Journal article
Hypothermia as an Adjunctive Therapy in Cardiogenic Shock: A Systematic Review and Meta-Analysis
Therapeutic hypothermia and temperature management, Vol.13(4), pp.160-169
12/01/2023
DOI: 10.1089/ther.2023.0005
PMID: 37074118
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;
= 0.08), short-term (RR: 0.90%, 95% CI: 0.75-1.06;
= 0.21), or mid-term (RR: 0.93%, 95% CI: 0.78-1.10;
= 0.38) mortality rates. Despite the improvement in the cardiac function in the TH group (SMD: 1.08, 95% CI: 0.02-2.1;
= 0.04), the TH strategy did not significantly shorten the MV days, or the ICU stay (
-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.
Details
- Title: Subtitle
- Hypothermia as an Adjunctive Therapy in Cardiogenic Shock: A Systematic Review and Meta-Analysis
- Creators
- Mohammed Mhanna - University of IowaAhmad Al-Abdouh - University of KentuckyMichael C Sauer - University of IowaAhmad Jabri - Case Western Reserve UniversityWaiel Abusnina - Creighton UniversityMohammed Safi - University of ToledoAzizullah Beran - Indiana University – Purdue University IndianapolisShareef Mansour - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Therapeutic hypothermia and temperature management, Vol.13(4), pp.160-169
- DOI
- 10.1089/ther.2023.0005
- PMID
- 37074118
- eISSN
- 2153-7933
- Language
- English
- Electronic publication date
- 04/18/2023
- Date published
- 12/01/2023
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984398206802771
Metrics
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