title: [Mild therapeutic hypothermia in cardiogenic shock : Retrospective analysis of 80 patients with preclinical cardiac arrest due to cardiac causes].
abstract: BACKGROUND
  The mortality in patients with cardiogenic shock after out-of-hospital cardiac arrest (OHCA) remains high despite advances in resuscitation and early revascularization strategies. The use of mild therapeutic hypothermia (MTH) for improvement of survival and neurological outcome in patients with cardiogenic shock is currently subject to renewed discussion.
  
  
  OBJECTIVE
  The aim of this study was the detection of risk factors for mortality and morbidity in patients under MTH in cardiogenic shock following preclinical resuscitation for OHCA.
  
  
  METHODS
  A total of 80 consecutive patients in cardiogenic shock after successful resuscitation (mean age 60 ± 3.2 years) treated with MTH were retrospectively analyzed. Patients were cooled to 33 °C for 24 h using an endovascular cooling device. Neurological outcome was assessed after 2 months based on the Glasgow-Pittsburgh cerebral performance category (CPC) and correlated with various blood parameter values.
  
  
  RESULTS
  After 2 months 31 patients (39 %) showed a good neurological recovery with CPC scores of 1-2, 20 patients (25 %) had a poor neurological outcome with CPC scores of 3-4 and 29 (36 %) patients enrolled in the trial died (CPC 5). Patients with a poor outcome showed significantly higher mean serum levels for lactate, creatinine and urea. In addition, these patients showed a continuous increase of serum neuron-specific enolase (NSE) values in contrast to patients with a good outcome (∆ NSE from admission to day 1, CPC 1 and 2: - 10.6 ± 3 µg/l and CPC 3-5: 33 ± 12 µg/l, p = 0.02).
  
  
  CONCLUSIONS
  Changes in the course of serum creatinine, urea and NSE levels within the first 72 h after OHCA could provide valuable additional information for the early assessment of the neurological prognosis in patients treated with MTH.
authors.affiliation: Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpenerstr. 62, 50937, Köln, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Adler
authors.affiliation: Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpenerstr. 62, 50937, Köln, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Pfister
authors.affiliation: Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpenerstr. 62, 50937, Köln, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Baldus
authors.affiliation: Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpenerstr. 62, 50937, Köln, Deutschland. hannes.reuter@uk-koeln.de.
authors.forename: H
authors.initials: H
authors.lastname: Reuter
mesh_terms: D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000401:mortality / Q000628:therapy*; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000097:blood / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
chemical_list: D019344:Lactic Acid; D003404:Creatinine; D010751:Phosphopyruvate Hydratase
keywords: Creatinine; Neuron-specific enolase; Prognostic factors; Treatment outcome, neurological; Urea