Abstract 17959: Effect of Mild Therapeutic Hypothermia on Outcome of Patients with Return of Spontaneous Circulation from Cardiac Arrest and Post-MI Cardiogenic Shock
Background The mortality of patients with cardiogenic shock after myocardial infarction (MI) is high despite reperfusion therapy and recent advances in medical care. Hypothermia has wide-ranging physiologic effects that could be of great advantage in the systemic manifestations of post-MI cardiogenic shock. These favorable effects on cardiogenic shock have been demonstrated in some case series. However there has been limited data of hypothermia on post- MI cardiogenic shock.
Methods This is a retrospective study of patients who had myocardial infarction (MI) and cardiac arrest with return of spontaneous circulation and developed post- MI cardiogenic shock. We identified patients admitted between 2007-2012 who underwent mild therapeutic hypothermia (MTH) after arrest and historical control patients from 2004-2007 who did not receive MTH. Survival was the main outcome. Chi-square and student t-test were used for comparison of the variables. Logistic regression was done for the assessment of independent predictors of survival.
Results and Conclusion There were 36 post-MI cardiogenic shock patients who underwent TH and 33 patients who did not. Most of the baseline characteristics between the groups were comparable, including: age, length of hospital stay, history of hypertension, hyperlipidemia, diabetes, coronary artery disease and smoking. None of the patients for both groups had a history of congestive heart failure. Majority of the patients in the MTH group were male (75% vs. 48.5%, p=0.028) and also appear to be sicker as evidenced by use of intra-aortic balloon pump (42.3% vs. 0%, p<0.001). There was a significantly higher percentage of survival in the group that underwent MTH (66.7% vs. 39.4%, p=0.031). After logistic regression, there were no significant predictors of survival. Diabetes had a hazard ratio (HR) of 3.688 (p=0.057, 95% CI 0.961-14.152). Length of stay had an HR of 1.103 (p=0.065, 95% CI 0.994-1.225). Hypothermia had an HR of 0.370 (p=0.072, 95% CI 0.125-1.092), a protective effect but not statistically significant. These results can be attributed to the limited sample size, but the difference in survival between patients who received hypothermia and those who did not are promising.
- © 2012 by American Heart Association, Inc.