Figure 2 Temperature management course and metabolic recovery during VA-ECMO supportThe core body temperature (solid blue line) and arterial pH (dashed red line) over the first 5 days of hospitalization are shown. The temperature was measured via an ECMO circuit until weaning from VA-ECMO, and an axillary temperature was used thereafter. Targeted temperature management was initiated at 32°C and maintained for 24 h (day 1 [20: 00 h] to day 2 [20: 00 h]), followed by controlled rewarming at 0.1°C/h until normothermia was achieved on day 4. Correction of concurrent metabolic acidosis is shown by progressive normalization of the pH from 6.85 to the normal range. VA-ECMO and CRRT support periods are indicated by horizontal bars. Vasopressor requirements (dobutamine 5 μg/kg/min, noradrenaline 0.4 μg/kg/min) are shown during the initial phase. VA-ECMO was successfully weaned on hospital day 4. BT – body temperature; CRRT – continuous renal replacement therapy; VA-ECMO – veno-arterial extracorporeal membrane oxygenation.