Induction of mild hypothermia in cardiac arrest survivors with cardiogenic shock syndrome
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KeywordsCardiac Arrest Primary Outcome Measure Performance Category Neurological Outcome Cardiogenic Shock
Induction of mild hypothermia (MH) in patients resuscitated from cardiac arrest can improve their outcome. However, benefits and risks of MH induction in patients who remain in cardiogenic shock after the return of spontaneous circulation (ROSC) are unclear. We therefore analysed a group of all cardiac arrest survivors who were indicated for MH induction in our coronary care unit (CCU) and compared the outcome of patients with cardiogenic shock syndrome after ROSC with the outcome of those who were relatively haemodynamically stable.
We performed retrospective analysis of all consecutive cardiac arrest survivors treated by MH in our CCU from November 2002 to August 2006. They were classified into two groups, according to whether they met the criteria for cardiogenic shock or not after ROSC and just before MH initiation. Primary outcome measures were inhospital mortality, and the best inhospital and discharge neurological result. Predicted mortality was evaluated by the APACHE II score, and neurological outcome by Cerebral Performance Category score. MH was initiated as soon as possible after ROSC and patients were cooled to body temperature 32–34°C for 12 hours.
From 50 consecutive patients, 28 fulfilled criteria of cardiogenic shock before MH initiation (group A), and 22 were relatively hemodynamically stable (group B). While predicted mortality was 83.1 ± 13.1% in group A and 63.2 ± 19.0% in group B (P < 0.001), real inhospital mortality was 55.6% in group A and only 18.2% in group B patients (P = 0.009). The best inhospital neurological outcome was found favourable in 71.4% patients in group A and in 86.3% in group B (P = 0.306). Favourable discharge neurological outcome was reached in 100% in group A and in 94% in group B (P = 1.000). Patients in both groups did not differ in rate of complications.
While inhospital mortality in cardiac arrest survivors treated by MH was expectably higher in those with cardiogenic shock than in stable patients, favourable neurological outcome was frequent and comparable in both groups of patients. Moreover, MH application was safe in both groups. Therefore, induction of MH should be considered also in cardiac arrest survivors with cardiogenic shock syndrome after ROSC.