A 48-Year-Old Man With Diabetic Ketoacidosis, Hypothermia, and Cardiac Arrest Managed With Veno-Arterial Extracorporeal Membrane Oxygenation.

BACKGROUND Insulin deficiency can cause hypothermia by preventing glucose uptake into cells, and acidosis can impair metabolic rate. Diabetic ketoacidosis (DKA) and a body temperature <35°C (hypothermia) is a combination with a high mortality rate due to refractory cardiocirculatory collapse and requires emergency management. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a rescue therapy to restore perfusion, rewarming, and manage cardiac arrest. This report describes the case of a 48-year-old man with DKA, hypothermia, and cardiac arrest managed with VA-ECMO. CASE REPORT A 48-year-old man with impaired glucose tolerance presented with unconsciousness and severe hypothermia (body surface temperature: <30°C), DKA (glucose concentration: 58.8 mmol/L, pH: 6.853, HbA1c: 11.1%), and subsequent ventricular fibrillation requiring cardiopulmonary resuscitation. Despite return of spontaneous circulation and conventional therapy, including insulin, fluid resuscitation, and vasopressor support, refractory cardiogenic shock unresponsive to maximal medical therapy required VA-ECMO. His temperature was maintained at 32°C for 24 h for neuroprotection, followed by controlled rewarming. Intensive metabolic management with continuous insulin therapy achieved rapid correction of hyperglycemia (52.2 to 12.1 mmol/L) and hyperosmolality (392 to 327 mmol/kg) within 72 h. Acidosis resolved rapidly, with progressive recovery of renal function, which allowed weaning from VA-ECMO on day 4 and extubation on day 8. Despite concerns for cerebral injury, brain magnetic resonance imaging (MRI) showed no major hypoxic-ischemic damage. The patient achieved good functional recovery. CONCLUSIONS VA-ECMO provides essential dual functionality as circulatory support and precise temperature control in complex metabolic emergencies, enabling successful management of diabetic ketoacidosis-associated hypothermia and cardiac arrest.