title: Serial hemodynamic measurements in post-cardiac arrest cardiogenic shock treated with therapeutic hypothermia.
abstract: OBJECTIVE
  Mortality from cardiogenic shock complicating acute myocardial infarction (MI) remains high despite contemporary treatment. Therapeutic Hypothermia (TH) offers cardiovascular and systemic effects that may prove beneficial in this population, however, current data are limited. This study sought to evaluate the effect of therapeutic hypothermia on serial hemodynamics obtained in subjects with post-cardiac arrest cardiogenic shock.
  
  
  METHODS
  We analyzed serial hemodynamics of 14 consecutive patients with cardiogenic shock after cardiac arrest treated with TH. Study inclusion required baseline hemodynamics obtained prior to initiation of TH confirming cardiogenic shock defined as cardiac index ≤2.2 L/min/m(2) with a systolic blood pressure of ≤90 mmHg, a vasopressor requirement, or need for mechanical circulatory support.
  
  
  RESULTS
  In our 14 patients, the mean age was 58 ± 13.1 years, mean ejection fraction was 21 ± 8%, six had an acute MI, 12 required vasopressors, and 10 required mechanical support prior to initiation of TH. When compared to baseline, patients had significant improvements in Fick cardiac index, mixed venous O2 saturations, and serum lactate concentrations while heart rate was reduced following initiation of TH. There was no significant change in mean arterial pressure, however vasopressor requirement was reduced.
  
  
  CONCLUSIONS
  In patients with cardiogenic shock following cardiac arrest, initiation of TH was associated with favorable changes in invasive hemodynamics suggesting safety in this population. Given potential for favorable hemodynamic and systemic effects of TH in cardiogenic shock, further prospective study of TH as a potentially novel adjunctive therapy to early reperfusion in post-MI cardiogenic shock should be considered.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Ohio, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Stegman
authors.affiliation: Department of Medicine, Cleveland Clinic, Ohio, USA.
authors.forename: Bhuvnesh
authors.initials: B
authors.lastname: Aggarwal
authors.affiliation: Department of Medicine, Cleveland Clinic, Ohio, USA.
authors.forename: Alpana
authors.initials: A
authors.lastname: Senapati
authors.affiliation: C5Research, Cleveland Clinic, Ohio, USA.
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Shao
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Ohio, USA menonv@ccf.org.
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
mesh_terms: D000368:Aged; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000503:physiopathology*
keywords: cardiac arrest; cardiogenic shock; hemodynamics; therapeutic hypothermia