Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention.
OBJECTIVE
Mild therapeutic hypothermia (MTH) has been integrated into international resuscitation guidelines. In the majority of patients, sudden cardiac arrest is caused by myocardial infarction. This study investigated whether a combination of MTH with primary percutaneous coronary intervention (PCI) is feasible, safe, and potentially beneficial in patients after cardiac arrest due to acute myocardial infarction.


METHODS
Single-center observational study with a historical control group.


METHODS
University clinic.


METHODS
Thirty-three patients after cardiac arrest with ventricular fibrillation as initial rhythm and restoration of spontaneous circulation who remained unconscious at admission and presented with acute ST elevation myocardial infarction (STEMI).


METHODS
In 16 consecutive patients (2005-2006), MTH was initiated immediately after admission and continued during primary PCI. Seventeen consecutive patients who were treated in a similar 2-yr observation interval before implementation of MTH (2003-2004) served as a control group. Feasibility, safety, mortality, and neurologic outcome were documented.


RESULTS
Initiation of MTH did not result in longer door-to-balloon times compared with the control group (82 vs. 85 mins), indicating that implementation of MTH did not delay the onset of primary PCI. Target temperature (32-34 degrees C) in the MTH group was reached within 4 hrs, consistent with previous trials and suggesting that primary PCI did not affect the velocity of cooling. Despite a tendency to increased bleeding complications and infections, patients treated with MTH tended to have a lower mortality after 6 months (25% vs. 35%, p = .71) and an improved neurologic outcome as determined by a Glasgow-Pittsburgh Cerebral Performance Scale score of 1 or 2 (69% vs. 47% in the control group, p = .30).


CONCLUSIONS
MTH in combination with primary PCI is feasible and safe in patients resuscitated after cardiac arrest due to acute myocardial infarction. A combination of these therapeutic procedures should be strongly considered as standard therapy in patients after out-of-hospital cardiac arrest due to STEMI.
Wolfrum
Sebastian
S
Medical Clinic II, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. sebastian.wolfrum@uk-sh.de
Pierau
Christian
C
Radke
Peter W
PW
Schunkert
Heribert
H
Kurowski
Volkhard
V
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D019091:Critical Pathways; D004562:Electrocardiography; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009460:Neurologic Examination; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D015996:Survival Rate; D013996:Time and Motion Studies; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy