title: The impact of therapeutic hypothermia as adjunctive therapy in a regional primary PCI program.
abstract: BACKGROUND
  Therapeutic hypothermia (TH) is associated with improved neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest (OHCA). There are currently limited data on the outcomes of patients presenting with resuscitated OHCA in the setting of ST-segment elevation myocardial infarction (STEMI). We conducted a retrospective study to determine the outcomes of patients treated with TH for OHCA in a large regionalized STEMI program.
  
  
  METHODS
  Patients referred for primary PCI and TH between July 2004 and April 2011 were identified from the University of Ottawa Heart Institute STEMI database. The primary endpoint was survival to hospital discharge with sufficient neurologic recovery to enable discharge home.
  
  
  RESULTS
  Among 2467 consecutive patients referred for primary PCI, we identified 50 patients treated with TH following OHCA. Forty-nine underwent PCI, of which 47 (96%) received a stent. Median door-to-balloon time was 113min (IQR 91-151). Patients with good neurologic recovery were younger, mean 51 ± 9 years versus 64 ± 12, p<0.001, and had higher baseline creatinine clearance, 70 ± 19 mL/min/1.73 m(2) versus 53 ± 23 mL/min/1.73 m(2), p=0.007. The primary endpoint of survival with sufficient neurologic recovery to enable discharge home was reached in 30 patients (60%). Four survivors required levels of assistance that precluded discharge home.
  
  
  CONCLUSIONS
  Therapeutic hypothermia in conjunction with primary PCI is associated with a favorable neurologic outcome in the majority of STEMI patients surviving OHCA. Our results suggest that TH is an important adjunctive therapy for STEMI patients suffering OHCA.
authors.affiliation: University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada.
authors.forename: Ronnen
authors.initials: R
authors.lastname: Maze
authors.forename: Michel R
authors.initials: MR
authors.lastname: Le May
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hibbert
authors.forename: Derek Y
authors.initials: DY
authors.lastname: So
authors.forename: Michael
authors.initials: M
authors.lastname: Froeschl
authors.forename: Chris A
authors.initials: CA
authors.lastname: Glover
authors.forename: Alexander
authors.initials: A
authors.lastname: Dick
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Marquis
authors.forename: Melissa
authors.initials: M
authors.lastname: Blondeau
authors.forename: Marino
authors.initials: M
authors.lastname: Labinaz
mesh_terms: D000367:Age Factors; D003131:Combined Modality Therapy; D003404:Creatinine / Q000032:analysis; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention; D020127:Recovery of Function; D012189:Retrospective Studies; D061665:Time-to-Treatment
chemical_list: D003404:Creatinine