Beneficial Effects of Ketone Ester in Patients With Cardiogenic Shock: A Randomized, Controlled, Double-Blind Trial

In this double-blind crossover trial, 12 patients with cardiogenic shock were randomized to an enteral bolus of ketone ester (KE) or an isocaloric maltodextrin placebo, and assessed for 3 hours after each. KE raised circulating 3-hydroxybutyrate to 2.9 mmol/L versus 0.2 mmol/L with placebo and increased cardiac output (area under the curve of relative change 61 L vs 1 L, p = 0.044). Left ventricular ejection fraction improved by 4 percentage points, cardiac power output and mixed venous saturation increased, ventricular filling pressures fell, and glucose decreased by 2.6 mmol/L.