{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T14:18:46Z","timestamp":1783088326740,"version":"3.54.6"},"reference-count":95,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T00:00:00Z","timestamp":1776556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Severe accidental hypothermia represents a unique and potentially reversible cause of cardiac arrest in which prolonged resuscitation may still result in favorable neurological recovery. Unlike normothermic cardiac arrest, hypothermic cardiac arrest (HCA) is characterized by profound metabolic suppression and temperature-mediated myocardial instability, requiring a fundamentally different therapeutic paradigm. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) provides not only circulatory support but also controlled reperfusion and rewarming, positioning it as the cornerstone of modern management. Recent international guidelines have clarified indications for extracorporeal life support (ECLS) in HCA and have contributed to improved standardization of care. Building upon these recommendations, this narrative review focuses on physiological principles underlying extracorporeal rewarming and their implications for bedside management. We examine mechanisms of ischemia\u2013reperfusion injury, rewarming-associated hemodynamic instability and myocardial stunning, discuss dynamic risk assessment beyond statistical thresholds such as the HOPE score and summarize practical considerations regarding cannulation strategies, differential hypoxia, left ventricular unloading and neurologic evaluation. By integrating current evidence with pathophysiological insight and organizational considerations, this review proposes a clinically oriented framework to support decision-making in hypothermic cardiac arrest and to optimize meaningful neurological recovery.<\/jats:p>","DOI":"10.3390\/jcm15083119","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T08:24:23Z","timestamp":1776673463000},"page":"3119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Extracorporeal Life Support in Severe Accidental Hypothermia: Mechanisms, Challenges and Clinical Horizons"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5046-4275","authenticated-orcid":false,"given":"Debora Emanuela","family":"Torre","sequence":"first","affiliation":[{"name":"Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Surgery, Ospedale dell\u2019Angelo, Mestre, 30174 Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-6549","authenticated-orcid":false,"given":"Carmelo","family":"Pirri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Paal, P., Pasquier, M., Darocha, T., Lechner, R., Kosinski, S., Wallner, B., Zafren, K., and Brugger, H. (2022). Accidental Hypothermia: 2021 Update. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19010501"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1152\/physiol.00025.2021","article-title":"Physiological Impact of Hypothermia: The Good, the Bad, and the Ugly","volume":"37","author":"Tveita","year":"2022","journal-title":"Physiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/MAT.0000000000001518","article-title":"Extracorporeal Life Support in Accidental Hypothermia with Cardiac Arrest-A Narrative Review","volume":"68","author":"Swol","year":"2022","journal-title":"ASAIO J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"109663","DOI":"10.1016\/j.resuscitation.2022.12.001","article-title":"Outcome of extracorporeal membrane oxygenation use in severe accidental hypothermia with cardiac arrest and circulatory instability: A multicentre, prospective, observational study in Japan (ICE-CRASH study)","volume":"182","author":"Takauji","year":"2023","journal-title":"Resuscitation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.resuscitation.2018.02.026","article-title":"Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score","volume":"126","author":"Pasquier","year":"2018","journal-title":"Resuscitation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1097\/MAT.0000000000002557","article-title":"ELSO 2025 Narrative Guideline on the Use of ECMO for Accidental Hypothermia","volume":"71","author":"Cools","year":"2025","journal-title":"ASAIO J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bjertn\u00e6s, L.J., N\u00e6sheim, T.O., Reierth, E., Suborov, E.V., Kirov, M.Y., Lebedinskii, K.M., and Tveita, T. (2022). Physiological Changes in Subjects Exposed to Accidental Hypothermia: An Update. Front. Med., 9.","DOI":"10.3389\/fmed.2022.824395"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/01.WCB.0000066287.21705.21","article-title":"Effects of hypothermia on energy metabolism in Mammalian central nervous system","volume":"23","author":"Erecinska","year":"2003","journal-title":"J. Cereb. Blood Flow. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1152\/japplphysiol.00317.2017","article-title":"Effects of hypothermia and rewarming on cardiovascular autonomic control in vivo","volume":"124","author":"Dietrichs","year":"2018","journal-title":"J. Appl. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4037\/aacnacc2025895","article-title":"Electrocardiogram Changes Associated with Hypothermia","volume":"36","author":"Leeper","year":"2025","journal-title":"AACN Adv. Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1093\/cvr\/cvy305","article-title":"Hypothermia and cardiac electrophysiology: A systematic review of clinical and experimental data","volume":"115","author":"Dietrichs","year":"2019","journal-title":"Cardiovasc. