Elsevier

Resuscitation

Volume 74, Issue 2, August 2007, Pages 227-234
Resuscitation

Clinical paper
Primary percutaneous coronary intervention and mild induced hypothermia in comatose survivors of ventricular fibrillation with ST-elevation acute myocardial infarction

https://doi.org/10.1016/j.resuscitation.2007.01.016Get rights and content

Summary

Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for ST-elevation acute myocardial infarction (STEMI). In comatose survivors of cardiac arrest, mild induced hypothermia (MIH) improves neurological recovery. In the present study, we investigated feasibility and safety of combining primary PCI and MIH in comatose survivors of ventricular fibrillation with signs of STEMI after reestablishment of spontaneous circulation. Forty consecutive patients undergoing primary PCI and MIH from November 1, 2003 to December 31, 2005 were compared to 32 consecutive patients who underwent primary PCI but no MIH between January 1, 2000 and November 1, 2003. There were no significant differences between the MIH and no MIH groups in general characteristics, cardiac arrest circumstances and angiographic features. Except for decreases in heart rate during hypothermia interval, there was no difference between the MIH and no MIH groups in arterial pressure, peak arterial lactate (5.1 mmol/l versus 5.7 mmol/l; p = .56), need for vasopressors (65% versus 53%; p = .44), inotropes (48% versus 59%; p = .44), aortic balloon counterpulsation (20% versus 22%; p = .92), repeat cardioversion/defibrillation (30% versus 34%; p = .89) and use of antiarrhythmics (33% versus 53%; p = .13). There was also no difference in inspired oxygen requirements during mechanical ventilation and in renal function. Hospital survival with cerebral performance category 1 and 2 was significantly better in MIH group (55% versus 16%; p = .001). Our preliminary experience indicates that primary PCI and MIH are feasible and may be combined safely in comatose survivors of ventricular fibrillation with signs of STEMI. Such a strategy may improve survival with good neurological recovery.

Introduction

Immediate, complete and sustained recanalization of culprit coronary artery with primary percuatneous coronary intervention (PCI) is currently viewed as the most effective reperfusion strategy in patients with evolving acute ST-elevation myocardial infarction (STEMI).1, 2, 3 Using contemporary technology, primary PCI is both feasible and highly successful in patients with evolving STEMI after resuscitated cardiac arrest.4, 5, 6, 7 Mild induced hypothermia (MIH) has been demonstrated recently to improve neurological recovery in comatose survivors of cardiac arrest from diverse aetiology.8, 9, 10 Unfortunately, the number of patients with STEMI and details related to acute reperfusion therapy and especially primary PCI has not been reported in these studies.8, 9 Moreover, patients with STEMI were even excluded in one report.11 In the present study, we therefore addressed the feasibility and safety of combining primary PCI and MIH in comatose survivors of cardiac arrest with electrocardiographic sings of evolving STEMI after reestablishment of spontaneous circulation (ROSC).

Section snippets

Materials and methods

The study was conducted at University Medical Center Ljubljana and was approved by the Slovenian National Ethical Committee (Number 79/10/05) which waived the need for informed consent. Consecutive comatose survivors of witnessed ventricular fibrillation with STEMI admitted from November 1, 2003 to December 31, 2005 who underwent primary PCI and MIH were investigated. The control group consisted of consecutive patients with the same features admitted from January 1, 2000 to October 31, 2003 who

Results

Among 44 comatose survivors of ventricular fibrillation with STEMI admitted from November 1, 2003 to December 31, 2005, 40 (91%) underwent primary PCI and MIH. Between January 1, 2000 and November 1, 2003, 32 out of 35 comatose survivors with ventricular fibrillation and STEMI (91%) underwent primary PCI but no MIH. The two groups of patients were comparable in terms of sex and age with some imbalances among risk factors for coronary artery disease (Table 1). There was no significant difference

Discussion

Our preliminary experience indicates that combination of primary PCI to restore the patency of IRA and MIH to facilitate neurological recovery in comatose survivors of cardiac arrest with signs of STEMI after ROSC is feasible and safe. There was no excess in adverse events including recurrent malignant ventricular arrhythmias, haemodynamic instability, impairment of pulmonary gas exchange and renal function if MIH was added to primary PCI. There was somewhat greater incidence of positive

Conflict of interest

None.

Acknowledgments

We greatly appreciate the contribution of Vojka Gorjup, MD, Anja Jazbec, MD, Hugon Možina, MD, Dušan Štajer, MD, PhD and Simona Zorman MD, PhD in the introduction of mild induced hypothermia in our department.

Cited by (0)

A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.01.016.

View full text