Strategic target temperature management in myocardial infarction--a feasibility trial.
OBJECTIVE
The purpose of this study was to demonstrate the feasibility of a combined cooling strategy started out of hospital as an adjunctive to percutaneous coronary intervention (PCI) in the treatment of ST-elevation acute coronary syndrome (STE-ACS).


METHODS
Non-randomised, single-centre feasibility trial.


METHODS
Department of emergency medicine of a tertiary-care facility, Medical University of Vienna, Vienna, Austria. In cooperation with the Municipal ambulance service of the city of Vienna.


METHODS
Consecutive patients with STE-ACS presenting to the emergency medical service within 6 h after symptom onset.


METHODS
Cooling was initiated with surface cooling pads in the out-of-hospital setting, followed by the administration of 1000-2000 mL of cold saline at hospital arrival and completed by endovascular cooling in the catheterisation laboratory.


METHODS
Feasibility of lowering core temperature below 35.0°C prior to immediately performed revascularisation. Safety and tolerability of the cooling procedure.


RESULTS
In enrolled 19 patients (one woman, median age 51 years (IQR 45-59)), symptom onset to first medical contact (FMC) was 45 min (IQR 31-85). A core temperature below 35.0°C at reperfusion of the culprit lesion was achieved in 11 patients (78%) within 100 min (IQR 90-111) after FMC without any cooling-related serious adverse event. Temperature could be lowered from baseline 36.4°C (IQR 36.2-36.5°C) to 34.4°C (IQR 34.1-35.0°C) at the time of reperfusion.


CONCLUSIONS
With limitations an immediate out-of-hospital therapeutic hypothermia strategy was feasible and safe in patients with STE-ACS undergoing primary PCI.


BACKGROUND
http://www.clinicaltrials.gov/ct2/show/NCT01864343; clinical trials unique identifier: NCT01864343.
Department of Emergency Medicine, Medical University of Vienna, , Vienna, Austria.
Christoph
C
Testori
Fritz
F
Sterz
Georg
G
Delle-Karth
Reinhard
R
Malzer
Michael
M
Holzer
Peter
P
Stratil
Mathias
M
Stöckl
Christoph
C
Weiser
Raphael
R
van Tulder
Clemens
C
Gangl
Dieter
D
Sebald
Andreas
A
Zajicek
Angelika
A
Buchinger
Irene
I
Lang
D003131:Combined Modality Therapy; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies
Coronary Artery Disease; Myocardial Ischaemia and Infarction (IHD)