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/B978-0-12-394309-5.00006-7","article-title":"Cell biology of ischemia\/reperfusion injury","volume":"298","author":"Kalogeris","year":"2012","journal-title":"Int. Rev. Cell Mol. Biol."},{"key":"ref_13","first-page":"260","article-title":"Rewarming from hypothermia. Newer aspects on the pathophysiology of rewarming shock","volume":"59","author":"Tveita","year":"2000","journal-title":"Int. J. Circumpolar Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"109387","DOI":"10.1016\/j.mehy.2019.109387","article-title":"Hypothermia-rewarming: A Double-edged sword?","volume":"133","author":"Hou","year":"2019","journal-title":"Med. Hypotheses"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"137","DOI":"10.21037\/acs.2018.10.12","article-title":"Extracorporeal membrane oxygenation for accidental deep hypothermia-current challenges and future perspectives","volume":"8","author":"Mazur","year":"2019","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/0300-9572(94)90021-3","article-title":"Prognostic markers in patients with severe accidental hypothermia and cardiocirculatory arrest","volume":"27","author":"Mair","year":"1994","journal-title":"Resuscitation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s13049-016-0281-9","article-title":"The chain of survival in hypothermic circulatory arrest: Encouraging preliminary results when using early identification, risk stratification and extracorporeal rewarming","volume":"24","author":"Darocha","year":"2016","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"110753","DOI":"10.1016\/j.resuscitation.2025.110753","article-title":"European Resuscitation Council Guidelines 2025 Special Circumstances in Resuscitation","volume":"215","author":"Lott","year":"2025","journal-title":"Resuscitation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"109711","DOI":"10.1016\/j.resuscitation.2023.109711","article-title":"Implementation of a regional extracorporeal membrane oxygenation program for refractory ventricular fibrillation out-of-hospital cardiac arrest","volume":"187","author":"Bosson","year":"2023","journal-title":"Resuscitation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s13613-023-01174-1","article-title":"Percutaneous cannulation is associated with lower rate of severe neurological complication in femoro-femoral ECPR: Results from the Extracorporeal Life Support Organization Registry","volume":"13","author":"Wang","year":"2023","journal-title":"Ann. Intensive Care"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Torre, D.E., and Pirri, C. (2025). Point-of-Care Transesophageal Echocardiography in Emergency and Intensive Care: An Evolving Imaging Modality. Biomedicines, 13.","DOI":"10.3390\/biomedicines13112680"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ijcard.2022.04.084","article-title":"Strategies to reduce limb ischemia in peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and Meta-analysis","volume":"361","author":"Marbach","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.resuscitation.2018.10.014","article-title":"Extracorporeal life support in the emergency department: A narrative review for the emergency physician","volume":"133","author":"Swol","year":"2018","journal-title":"Resuscitation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1007\/s00134-018-5442-z","article-title":"Percutaneous versus surgical femoro-femoral veno-arterial ECMO: A propensity score matched study","volume":"44","author":"Danial","year":"2018","journal-title":"Intensive Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"39992","DOI":"10.31083\/RCM39992","article-title":"Harlequin Syndrome in Venoarterial ECMO and ECPELLA: When ECMO and Native or Impella Circulations Collide\u2014A Comprehensive Review","volume":"26","author":"Torre","year":"2025","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1007\/s00134-024-07645-8","article-title":"Extracorporeal Life Support Organization (ELSO). Position paper on the physiology and nomenclature of dual circulation during venoarterial ECMO in adults","volume":"50","author":"Badulak","year":"2024","journal-title":"Intensive Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1161\/CIRCULATIONAHA.120.048792","article-title":"Left Ventricular Unloading Is Associated with Lower Mortality in Patients with Cardiogenic Shock Treated with Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study","volume":"142","author":"Schrage","year":"2020","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1161\/CIRCULATIONAHA.122.062371","article-title":"Unloading the Left Ventricle in Venoarterial ECMO: In Whom, When, and How?","volume":"147","author":"Ezad","year":"2023","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1177\/02676591211027118","article-title":"Average mean arterial pressure in the first 6\u2009hours of extracorporeal cardiopulmonary resuscitation in the prediction of the prognosis of neurological outcome: A single-center retrospective study","volume":"37","author":"Sun","year":"2022","journal-title":"Perfusion"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.amjcard.2023.09.023","article-title":"Left Ventricular Unloading with Impella Versus IABP in Patients with VA-ECMO: A Systematic Review and Meta-Analysis","volume":"208","author":"Gandhi","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Torre, D.E., and Pirri, C. (2025). Beyond Standard Parameters: Precision Hemodynamic Monitoring in Patients on Veno-Arterial ECMO. J. Pers. Med., 15.","DOI":"10.3390\/jpm15110541"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1177\/0885066620966962","article-title":"The Use of Cerebral NIRS Monitoring to Identify Acute Brain Injury in Patients with VA-ECMO","volume":"36","author":"Hunt","year":"2021","journal-title":"J. Intensive Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.cryobiol.2018.02.010","article-title":"Role of superoxide ion formation in hypothermia\/rewarming induced contractile dysfunction in cardiomyocytes","volume":"81","author":"Schaible","year":"2018","journal-title":"Cryobiology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1056\/NEJMra1114208","article-title":"Accidental hypothermia","volume":"367","author":"Brown","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/00000542-199003000-00020","article-title":"Oxygen delivery and consumption during hypothermia and rewarming in the dog","volume":"72","author":"Morray","year":"1990","journal-title":"Anesthesiology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/j.jtcvs.2020.09.045","article-title":"2020 EACTS\/ELSO\/STS\/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients","volume":"161","author":"Lorusso","year":"2021","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1097\/CCM.0000000000006134","article-title":"Oxygenation During Venoarterial Extracorporeal Membrane Oxygenation: Physiology, Current Evidence, and a Pragmatic Approach to Oxygen Titration","volume":"52","author":"Premraj","year":"2024","journal-title":"Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/S0022-5223(96)70230-1","article-title":"Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting","volume":"111","author":"Patel","year":"1996","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.athoracsur.2013.09.008","article-title":"Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1866 adult patients","volume":"97","author":"Cheng","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S578","DOI":"10.1161\/CIR.0000000000001380","article-title":"Part 10: Adult and Pediatric Special Circumstances of Resuscitation: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"152","author":"Cao","year":"2025","journal-title":"Circulation"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e517","DOI":"10.1161\/CIR.0000000000000702","article-title":"Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement from the American Heart Association","volume":"140","author":"Geocadin","year":"2019","journal-title":"Circulation"},{"key":"ref_42","first-page":"CD004128","article-title":"Hypothermia for neuroprotection in adults after cardiac arrest","volume":"5","author":"Arrich","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"S673","DOI":"10.1161\/CIR.0000000000001375","article-title":"Part 11: Post-Cardiac Arrest Care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"152","author":"Hirsch","year":"2025","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"S366","DOI":"10.1161\/CIR.0000000000000916","article-title":"Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"142","author":"Panchal","year":"2020","journal-title":"Circulation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e194","DOI":"10.1161\/CIR.0000000000000697","article-title":"Pediatric Post-Cardiac Arrest Care: A Scientific Statement from the American Heart Association","volume":"140","author":"Topjian","year":"2019","journal-title":"Circulation"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1001\/jama.2019.1696","article-title":"In-Hospital Cardiac Arrest: A Review","volume":"321","author":"Andersen","year":"2019","journal-title":"JAMA"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1161\/CIR.0000000000001194","article-title":"2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"149","author":"Perman","year":"2024","journal-title":"Circulation"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e168","DOI":"10.1161\/CIR.0000000000001163","article-title":"Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society","volume":"149","author":"Hirsch","year":"2024","journal-title":"Circulation"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S1474-4422(20)30117-4","article-title":"Brain injury after cardiac arrest: From prognostication of comatose patients to rehabilitation","volume":"19","author":"Cronberg","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1053\/j.jvca.2025.10.011","article-title":"Neuroprognostication in Extracorporeal Membrane Oxygenation Patients After Cardiac Arrest: A Narrative Review","volume":"40","author":"Maj","year":"2026","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1186\/s13054-025-05572-8","article-title":"Beyond blood-brain barrier disruption and molecular weight: Compartmental kinetics of S100B and NSE for neurological prognostication after cardiac arrest","volume":"29","author":"Jeon","year":"2025","journal-title":"Crit. Care"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Akin, M., Garcheva, V., Sieweke, J.T., Adel, J., Flierl, U., Bauersachs, J., and Sch\u00e4fer, A. (2021). Neuromarkers and neurological outcome in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia-experience from the HAnnover COoling REgistry (HACORE). PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0245210"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s12028-023-01688-3","article-title":"Guidelines for Neuroprognostication in Comatose Adult Survivors of Cardiac