Strategic target temperature management in myocardial infarction--a feasibility trial

Abstract

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).

Design: Non-randomised, single-centre feasibility trial.

Setting: 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.

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

Interventions: 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.

Main outcome measures: 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.

Clinical trial registration: http://www.clinicaltrials.gov/ct2/show/NCT01864343; clinical trials unique identifier: NCT01864343.

Keywords: Coronary Artery Disease; Myocardial Ischaemia and Infarction (IHD).

Figure 1

Individual temperature courses of 14 patients during preventive cooling in ST-elevation acute coronary syndrome. *Temperatures at these time points were measured with infrared tympanic thermometer. All other temperatures reflect blood temperature measured by the endovascular catheter.