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Mild hypothermia in cardiogenic shock complicating myocardial infarction the randomized SHOCK-COOL pilot trial

Session Rapid Fire Session

Speaker Georg Fuernau

Congress : Acute Cardiovascular Care 2016

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care - Cardiogenic Shock
  • Session type : Rapid Fire Abstracts
  • FP Number : 365

Authors : G Fuernau (Lubeck,DE), J Beck (Leipzig,DE), S Desch (Lubeck,DE), I Eitel (Lubeck,DE), C Jung (Duesseldorf,DE), S Erbs (Leipzig,DE), N Mangner (Leipzig,DE), K Fengler (Leipzig,DE), M Sandri (Leipzig,DE), GC Schuler (Leipzig,DE), H Thiele (Lubeck,DE)

Authors:
G Fuernau1 , J Beck2 , S Desch1 , I Eitel1 , C Jung3 , S Erbs2 , N Mangner2 , K Fengler2 , M Sandri2 , GC Schuler2 , H Thiele1 , 1University Hospital of Schleswig-Holstein , Universitäres Herzzentrum - Lubeck - Germany , 2University of Leipzig, Heart Center - Leipzig - Germany , 3University Hospital Dusseldorf - Dusseldorf - Germany ,

Citation:
European Heart Journal Supplement ( 2010 ) 12 ( Supplement F ), F173

Background: In experimental animal studies and a small retrospective observational human study mild therapeutic hypothermia (MTH) has been found as possible beneficial treatment for cardiogenic shock (CS) following acute myocardial infarction (AMI). No randomized trial in CS patients addressed this question yet.
Methods: Intubated, mechanically ventilated Patients (n=40) with CS complicating AMI undergoing primary percutaneous intervention without classical indication for MTH underwent randomization in a 1:1 fashion to MTH for 24 hours or to conventional therapy. The primary endpoint was cardiac power index (CPI) after 24 h, secondary endpoints included other hemodynamical parameters as well as serial measurements of serum lactate and sublingual microcirculation.
Results: Between the MTH-group (n=20) and control (n=20) baseline characteristics were similar. No differences were observed for the primary endpoint CPI measured by thermodilution (MTH vs. control: 0.30 [IQR 0.09-0.36] vs. 0.32 [IQR 0.16-0.52] W/m2; p=0.32) or Fick’s equation (MTH vs. control: 0.37 [IQR 0.23-0.51] vs. 0.34 [IQR 0.29-0.46] W/m2; p=0.78). Similarly, all other hemodynamical measurement and also mixed venous oxygen saturation measurements were not statistically different (p>0.05 for all). Serum lactate levels after 6, 8 and 10 hours were significantly higher in patients in the MTH group (6h: 3.3 [IQR 2.4-5.9] vs. 1.6 [IQR 1.1-2.6] mmol/L; p=0.006; 8h: 3.7 [IQR 2.4-5.8] vs. 1.5 [IQR 1.3-2.9] mmol/L; p=0.01; 10h: 2.7 [IQR 2.3-5.3] vs. 1.3 [IQR 1.0-3.8] mmol/L; p=0.02) reflecting a slower decline of lactate levels in the MTH group. No differences were seen in sublingual microcirculation measured by dark stream side field imaging (Table 1). Short-term 30-day and mid-term 6 months mortality rates were similar between the groups (MTH vs. control: 30 day: 60% vs. 50%; p=0.75; 6 months: 65% vs. 60%; p=0.99).
Conclusion: In this randomized small pilot study MTH failed to show a beneficial effect in patients with CS after AMI on hemodynamical parameters, serum lactate and sublingual microcirculation.

Day 1 Day 2 Day 3
MTH No MTH p MTH No MTH p MTH No MTH p
Total vessel density (mm/mm ²) 7.5 (6.4;9.2) 6.6 (5.3;8.0) 0.26 6.7 (5.5;7.8) 6.3 (5.8;8.4) 0.52 7.3 (5.3;9.0) 6.3 (5.2;9.0) 0.67
Perfused capillary density (mm/mm ²) 3.5 (2.8;4.8) 2.7 (2.6;4.5) 0.39 3.8 (3.2;4.1) 3.5 (3.3;4.4) 0.47 3.8 (3.5;4.9) 3.9 (3.5;4.6) 0.90
Table 1

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