Arrest","volume":"38","author":"Rajajee","year":"2023","journal-title":"Neurocrit. Care"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13054-025-05794-w","article-title":"Management of post-resuscitation vasoplegic shock: Targets, strategies and outcomes","volume":"30","author":"Jendoubi","year":"2025","journal-title":"Crit. Care"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s00134-022-06620-5","article-title":"ERC-ESICM guidelines on temperature control after cardiac arrest in adults","volume":"48","author":"Sandroni","year":"2022","journal-title":"Intensive Care Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1055\/s-0036-1595814","article-title":"withdrawal of Life-Sustaining Therapy after Cardiac Arrest","volume":"37","author":"Cronberg","year":"2017","journal-title":"Semin. Neurol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jcrc.2020.11.008","article-title":"Impact of therapeutic hypothermia on bleeding events in adult patients treated with extracorporeal life support peri-cardiac arrest","volume":"62","author":"Mecklenburg","year":"2021","journal-title":"J. Crit. Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1093\/ageing\/17.5.343","article-title":"Impaired coagulation in accidental hypothermia of the elderly","volume":"17","author":"Breen","year":"1988","journal-title":"Age Ageing"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1097\/00003246-199210000-00007","article-title":"Effect of hypothermia on the coagulation cascade","volume":"20","author":"Rohrer","year":"1992","journal-title":"Crit. Care Med."},{"key":"ref_60","first-page":"5348835","article-title":"Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors","volume":"2022","author":"Nguyen","year":"2022","journal-title":"Crit. Care Res. Pract."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1097\/MAT.0000000000001605","article-title":"Thrombosis in Extracorporeal Membrane Oxygenation (ECMO) Circuits","volume":"68","author":"McMullan","year":"2022","journal-title":"ASAIO J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"H2680\u20137","DOI":"10.1152\/ajpheart.00425.2005","article-title":"Sustained hypothermia accelerates microvascular thrombus formation in mice","volume":"289","author":"Lindenblatt","year":"2005","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1055\/s-0038-1648231","article-title":"Hemostasis and Thrombosis in Extreme Temperatures (Hypo- and Hyperthermia)","volume":"44","author":"Levi","year":"2018","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.jtha.2022.11.014","article-title":"Anticoagulation in adult patients supported with extracorporeal membrane oxygenation: Guidance from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis","volume":"21","author":"Helms","year":"2023","journal-title":"J. Thromb. Haemost."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1053\/j.jvca.2018.07.045","article-title":"Bleeding, Thrombosis, and Transfusion with Two Heparin Anticoagulation Protocols in Venoarterial ECMO Patients","volume":"33","author":"Mazzeffi","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1186\/s13054-019-2541-3","article-title":"Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: A narrative review of incidence, prevention, monitoring, and treatment","volume":"23","author":"Bonicolini","year":"2019","journal-title":"Crit. Care"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jacc.2018.11.038","article-title":"Venoarterial ECMO for Adults: JACC Scientific Expert Panel","volume":"73","author":"Guglin","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.jemermed.2017.12.013","article-title":"Point-of-Care Ultrasound-Guided Percutaneous Cannulation of Extracorporeal Membrane Oxygenation: Make it Simple","volume":"54","author":"Ahn","year":"2018","journal-title":"J. Emerg. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e611","DOI":"10.1097\/CCM.0000000000004377","article-title":"Brain Injury and Neurologic Outcome in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis","volume":"48","author":"Migdady","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/CCM.0000000000004789","article-title":"CNS Complications in Adult Patients Treated with Extracorporeal Membrane Oxygenation","volume":"49","author":"Chapman","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/CCM.0000000000006946","article-title":"Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan (SAVE-J II Study) Group. Acute Kidney Injury After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest","volume":"54","author":"Taira","year":"2026","journal-title":"Crit. Care Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1097\/CCM.0000000000006102","article-title":"Post-Cardiac Arrest Care in Adult Patients After Extracorporeal Cardiopulmonary Resuscitation","volume":"52","author":"Kang","year":"2024","journal-title":"Crit. Care Med."},{"key":"ref_73","first-page":"241","article-title":"Management of postcardiac arrest myocardial dysfunction","volume":"17","author":"Zia","year":"2011","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1136\/emj.19.5.478","article-title":"Dead? Or just cold: Profoundly hypothermic patient with no signs of life","volume":"19","author":"Ko","year":"2002","journal-title":"Emerg. Med. J."