Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction - SHOCK-COOL

Contribution To Literature:

The SHOCK-COOL trial failed to show that targeted temperature management improved cardiac power index among patients with cardiogenic shock complicating AMI.

Description:

The goal of the trial was to evaluate targeted temperature management compared with control among patients with cardiogenic shock complicating acute myocardial infarction (AMI).

Study Design

  • Randomized
  • Parallel
  • Stratified

Eligible patients were randomized to targeted temperature management to 33°C for 12 hours (n = 20) versus control (n = 20).

  • Total number of enrollees: 40
  • Duration of follow-up: 30 days
  • Mean patient age: 77 years
  • Percentage female: 40%
  • Percentage with diabetes: 50%

Inclusion criteria:

  • Cardiogenic shock complicating AMI
  • Intubated and sedated

Exclusion criteria:

  • Cardiogenic shock >12 hours
  • Indication for targeted temperature management by current guidelines

Principal Findings:

The primary outcome, cardiac power index, was 0.41 in the targeted temperature group compared with 0.36 in the control group (p = 0.50). (Cardiac power index is a parameter calculated with mean arterial pressure and cardiac output.)

Secondary outcomes:

  • 30-day mortality: 60% in the targeted temperature group vs. 50% in the control group (p = 0.55)
  • Arterial lactate levels at 6, 8, and 10 hours: significantly higher in the targeted temperature group, with a slower decline compared with control (p for interaction = 0.03)

Interpretation:

Among intubated/sedated patients with cardiogenic shock complicating AMI, targeted temperature management was not superior to control at improving cardiac power index. Arterial lactate levels were higher in the targeted temperature group, and there was no difference in 30-day mortality in this small randomized trial.

References:

Fuernau G, Beck J, Desch S, et al. Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction: The Randomized SHOCK-COOL Trial. Circulation 2018;Jul 19:[Epub ahead of print].

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Acute Heart Failure, Interventions and ACS

Keywords: Acute Coronary Syndrome, Arterial Pressure, Heart Failure, Hypothermia, Hypothermia, Induced, Lactates, Myocardial Infarction, Percutaneous Coronary Intervention, Shock, Cardiogenic, Temperature


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