Abstract 173: Cardiogenic Shock in Cardiac Arrest No Longer a Contraindication for Therapeutic Hypothermia

Abstract

Introduction: Therapeutic hypothermia (TH) is neuroprotective and increases survival in cardiac arrest patients. Cardiac arrest is often seen in the setting of acute myocardial infarction (MI), and cardiogenic shock is a known poor prognostic factor. Methods: “Cool It” is a comprehensive TH protocol integrated into a regional STEMI network. From Feb 2006 to July 2010, 192 consecutive cardiac arrest patients who remained unresponsive following return of spontaneous circulation were enrolled in the Cool It protocol, regardless of initial rhythm or hemodynamic status. We hypothesize patients in cardiogenic shock secondary to MI treated with primary PCI will have greater survival and neurologic outcome than those without concurrent MI. Results: Of the 192 patients, 77 (40.1%) were in cardiogenic shock. Survival with favorable neurologic outcome (CPC 1 or 2) was poorer in cardiogenic shock patients than non-cardiogenic shock patients, 34/77 (44.2%) vs. 60/115 (52.2%) p=0.28, but not statistically significantly. Of those in cardiogenic shock, 32 (41.6%) had ST elevation on EKG, and a total of 42 (54.6%) were found to have an acute occlusion by angiography. Culprit arteries were: LAD n=19 (45.2%), RCA n=14 (33.3%), CMX n=5 (11.9%), L main n=4 (9.5%), and 39/42 (92.9%) and were successfully reperfused and stented. For patients with cardiogenic shock, survival with favorable neurologic outcome (CPC 1 or 2) was greater in patients with concurrent MI than without MI, 21/42 (50.0%) vs. 9/35 (25.7%) p=0.03. Cardiogenic shock with LAD lesions had the greatest favorable neurologic survival compared to other lesions, 13/19 (68.4%) vs. 8/23 (34.8%) p=0.03. Non-LAD lesion cardiogenic shock had no statistically significant survival or neurologic benefit over cardiogenic shock without concurrent MI, 8/23 (34.8%) vs. 9/35 (25.7%) p=0.46. Conclusion: TH should be the standard of care for unresponsive cardiac arrest patients in cardiogenic shock. Patients with cardiogenic shock and concurrent LAD STEMI have improved survival and neurologic outcomes than those cardiogenic shock patients without concurrent STEMI. Cardiogenic shock should no longer be considered a contraindication to TH, especially with concurrent STEMI.