TY - JOUR
T1 - Hypothermia as an Adjunctive Therapy in Cardiogenic Shock
T2 - A Systematic Review and Meta-Analysis
AU - Mhanna, Mohammed
AU - Al-Abdouh, Ahmad
AU - Sauer, Michael C.
AU - Jabri, Ahmad
AU - Abusnina, Waiel
AU - Safi, Mohammed
AU - Beran, Azizullah
AU - Mansour, Shareef
N1 - Publisher Copyright:
ª Mary Ann Liebert, Inc.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - 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.
AB - 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.
KW - cardiac index
KW - cardiogenic shock
KW - cooling
KW - hypothermia
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U2 - 10.1089/ther.2023.0005
DO - 10.1089/ther.2023.0005
M3 - Review article
C2 - 37074118
AN - SCOPUS:85163574102
SN - 2153-7658
VL - 13
SP - 160
EP - 169
JO - Therapeutic hypothermia and temperature management
JF - Therapeutic hypothermia and temperature management
IS - 4
ER -