PMID- 18496378
OWN - NLM
STAT- MEDLINE
DCOM- 20080617
LR  - 20191210
IS  - 1530-0293 (Electronic)
IS  - 0090-3493 (Linking)
VI  - 36
IP  - 6
DP  - 2008 Jun
TI  - Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due 
      to acute ST-segment elevation myocardial infarction undergoing immediate 
      percutaneous coronary intervention.
PG  - 1780-6
LID - 10.1097/CCM.0b013e31817437ca [doi]
AB  - 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. DESIGN: Single-center observational 
      study with a historical control group. SETTING: University clinic. PATIENTS: 
      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). INTERVENTIONS: 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. 
      MEASUREMENTS AND MAIN 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.
FAU - Wolfrum, Sebastian
AU  - Wolfrum S
AD  - Medical Clinic II, University of Schleswig-Holstein, Campus Lubeck, Lubeck, 
      Germany. sebastian.wolfrum@uk-sh.de
FAU - Pierau, Christian
AU  - Pierau C
FAU - Radke, Peter W
AU  - Radke PW
FAU - Schunkert, Heribert
AU  - Schunkert H
FAU - Kurowski, Volkhard
AU  - Kurowski V
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Crit Care Med
JT  - Critical care medicine
JID - 0355501
SB  - IM
CIN - Crit Care Med. 2008 Jun;36(6):1967-8. PMID: 18520656
CIN - Crit Care Med. 2008 Nov;36(11):3130-1; author reply 3131. PMID: 18941339
CIN - Crit Care Med. 2008 Dec;36(12):3280; author reply 3280-1. PMID: 19020447
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Cardiopulmonary Resuscitation/*methods
MH  - Critical Pathways
MH  - *Electrocardiography
MH  - *Emergency Medical Services
MH  - Feasibility Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Germany
MH  - Heart Arrest/mortality/*therapy
MH  - Humans
MH  - Hypothermia, Induced/*methods
MH  - Intensive Care Units/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/mortality/*therapy
MH  - Neurologic Examination
MH  - Outcome and Process Assessment, Health Care
MH  - Prospective Studies
MH  - Survival Rate
MH  - Time and Motion Studies
MH  - Ventricular Fibrillation/mortality/therapy
EDAT- 2008/05/23 09:00
MHDA- 2008/06/18 09:00
CRDT- 2008/05/23 09:00
PHST- 2008/05/23 09:00 [pubmed]
PHST- 2008/06/18 09:00 [medline]
PHST- 2008/05/23 09:00 [entrez]
AID - 10.1097/CCM.0b013e31817437ca [doi]
PST - ppublish
SO  - Crit Care Med. 2008 Jun;36(6):1780-6. doi: 10.1097/CCM.0b013e31817437ca.