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SHOCK-COOL: Hypothermia fails to benefit in cardiogenic shock
Inducing mild hypothermia in patients with STEMI and cardiogenic shock did not improve cardiac power index or other hemodynamic metrics, according to the results of the SHOCK-COOL trial.
The researchers assigned 40 patients (median age, 76 years; 65% men) with STEMI and cardiogenic shock undergoing PCI without classical indication for mild therapeutic hypothermia to mild therapeutic hypothermia for 24 hours or the standard of care.
The primary endpoint was cardiac power index at 24 hours. The researchers also assessed other hemodynamic parameters.
At 24 hours, cardiac power index was 0.41 W/m2 (interquartile range, 0.31-0.52) in the hypothermia group and 0.36 W/m2 (interquartile range, 0.31-0.48) and the control group (P = .5; median difference, –0.025 W/m2; 95% CI, –0.12 to 0.06), Georg Fuernau, MD, from Medical Clinic II, University Heart Center Luebeck, University Hospital Schleswig-Holstein, University of Luebeck, Germany, and colleagues wrote.
There were no significant differences in other hemodynamic metrics or in 30-day mortality (hypothermia group, 60%; control group. 50%; HR = 1.27; 95% CI, 0.55-2.94), according to the researchers.
Arterial lactate levels were higher in the hypothermia group at 6, 8 and 10 hours and declined more slowly vs. the control group (P for interaction = .03), the researchers wrote.
“The present study is the first prospective randomized trial investigating [mild therapeutic hypothermia] in patients with [cardiogenic shock] complicating [acute] MI undergoing early revascularization. The primary finding is that applying [mild therapeutic hypothermia] to patients in [cardiogenic shock] complicating [acute] MI provided no hemodynamic benefit and may even have a negative impact on arterial lactate clearance,” Fuernau and colleagues wrote. – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.