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 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