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 myoca...

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Bibliographic Details
Published in:Resuscitation 2013-04, Vol.84 (4), p.460-464
Main Authors: Maze, Ronnen, Le May, Michel R, Hibbert, Benjamin, So, Derek Y, Froeschl, Michael, Glover, Chris A, Dick, Alexander, Marquis, Jean-Francois, Blondeau, Melissa, Labinaz, Marino
Format: Article
Language:English
Subjects:
Age Factors
Cardiac arrest
Combined Modality Therapy
Creatinine - analysis
Emergency
Female
Humans
Hypothermia, Induced
Intra-Aortic Balloon Pumping
Male
Middle Aged
Myocardial Infarction - mortality
Myocardial Infarction - therapy
Out-of-Hospital Cardiac Arrest - mortality
Out-of-Hospital Cardiac Arrest - therapy
Patient Discharge
Percutaneous Coronary Intervention
Recovery of Function
Retrospective Studies
ST-segment elevation myocardial infarction
Therapeutic hypothermia
Time-to-Treatment
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Summary: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 113 min (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 m2 versus 53 ± 23 mL/min/1.73 m2 , 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.
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2012.08.002