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). 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 6h after symptom onset. Interventions Cooling was initiated with surface cooling pads in the out-of-hospital setting, followed by the administration of 1000-2000mL 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 degrees C prior to immediately performed revascularisation. Safety and tolerability of the cooling procedure. Results In enrolled 19 patients (one woman, median age 51years (IQR 45-59)), symptom onset to first medical contact (FMC) was 45min (IQR 31-85). A core temperature below 35.0 degrees C at reperfusion of the culprit lesion was achieved in 11 patients (78%) within 100min (IQR 90-111) after FMC without any cooling-related serious adverse event. Temperature could be lowered from baseline 36.4 degrees C (IQR 36.2-36.5 degrees C) to 34.4 degrees C (IQR 34.1-35.0 degrees 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.