- Meeting abstract
- Open Access
Hypothermia in cardiogenic shock
Critical Care volume 16, Article number: A21 (2012)
Cardiogenic shock is a state of inadequate systemic tissue perfusion, despite adequate left ventricular filling pressure. It is caused by extensive myocardial damage and appears to be aggravated by a systemic inflammatory response [1–4]. The result is hypotension with metabolic acidosis and often a fatal outcome. The condition affects approximately 5% of the patients with myocardial infarction, and carries a dismal prognosis if it prevails after reperfusion.
Therapeutic hypothermia has several properties of potential benefit in cardiogenic shock: Experiments with isolated myofibrils, papillary muscles and cross-circulated hearts have demonstrated that mild hypothermia increases myocardial contractility [5–7]. In the in vivo heart, mild hypothermia has been found to increase stroke volume and cardiac output [6, 8].
The increase in contractility is considered to be mediated by an increased myofilament sensitivity to existing Ca2+, without a corresponding increase in myocardial oxygen consumption . Moreover, hypothermia reduces the metabolic rate with 5 to 7%/°C [10, 11], thereby reducing the demand on the circulation from the peripheral tissues. In an experimental setting, it also has the ability to reduce infarct size if applied prior to reperfusion [12, 13].
In dog-based and porcine-based models of cardiogenic shock secondary to ischemia, therapeutic hypothermia has improved hemodynamic and metabolic parameters, and reduced mortality [14, 15]. No randomized controlled trials of therapeutic hypothermia in cardiogenic shock in humans exist, but case series indicate that the effects observed in animal experiments can be reproduced [16–19].
In conclusion, therapeutic hypothermia is a promising treatment option for patients in cardiogenic shock that warrants further investigation.
Hochman JS: Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation 2003, 107: 2998-3002. 10.1161/01.CIR.0000075927.67673.F2
Kaluski E, Hendler A, Blatt A, Uriel N: Nitric oxide synthase inhibitors in post-myocardial infarction cardiogenic shock - an update. Clin Cardiol 2006, 29: 482-488. 10.1002/clc.4960291103
Cotter G, Berger PB: Cardiogenic shock - beyond the large infarction. Crit Care Med 2006, 34: 2234-2235. 10.1097/01.CCM.0000229671.12922.27
Geppert A, Dorninger A, Delle-Karth G, Zorn G, Heinz G, Huber K: Plasma concentrations of interleukin-6, organ failure, vasopressor support, and successful coronary revascularization in predicting 30-day mortality of patients with cardiogenic shock complicating acute myocardial infarction. Crit Care Med 2006, 34: 2035-2042. 10.1097/01.CCM.0000228919.33620.D9
Bjornstad H, Tande PM, Refsum H: Mechanisms for hypothermia-induced increase in contractile force studied by mechanical restitution and post-rest contractions in guinea-pig papillary muscle. Acta Physiol Scand 1993, 148: 253-264. 10.1111/j.1748-1716.1993.tb09556.x
Weisser J, Martin J, Bisping E, Maier LS, Beyersdorf F, Hasenfuss G, Pieske B: Influence of mild hypothermia on myocardial contractility and circulatory function. Basic Res Cardiol 2001, 96: 198-205. 10.1007/s003950170071
Mattheussen M, Mubagwa K, Van Aken H, Wusten R, Boutros A, Flameng W: Interaction of heart rate and hypothermia on global myocardial contraction of the isolated rabbit heart. Anesth Analg 1996, 82: 975-981.
Nishimura Y, Naito Y, Nishioka T, Okamura Y: The effects of cardiac cooling under surface-induced hypothermia on the cardiac function in the in situ heart. Interact Cardiovasc Thorac Surg 2005, 4: 101-105. 10.1510/icvts.2004.097188
Suga H, Goto Y, Igarashi Y, Yasumura Y, Nozawa T, Futaki S, Tanaka N: Cardiac cooling increases E max without affecting relation between O 2 consumption and systolic pressure-volume area in dog left ventricle. Circ Res 1988, 63: 61-71.
Polderman KH: Mechanisms of action, physiological effects, and complications of hypothermia. Critical Care Med 2009, 37: S186-S202. 10.1097/CCM.0b013e3181aa5241
Polderman KH: Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality - Part 2: practical aspects and side effects. Intensive Care Med 2004, 30: 757-769. 10.1007/s00134-003-2151-y
Gotberg M, Olivecrona GK, Koul S, Carlsson M, Engblom H, Ugander M, van der Pals J, Algotsson L, Arheden H, Erlinge D: A pilot study of rapid cooling by cold saline and endovascular cooling before reperfusion in patients with ST-elevation myocardial infarction. Circ Cardiovasc Interv 2010, 3: 400-407. 10.1161/CIRCINTERVENTIONS.110.957902
Götberg M M, Olivecrona GK, Engblom H, Ugander M, van der Pals J, Heiberg E, Arheden H, Erlinge D: Rapid short-duration hypothermia with cold saline and endovascular cooling before reperfusion reduces microvascular obstruction and myocardial infarct size. BMC Cardiovasc Disord 2008, 8: 7. 10.1186/1471-2261-8-7
Gotberg M, van der Pals J, Olivecrona GK, Koul S, Erlinge D: Mild hypothermia reduces acute mortality and improves hemodynamic outcome in a cardiogenic shock pig model. Resuscitation 2010, 81: 1190-1196. 10.1016/j.resuscitation.2010.04.033
Boyer NH, Gerstein MM: Induced hypothermia in dogs with acute myocardial infarction and shock. J Thorac Cardiovasc Surg 1977, 74: 286-294.
Skulec R, Kovarnik T, Dostalova G, Kolar J, Linhart A: Induction of mild hypothermia in cardiac arrest survivors presenting with cardiogenic shock syndrome. Acta Anaesthesiol Scand 2008, 52: 188-194. 10.1111/j.1399-6576.2007.01510.x
Hovdenes J, Laake JH, Aaberge L, Haugaa H, Bugge JF: Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shock. Acta Anaesthesiol Scand 2007, 51: 137-142. 10.1111/j.1399-6576.2006.01209.x
Yahagi N, Kumon K, Watanabe Y, Tanigami H, Haruna M, Hayashi H, Imanaka H, Takeuchi M, Ohashi Y, Takamoto S: Value of mild hypothermia in patients who have severe circulatory insufficiency even after intra-aortic balloon pump. J Clin Anesth 1998, 10: 120-125. 10.1016/S0952-8180(97)00255-9
Moriyama Y, Iguro Y, Shimokawa S, Saigenji H, Toyohira H, Taira A: Successful application of hypothermia combined with intra-aortic balloon pump support to low-cardiac-output state after open heart surgery. Angiology 1996, 47: 595-599. 10.1177/000331979604700608
About this article
Cite this article
van der Pals, J. Hypothermia in cardiogenic shock. Crit Care 16 (Suppl 2), A21 (2012). https://doi.org/10.1186/cc11279
- Infarct Size
- Metabolic Acidosis
- Papillary Muscle
- Cardiogenic Shock
- Filling Pressure