelled: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be lifesaving in patients with cardiopulmonary collapse. However, observation studies have implied that oxygenated blood does not pass in a retrograde fashion from the VA-ECMO circuit to the aortic root and arch when the femoral artery (FA) is used. This study aims at accurately measuring the oxygen saturation in various arteries during VA-ECMO through different cannula sites. A total of 20 patients with VA-ECMO were in the study. Fourteen patients had FA cannulation, two patients received axillary arterial (AA) cannulation, and four patients received cannulation of the ascending aorta. Oxygen saturation was measured simultaneously in the radial artery and oxygenator outlet. In the patient group with FA cannulation, the oxygen saturation was lower in the radial artery (97%) when compared with the oxygenator outlet (> 99%). In the subset group of patients with severe lung dysfunction, oxygen saturation was even lower in the radial artery (73% saturation). In the patient group with AA cannulation, the oxygen saturation and partial oxygen pressure (PO2) in the oxygenator outlet and radial artery were similar (99% or greater). In the patient group with direct ascending aorta cannulation, the oxygen saturation and PO2 in the oxygenator outlet and radial artery were similar as well. Regional variations occur in the blood oxygen saturation depending on the site of the arterial cannulation in patients with VA-ECMO. With FA cannulation, the oxygen saturation in the radial artery is significantly lower than the one in the oxygenator outlet. This may imply that the coronaries and the brain receive hypoxic blood from the left ventricle. These results suggest that antegrade cannulation for VA-ECMO improves oxygen delivery to the proximal aorta distribution., Keywords: VA-ECMO, arterial oxygen saturation.