title: Moderate hypothermia for severe cardiogenic shock (COOL Shock Study I & II).
abstract: OBJECTIVE
  Hypothermia exerts profound protection from neurological damage and death after resuscitation from circulatory arrest. Its application during concomitant cardiogenic shock has been discussed controversially, and still hypothermia is used with reserve when haemodynamic parameters are impaired. On the other hand hypothermia improves force development in isolated human myocardium. Thus, we hypothesized that hypothermia could beneficially affect cardiac function in patients during cardiogenic shock.
  
  
  METHODS
  14 Patients, admitted to Intensive Care Unit for cardiogenic shock under inotropic support, were enrolled and moderate hypothermia (33 °C) was induced for either one (n=5, short-term) or twenty-four (n=9, mid-term) hours.
  
  
  RESULTS
  12 patients suffered from ischaemic cardiomyopathy, 2 were female, and 6 were included after cardiac arrest and resuscitation. Body temperature was controlled by an intravascular cooling device. Short-term hypothermia consistently decreased heart rate, and increased stroke volume, cardiac index and cardiac power output. Metabolic and electrocardiographic parameters remained constant during cooling. Improved cardiac function persisted during mid-term hypothermia, but was reversed during re-warming. No severe or persistent adverse effects of hypothermia were observed.
  
  
  CONCLUSIONS
  Moderate Hypothermia is safe and feasable in patients during cardiogenic shock. Moreover, hypothermia improved parameters of cardiac function, suggesting that hypothermia might be considered as a positive inotropic intervention rather than a risk for patients during cardiogenic shock.
authors.affiliation: Department of Cardiology and Pneumology, Heart Center Göttingen, Georg August University of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Schmidt-Schweda
authors.forename: Andreas
authors.initials: A
authors.lastname: Ohler
authors.forename: Heiner
authors.initials: H
authors.lastname: Post
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome