Boccalandro Fernando, Cedeno Francisco A
Procare, Odessa Heart Institute, Odessa, TX, USA.
Permian Research Fundation, Odessa, TX, USA.
Am J Case Rep. 2019 Mar 12;20:323-329. doi: 10.12659/AJCR.913459.
BACKGROUND Acute myocardial infarction (AMI) complicated by cardiogenic shock has a high mortality rate, despite prompt revascularization, advanced medical therapy and the use of mechanical circulatory support devices. Therapeutic hypothermia is associated with physiological cellular changes in the ischemic myocardium, and a trend towards improved hemodynamics in patients with AMI and cardiogenic shock, but is currently not considered to be a therapeutic modality. A case is presented that supports the role of therapeutic hypothermia as salvage therapy in patients with cardiogenic shock following AMI. CASE REPORT A 37-year-old man who presented with cardiac arrest following an anterior wall AMI due to occlusion of the left anterior descending coronary artery complicated by cardiogenic shock, underwent emergent percutaneous revascularization with placement of a stent, a percutaneous left ventricular-assist device (LVAD), and a pulmonary artery catheter. Therapeutic hypothermia was initiated to achieve a target core body temperature of between 32-34°C for 24 hours, followed by slow re-warming. However, after rewarming, the patient developed refractory cardiogenic shock, despite revascularization, pharmacological and mechanical circulatory support. A second cycle of therapeutic hypothermia was initiated as salvage therapy, leading to clinical improvement. The patient had a favorable outcome, was discharged from hospital and was able to return to work. CONCLUSIONS The first successful case is described in which therapeutic hypothermia was re-initiated as salvage therapy for cardiogenic shock where no other hemodynamic support resources were available.
急性心肌梗死（AMI）合并心源性休克的死亡率很高，尽管进行了及时的血运重建、先进的药物治疗以及使用了机械循环支持装置。治疗性低温与缺血心肌的生理细胞变化有关，并且在AMI合并心源性休克的患者中有改善血流动力学的趋势，但目前不被视为一种治疗方式。本文介绍了一个病例，该病例支持治疗性低温作为AMI后心源性休克患者挽救治疗的作用。病例报告：一名37岁男性，因左前降支冠状动脉闭塞导致前壁AMI后发生心脏骤停，并合并心源性休克，接受了紧急经皮血运重建，置入了支架、经皮左心室辅助装置（LVAD）和肺动脉导管。开始进行治疗性低温，使目标核心体温维持在32 - 34°C达24小时，随后缓慢复温。然而，复温后，尽管进行了血运重建、药物治疗和机械循环支持，患者仍发生了难治性心源性休克。作为挽救治疗，开始了第二个治疗性低温周期，从而使临床症状得到改善。患者预后良好，出院后能够重返工作岗位。结论：本文描述了首例成功病例，即在没有其他血流动力学支持资源的情况下，重新启动治疗性低温作为心源性休克的挽救治疗。
