In CS patients requiring VA-ECMO, body temperature elevated in 58.9% after the removal of VA-ECMO, and 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.
Elevated body temperature (maximum ≥38.0 °C within 24 h) after VA-ECMO removal occurred in more than half of cardiogenic shock patients without evidence of infection.
Patients with elevated body temperature had higher CRP levels, lower systolic blood pressure and systemic vascular resistance, and higher lactate.
CRP level independently predicted elevated body temperature after VA-ECMO removal.
All-cause mortality did not differ between patients with and without elevated body temperature.
Among patients with elevated body temperature, a greater temperature rise, especially ≥1.1 °C, was associated with higher all-cause mortality.
This study looked at 163 patients with cardiogenic shock (a severe form of heart failure) who were taken off a heart-lung support machine called VA-ECMO and who had no signs of infection. About 59% of them developed a fever of 38.0 °C or higher within 24 hours of removal. Those with fever had higher levels of an inflammation marker (CRP), lower blood pressure and vascular resistance, and higher lactate, a marker of poor tissue perfusion. Having a fever did not by itself change the chance of dying: about 30% died in both groups. However, among patients who did develop a fever, those whose temperature rose more, especially by 1.1 °C or more, had higher mortality. CRP level was independently linked with developing a fever. This research suggests that a fever after VA-ECMO removal is common and not necessarily a sign of infection, but how much the temperature rises may help identify patients at higher risk. The study was retrospective, so it shows associations and cannot prove cause and effect.
Nakayama T, Kataoka Y, Makimura Y, Hirashima K, Miyagawa S, Mitsui K, et al.. (2026). Clinical significance of elevated body temperature without infection following removal of VA-ECMO.. Heart & lung : the journal of critical care. https://doi.org/10.1016/j.hrtlng.2026.102980