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Cooling procedure safe, tolerable in ST-elevation ACS
Therapeutic hypothermia adjunct to PCI had a success rate of more than 75% when administered with PCI in a cohort of patients with ST-elevation ACS.
Researchers of the study published in Heart conducted the non-randomized, feasibility study in a single center in Vienna. They investigated a cooling strategy of therapeutic hypothermia as an adjunct to PCI in a cohort of consecutive patients with ST-elevation ACS (STEACS). Eligible patients presented within 6 hours of symptom onset and were treated at an ED in a tertiary-care facility.
The out-of-hospital treatment consisted of surface cooling pads. When patients arrived at the hospital, clinicians administered 1,000 mL to 2,000 mL of cold saline. The final step included endovascular cooling conducted in the cath lab.
The primary outcome measure was the feasibility of lowering the core body temperature less than 35°C immediately before revascularization. The other outcome measures included the safety and tolerability of the procedure.
There was one woman among the 19 patients in the study (median age, 51 years). The duration from symptom onset to first medical contact was 45 minutes (interquartile range [IQR], 31-85 minutes).
Clinicians successfully lowered the core temperature less than 35°C at reperfusion of the culprit lesion in 78% of the patient cohort. This was achieved within 100 minutes (IQR, 90-111) after first medical contact. There were no serious adverse events reported in the success cohort.
Baseline temperatures were 36.4°C (IQR, 36.2-36.5). Core temperatures could be lowered to 34.4°C (IQR, 34.1-35) at the time of reperfusion.
“With limitations, an immediate out-of-hospital therapeutic hypothermia strategy was feasible and safe in patients with STEACS undergoing primary PCI,” the researchers concluded. “Further studies are needed to evaluate if changes in the cooling procedure enable to get more patients within therapeutic ranges of hypothermia and if this approach improves outcomes in patients with ongoing STEACS.”
Disclosure: The researchers report no relevant financial disclosures.