Value of mild hypothermia in patients who have severe circulatory insufficiency even after intra-aortic balloon pump.
OBJECTIVE
To evaluate the effectiveness of mild hypothermia in postcardiac surgical patients with severe heart failure in spite of conventional medical therapy and the use of intra-aortic balloon pumping (IABP).


METHODS
Prospective, clinical study.


METHODS
Teaching hospital.


METHODS
10 postcardiac surgical patients with severe heart failure despite the use of IABP with massive doses of catecholamine.


METHODS
Patients underwent mild hypothermia produced by surface cooling (to approximately 34.5 degrees C). Hemodynamic criteria for the induction of hypothermia included a cardiac index (CI) of less than 2.2 L/min/m2 with a pulmonary capillary wedge pressure (PCWP) of up to 18 mmHg despite the use of IABP with massive doses of catecholamine.


RESULTS
After control measurements had been taken at normal core body temperature (37 degrees C), patients were cooled to approximately 34.5 degrees C (using a cooling blanket and gastric lavage with cold water) to decrease tissue oxygen (O2) demand. Patients showed significant improvements in CI (1.9 +/- 0.3 to 2.2 +/- 0.3 L/min/m2), mixed venous O2 saturation, (SvO2; 55 +/- 7 to 64 +/- 6%), and urine output (2.1 +/- 1.1 to 3.4 +/- 2.2 ml/kg/hr). Patients were rewarmed while SvO2 was being monitored. The duration of the hypothermia was 38 +/- 41 hours. Oxygen delivery increased in 8 of the 10 patients, the mean value (+/- SD) for the group rising from 309 +/- 65 ml/min/m2 to 358 +/- 57 ml/min/m2 as temperature was reduced from 36.7 +/- 0.4 degrees C to 34.7 +/- 0.3 degrees C. All patients were successfully weaned from IABP at 140 +/- 107 hours after admission to the intensive care unit.


CONCLUSIONS
Mild hypothermia is a simple and useful procedure for improving the circulation of postcardiac surgical patients with severe heart failure despite the use of IABP.
Yahagi
N
N
Surgical Intensive Care Unit, National Cardiovascular Center, Osaka, Japan.
Kumon
K
K
Watanabe
Y
Y
Tanigami
H
H
Haruna
M
M
Hayashi
H
H
Imanaka
H
H
Takeuchi
M
M
Ohashi
Y
Y
Takamoto
S
S
D000368:Aged; D000369:Aged, 80 and over; D001775:Blood Circulation / Q000502:physiology*; D001784:Blood Gas Analysis; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged