Hypothermia as an Adjunctive Therapy in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Mohammed Mhanna, Ahmad Al-Abdouh, Michael C. Sauer, Ahmad Jabri, Waiel Abusnina, Mohammed Safi, Azizullah Beran, Shareef Mansour

Research output: Contribution to journalReview articlepeer-review

Abstract

In the setting of out-of-hospital cardiac arrest, therapeutic hypothermia (TH) has been shown to improve clinical outcomes. However, trials showing the advantage of TH did not include patients with cardiogenic shock (CS). We performed a comprehensive literature search for studies that evaluated the efficacy and safety of adjunctive TH compared with the standard of care (SOC) in patients with CS. The primary outcome was the mortality rate (in-hospital, short-, and mid-term). The secondary outcomes were the TH-related complications, duration of Intensive Care Unit (ICU) stay, duration of mechanical ventilation (MV-days), and improvement in cardiac function. Relative risk (RR) or the standardized mean difference (SMD) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. A total of 7 clinical studies (3 RCTs included), and 712 patients (341 in the TH group and 371 in the SOC group) were included. As compared with the SOC, TH was not associated with a statistically significant improvement in the in-hospital (RR: 0.73%, 95% CI: 0.51–1.03; p = 0.08), short-term (RR: 0.90%, 95% CI: 0.75–1.06; p = 0.21), or mid-term (RR: 0.93%, 95% CI: 0.78–1.10; p = 0.38) mortality rates. Despite the improvement in the cardiac function in the TH group (SMD: 1.08, 95% CI: 0.02–2.1; p = 0.04), the TH strategy did not significantly shorten the MV days, or the ICU stay (p-values >0.05). Finally, there was a trend toward higher risks for infection, major bleeding, and the need for blood transfusion in the TH group. According to our meta-analysis of published clinical studies, TH is not beneficial in patients with CS and has a marginal safety profile. Larger-scale RCTs are needed to further clarify our results.

Original languageEnglish (US)
Pages (from-to)160-169
Number of pages10
JournalTherapeutic hypothermia and temperature management
Volume13
Issue number4
DOIs
StatePublished - Dec 1 2023
Externally publishedYes

Keywords

  • cardiac index
  • cardiogenic shock
  • cooling
  • hypothermia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

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