title: ACS network-based implementation of therapeutic hypothermia for the treatment of comatose out-of-hospital cardiac arrest survivors improves clinical outcomes: the first European experience.
abstract: BACKGROUND
  There is a paucity of data regarding clinical outcomes associated with the integration of a mild therapeutic hypothermia (MTH) protocol into a regional network dedicated to treatment of patients with acute coronary syndromes (ACS). Additionally, a recent report suggests that the neurological benefits of MTH therapy in interventionally managed ACS patients resuscitated from out-of-hospital cardiac arrest (OHCA) may be potentially offset by the catastrophic occurrence of stent thrombosis. The goal of this study was to share our experience with the implementation of an MTH program using a previously established ACS network in consecutive comatose OHCA survivors undergoing interventional management due to an initial diagnosis of ACS and to assess the clinical effectiveness and safety of MTH.
  
  
  METHODS
  We conducted a retrospective historically controlled single centre study. Hospital survival with a favourable neurological outcome (Cerebral Performance Category of 1 or 2) and all-cause in-hospital mortality were the primary and secondary efficacy end points, respectively. Occurrence of definite stent thrombosis was the primary safety end point while the development of pneumonia, presence of positive blood cultures, occurrence of probable stent thrombosis, any bleeding complications, need for red blood cell transfusion and presence of rhythm and conductions disorders during hospitalisation constituted secondary safety end points.
  
  
  RESULTS
  Comatose OHCA survivors (n = 32) were referred to our Department based on ECG recording transmissions and/or phone consultations or admitted from the Emergency Department. Compared with controls (n = 33), they were significantly more likely to be discharged from hospital with a favourable neurological outcome (59 vs. 27%; p < 0.05; number needed to treat [NNT] = 3.11) and experienced lower all-cause in-hospital mortality (13 vs. 55%; p < 0.05; NNT = 2.38). Rates of all safety end points were similar in patients treated with and without MTH.
  
  
  CONCLUSIONS
  Our study indicates that a regional system of care for OHCA survivors may be successfully implemented based on an ACS network, leading to an improvement in neurological status and to a reduction of in-hospital mortality in patients treated with MTH, without any excess of complications. However, our findings should be verified in large, prospective trials.
authors.affiliation: Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. marekozinski@wp.pl
authors.forename: Marek
authors.initials: M
authors.lastname: Kozinski
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Pstragowski
authors.forename: Julia Maria
authors.initials: JM
authors.lastname: Kubica
authors.forename: Tomasz
authors.initials: T
authors.lastname: Fabiszak
authors.forename: Michal
authors.initials: M
authors.lastname: Kasprzak
authors.forename: Blazej
authors.initials: B
authors.lastname: Kuffel
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Paciorek
authors.forename: Eliano Pio
authors.initials: EP
authors.lastname: Navarese
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Grzesk
authors.forename: Jacek
authors.initials: J
authors.lastname: Kubica
mesh_terms: D000368:Aged; D029681:Arabidopsis Proteins; D003128:Coma; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D016015:Logistic Models; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis
chemical_list: D029681:Arabidopsis Proteins; C573497:MLO2 protein, Arabidopsis; D008565:Membrane Proteins