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"S323","DOI":"10.1161\/CIR.0000000000001371","article-title":"Part 3: Ethics: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"152","author":"Elmer","year":"2025","journal-title":"Circulation"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Hymczak, H., Go\u0142\u0105b, A., Kosi\u0144ski, S., Podsiad\u0142o, P., Sobczyk, D., Drwi\u0142a, R., Kapelak, B., Darocha, T., and Plicner, D. (2023). The Role of Extracorporeal Membrane Oxygenation ECMO in Accidental Hypothermia and Rewarming in Out-of-Hospital Cardiac Arrest Patients-A Literature Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216730"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.resuscitation.2021.02.017","article-title":"European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions","volume":"161","author":"Mentzelopoulos","year":"2021","journal-title":"Resuscitation"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/s13049-025-01445-9","article-title":"Use of the HOPE score to assess survival outcome of hypothermic cardiac arrest selected by ECLS rewarming","volume":"33","author":"Hall","year":"2025","journal-title":"Scand. J. Trauma. Resusc. Emerg. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1177\/10499091211041079","article-title":"Clinician Ethical Perspectives on Extracorporeal Membrane Oxygenation in Practice","volume":"39","author":"Piscitello","year":"2022","journal-title":"Am. J. Hosp. Palliat. Care"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/15265161.2022.2075959","article-title":"From Bridge to Destination? Ethical Considerations Related to withdrawal of ECMO Support over the Objections of Capacitated Patients","volume":"23","author":"Childress","year":"2023","journal-title":"Am. J. Bioeth."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"3541","DOI":"10.1053\/j.jvca.2025.07.032","article-title":"Ethical Considerations for Patients Requiring Extracorporeal Cardiopulmonary Resuscitation","volume":"39","author":"Rajsic","year":"2025","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s13054-023-04432-7","article-title":"Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: Ethical and logistical considerations","volume":"27","author":"Schiff","year":"2023","journal-title":"Crit. Care"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.jtcvs.2007.03.049","article-title":"Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest","volume":"134","author":"Ruttmann","year":"2007","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s13049-026-01543-2","article-title":"Emergency care for avalanche buried patients\u2014A narrative review","volume":"34","author":"Strapazzon","year":"2026","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/B978-0-444-64074-1.00033-1","article-title":"Accidental hypothermia","volume":"157","author":"Paal","year":"2018","journal-title":"Handb. Clin. Neurol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1016\/j.jacc.2014.03.046","article-title":"Extracorporeal membrane oxygenation in cardiopulmonary disease in adults","volume":"63","author":"Abrams","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/acem.14585","article-title":"Extracorporeal membrane oxygenation versus conventional rewarming for severe hypothermia in an urban emergency department","volume":"30","author":"Prekker","year":"2023","journal-title":"Acad. Emerg. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"18918","DOI":"10.1038\/s41598-021-98044-2","article-title":"Effects of rewarming with extracorporeal membrane oxygenation to restore oxygen transport and organ blood flow after hypothermic cardiac arrest in a porcine model","volume":"11","author":"Nilsen","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1001\/jama.2025.14593","article-title":"Extracorporeal Life Support in Accidental Hypothermia","volume":"334","author":"Mendrala","year":"2025","journal-title":"JAMA"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.hlc.2014.06.011","article-title":"Extracorporeal-assisted rewarming in the management of accidental deep hypothermic cardiac arrest: A systematic review of the literature","volume":"23","author":"Dunne","year":"2014","journal-title":"Heart Lung Circ."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1152\/jappl.1998.85.6.2135","article-title":"Left ventricular dysfunction following rewarming from experimental hypothermia","volume":"85","author":"Tveita","year":"1998","journal-title":"J. Appl. Physiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1213\/00000539-199408000-00002","article-title":"Experimental hypothermia: Effects of core cooling and rewarming on hemodynamics, coronary blood flow, and myocardial metabolism in dogs","volume":"79","author":"Tveita","year":"1994","journal-title":"Anesth. Analg."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s00134-018-5064-5","article-title":"International ECMO Network (ECMONet) and The Extracorporeal Life Support Organization (ELSO). Position paper for the organization of ECMO programs for cardiac failure in adults","volume":"44","author":"Abrams","year":"2018","journal-title":"Intensive Care Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1016\/j.athoracsur.2020.04.076","article-title":"Outcomes of Extracorporeal Life Support Use in Accidental Hypothermia: A Systematic Review","volume":"110","author":"Austin","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Hymczak, H., Podsiad\u0142o, P., Kosi\u0144ski, S., Pasquier, M., Mendrala, K., Hudziak, D., Goco\u0142, R., Plicner, D., and Darocha, T. (2021). Prognosis of Hypothermic Patients Undergoing ECLS Rewarming\u2014Do Alterations in Biochemical Parameters Matter?. Int. J. Environ. Res. 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