Post-Myocardial Infarction Cardiogenic Shock Is a Systemic Illness in Need of Systemic Treatment: Is Therapeutic Hypothermia One Possibility?

• Published in: Journal of the American College of Cardiology Vol. 59; no. 7; pp. 644 - 647
• Main Authors: STEGMAN, Brian M, KRISTIN NEWBY, L, HOCHMAN, Judith S, MAGNUS OHMAN, E
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 14.02.2012
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Heart; Humans; Hypothermia, Induced - trends; Intensive care medicine; Medical sciences; Myocardial Infarction - epidemiology; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Shock, Cardiogenic - epidemiology; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - therapy; Treatment Outcome; Myocardial infarction; General anesthesia; Cardiovascular disease; Induced hypothermia; Systemic; Coronary heart disease; Myocardial disease; Chemotherapy; Treatment; Cardiogenic shock; Circulatory system; Disseminated; Cardiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.11.010

Early observations of cardiogenic shock as a systemic clinical syndrome were first described in 1942. Today, cardiogenic shock remains the leading cause of death among patients hospitalized for myocardial infarction (MI). Mortality rates in post-MI cardiogenic shock approach 50% despite rapid revascularization, optimal medical care, and use of mechanical support. New therapeutic strategies with global systemic effects may offer advances in treatment and outcome in post-MI cardiogenic shock. Therapeutic hypothermia for post-MI cardiogenic shock has multiple potentially beneficial physiologic effects, including the potential to improve post-ischemic cardiac function and hemodynamics, decrease myocardial damage, and reduce end-organ injury from prolonged hypoperfusion. Available data in animal models of post-MI cardiogenic shock and ischemia/reperfusion injury and small case series of human patients with cardiogenic shock suggest its promise as a potential therapeutic strategy for cardiogenic shock in the post-MI setting. We hypothesize that systemic therapeutic hypothermia could decrease morbidity and mortality in post-MI patients with cardiogenic shock and warrants study a new treatment that could be widely available at hospitals worldwide.