Mild induced hypothermia in patients with infarct-related cardiogenic shock and cardiac arrest: insights from the CULPRIT-SHOCK trial

Mild induced hypothermia (MIH) is often applied in patients with cardiac arrest (CA), but its impact on patients with infarct-related cardiogenic shock (CS) and CA remains unclear.

To evaluate the characteristics and outcomes of patients with infarct-related CS and CA who received MIH vs. those who did not in the randomized CULPRIT-SHOCK trial and the accompanying registry.

We included patients with CS and CA from the CULPRIT-SHOCK trial and registry. The primary endpoint was 1-year mortality. Secondary endpoints included death or renal replacement therapy within 30 days. A multivariate regression analysis was performed for 1-year mortality, adjusted for relevant baseline parameters. Among 550 patients with CA, 288 (52.4%) received MIH. Patients treated with MIH were younger (64 vs. 67 years, P = 0.03), had higher rates of mechanical ventilation (94.5% vs. 78.8%, P < 0.01), and higher mean arterial pressure (82 vs. 76 mmHg, P = 0.002). The unadjusted hazard ratio (HR) for 1-year mortality favoured MIH [HR: 0.77, 95% confidence interval (CI): 0.61–0.97, P = 0.024]; however, after multivariate adjustment, this effect was not statistically significant (HR: 0.83, 95% CI: 0.64–1.09, P = 0.18). MIH was associated with a higher need for renal replacement therapy (15.2% vs. 7.5%, P = 0.005) and less use of mechanical circulatory support (21.2% vs. 34.2%, P < 0.001).

In this retrospective analysis MIH was not significantly associated with lower 1-year mortality in patients with infarct-related CS and CA. Because of the numerically lower mortality rate, further research is necessary to clarify the role of MIH in this patient population.

ClinicalTrials.gov Identifier: NCT01927549