Clinical significance of elevated body temperature without infection following removal of VA-ECMO

BACKGROUND: Previous studies have reported elevated body temperature following the removal of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, the clinical implications of elevated body temperature after the removal of VA-ECMO remain unknown. OBJECTIVES: To characterize elevated body temperature after VA-ECMO removal in patients with cardiogenic shock (CS). METHODS: We retrospectively evaluated 163 CS patients undergoing VA-ECMO removal. All patients did not exhibit any evidence of infection. Blood temperature was continuously monitored using a Swan-Ganz catheter. Elevated body temperature was defined as a maximum body temperature ≥38.0 °C within 24 h after VA-ECMO removal. All-cause mortality was compared between patients with and without elevated body temperature. RESULTS: Elevated body temperature was observed in 58.9% (96/163) of study subjects. Patients with elevated body temperature had higher C-reactive protein (CRP) levels (11.1 ± 8.6 vs. 8.5 ± 6.1 mg/dL, p = 0.027), accompanied by reductions in systolic blood pressure and systemic vascular resistance, and increased lactate levels. CRP levels independently predicted elevated body temperature (OR=1.050, 95%CI=1.003-1.100, p = 0.037). All-cause mortality did not differ between the two groups (30.2%vs. 29.9%, log-rank p = 0.983). However, among patients with elevated body temperature, an increase in body temperature, especially ≥1.1 °C, was associated with higher all-cause mortality (HR=1.968, 95%CI=1.096-3.535, p = 0.023). CONCLUSIONS: In CS patients requiring VA-ECMO, body temperature elevated in 58.9% patients after the removal of VA-ECMO. In those with elevated body temperature, a greater rise in body temperature was associated with higher mortality, suggesting body temperature as a potential signature to stratify risks of mortality in CS patients without any infectious signs.