Abstract 17931: Serial Hemodynamic Measurements in Post-Cardiac Arrest Cardiogenic Shock Treated With Therapeutic Hypothermia
Background: Mortality from cardiogenic shock (CS) complicating acute myocardial infarction remains high despite advances in reperfusion and mechanical support. In animal models of CS initiation of Therapeutic Hypothermia (TH) has been demonstrated to have favorable direct cardiovascular and systemic effect. Given the lack of objective data on the hemodynamic effects of TH with CS, we aimed to evaluate serial hemodynamics obtained by invasive PA catheter monitoring in subjects with post-cardiac arrest CS.
Methods: We performed a retrospective analysis of the serial hemodynamics obtained in 13 post-cardiac arrest patients treated with TH with CS shock at the time of initiating TH. We included all consecutive subjects with baseline hemodynamics prior to initiation of TH that confirmed CS defined as cardiac index <2.2 L/min/m2 with a systolic blood pressure of <90 mmHg, vasopressor requirement, or need for a mechanical support device.
Results: In our 13 patients, mean age was 57.4 ± 13.5, 7 had an acute coronary syndrome as cause of arrest, initial ejection fraction was 20% ±12, 11 required vasopressors, and 9 had an IABP or Impella placed prior to initiation of TH. Hemodynamic results are shown in Table 1. Briefly, values obtained after initiation of TH demonstrated significant improvements in Fick cardiac index, mixed venous O2 saturations, and serum lactate concentrations while having significantly reduced heart rate with no change in mean arterial pressure when compared with baseline values obtained prior to cooling. A significant decrease in vasopressor requirement was also noted.[data not provided]
Conclusion: Our data demonstrates favorable hemodynamic effects of TH in patients with CS following cardiac arrest. We believe that based on prior animal experiments and the current lack of hemodynamic worsening with initiation of TH, the time has come for cardiologists to design clinical trials with TH as a randomized therapeutic intervention in patients with CS.
- © 2013 by American Heart Association, Inc.